bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Early Introduction of Geriatric Teaching to Undergraduate Medical Students and its Impact on Behaviour and Attitudes
Authors: Dennehy Karen , Cooke John 
Published: September 2024

Abstract

Background
The World Health Organization (WHO) advocates for investment in high-quality undergraduate education to meet the future needs of the aging global population. Studies conducted by the WHO have found that quality education in geriatric medicine positively influences medical students' attitudes towards older adults and encourages them to consider careers in geriatric care. This investment is especially crucial as the global population continues to age.

Methods
We piloted the introduction of dedicated geriatric medicine teaching into the third year of the undergraduate medical program at University College Cork. Two interactive lectures were developed and integrated into the preplacement lecture block. These sessions focused on commonly occurring conditions, incorporating case studies and fostering discussions. The curriculum was based on the findings from a European undergraduate geriatric medicine program developed through Delphi consensus and published in 2014.

Results
In the third year of the undergraduate program, 203 students attended two one-hour lectures during their lecture block month. An end-of-year survey, completed by 20 students, revealed common adjectives used to describe older adults, such as “frail,” “experienced,” “vulnerable,” “grandparent,” and “wise.” According to the survey, 9 out of 20 students reported a change in their perspective on older adults after the education sessions. Additionally,17 out of 20 students felt more confident interacting with older people during their clinical attachments, and 9 out of 20 expressed interest in a career in geriatric medicine. Students also highlighted the most valuable aspects of the sessions and how they applied their new knowledge in clinical settings.

Conclusion
The program increased students' awareness and comfort with older adults, there were positive signs that students were more likely to consider a career in geriatric medicine. To evaluate the effectiveness more precisely, we plan to collect baseline statistics from students and measure changes post-intervention. Based on student feedback, we will make necessary adjustments and continue the program in the next academic year.
Bridging The Gap: Between an Older Adult Attending The Ambulatory Day Unit and An Acute Hospital Presentation
Authors: McShane Nicola , Monaghan-Tyer Fiona , Toner Rebecca , Lynch Olwyn 
Published: September 2024

Abstract

Background
Older adults attending the ambulatory day units within the hospital group have a comprehensive geriatric assessment (CGA) completed. This identifies the older adult’s functional, physical, social, environmental and psychological baseline, in order to develop and implement a coordinated plan of care and follow up. The CGA is the gold standard in caring for older adults who are frail or at risk of frailty (HSE, 2016). The units are off site from the main hospital, therefore valuable information may not be available to the acute hospital. Valuable information from the CGA can provide the older adult’s functional and cognitive baseline and prevent unnecessary duplication of assessments and increased length of stay.

Methods
Plan-Do- Study-Act (PDSA) cycle was used. A questionnaire was produced to ascertain acute care staff’s understanding of; whether an older adult is attending the ambulatory unit? Would this information and a review by the RANP Gerontology be beneficial? A Registered Advanced Nurse Practitioner (RANP) Gerontology Pathway was developed. Education was provided to nursing, and the wider multidisciplinary team. An alert sheet was introduced and provided to older adult attending the ambulatory day units. The alert was for the older adult to produce, if attending or admitted to the acute hospital. This initiates the RANP pathway. Older adults are then seen by the RANP at source of admission. Clinic letters with baseline is documented in the Healthcare record, including advice plan and follow-up. Post-implementation questionnaire and verbal feedback were obtained.

Results
Positive feedback from older adults, family and staff. Avoidance of unnecessary duplication of assessments, data sharing, optimization of plan of care, treatment and rehabilitation potential. Effective discharge planning, reduction of unnecessary transfer to residential care.

Conclusion
Bridging the gap promotes positive outcomes: Reducing length of stay, positive impact on overall wellbeing, and an organizational cost containment.
Utilising a Co-Design Approach to Strategically Plan Dementia Education for Diverse Populations in Ireland
Authors: Kilgannon AnnMarie , O'Reilly Susan , Noone Paula , Galvin Noreen , McCabe Blanaid , Murphy Stephen , Lang Deirdre 
Published: September 2024

Abstract

Background
In Ireland, the number of people living with dementia is projected to treble by 2050. National dementia education programmes span all care groups and areas of work, and include a 4-hour, a 2-day programme and HSEland modules. However, there is concern that these programmes often adopt a pedagogical approach that does not meet the needs of modern learners. Adopting a coproduction approach in designing dementia education initiatives is essential to ensuring that these programmes effectively impact healthcare professional’s attitudes, beliefs and care practices, meeting the needs of people from diverse populations and cultural backgrounds.

Methods
Methods included three key components: Firstly, a dementia education online survey for facilitators of national programmes to ascertain the benefits, challenges and impact on care practices. Secondly, a national event using World Café methodology to share insights and ideas and co-produce a vision for advancing dementia education in Ireland. Primary stakeholders included individuals living with dementia, their advocates, and delegates from various demographics and cultural backgrounds. Thirdly, a review of literature relating to dementia education in other jurisdictions.

Results
Key themes that emerged include the significance of understanding the lived experience and recognising diversity and cultural differences. Additionally, there is a need to explore various teaching and delivery methods, such as incorporating technology, simulation, and a tiered approach. There was general agreement that co designing a more adaptable, interactive national programme, including the lived experience of people with dementia would be more impactful. Challenges identified include staff turnover, difficulties releasing staff from clinical areas and organisational culture.

Conclusion
Through establishing an inclusive and collaborative platform, we can collectively shape a future where dementia education and care practices are compassionate, rights based and supportive. Crucially, people living with dementia and their supporters are at the heart of planning and decision-making processes in co-designing dementia education initiatives.
Frailty Assessment and Management: A Qualitative Study of the Educational and Training Experiences of Postgraduate Doctors
Authors: Paine Wendy , Ntlholang Ontefetse , Browne Joseph 
Published: September 2024

Abstract

Background
Understanding and addressing frailty, a complex syndrome commonly found in older adults, demands a deep understanding and proficiency across various health domains. Existing research indicates a disparity between medical education and the hands-on management of frailty in practice. There is a scarcity of research on the educational requirements of postgraduate doctors in caring for frail patients.

Methods
Qualitative semi-structured interviews were conducted with post-internship doctors working in an AMU, using transcripts to analyse themes. The focus was on frailty conceptualisation, educational training, and clinical experience.

Results
Several themes were noted, particularly the lack of focus and variation on frailty teaching in undergraduate curriculums. This, coupled with limited hands-on experience, an emphasis on acute care over chronic management, inadequate multidisciplinary training, and a need for more structured education on frailty assessment tools, underscores the need for ongoing education and support. Many interviewees shared their experiences of being well-equipped to handle acute medical emergencies, demonstrating the effectiveness of their current medical education. However, they also pointed out that this preparation did not adequately equip them for the ongoing, multidimensional care that frail patients require. Several interviewees stressed the role of continued education and support for healthcare professionals managing frailty, suggesting ongoing professional development opportunities could effectively bridge the gap between initial medical education and the evolving demands of clinical practice. The potential of mentorship from experienced geriatricians adds invaluable guidance for early career doctors.

Conclusion
This qualitative study underscores a significant gap between medical education and the practical management of frailty. Addressing this gap requires a multifaceted approach that integrates frailty-focused content into undergraduate curricula, provides hands-on experience, fosters multidisciplinary collaboration, and offers ongoing professional development. By enhancing frailty education and training, healthcare systems can improve the quality of care for this vulnerable population, leading to better patient outcomes and more efficient use of resources.
Identification and Modification of Fall-Risk-Increasing-Drugs Following Fall-Related Hospitalization in Older Adults
Authors: Ashraf Mubashra , Boland Yvonne , Mello Sarah 
Published: September 2024

Abstract

Background
Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’.

Methods
Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded.

Results
Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases.

Conclusion
FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.
Community Flexible Endoscopic Evaluation Of Swallowing (FEES): A Prospective Cohort Study Of Clinical, Process And Patient-Reported Outcomes
Authors: Clancy Monica , Curran Sarah , Cregg Paula , Hayes Kate , Whelan Elaine , Kerins Elaine , Griffin Anne , Ryan Stephen , Quinn Colin , McGowan Caoimhe Hunter , Manning Molly , Galvin Rose , Deane Una , McCarthy Oonagh 
Published: September 2024

Abstract

Background
Dysphagia prevalence increases with age, impacts on quality of life and increases healthcare utilisation and cost (Atrill 2018). Instrumental swallowing assessment is essential for accurate diagnosis and treatment of dysphagia but can be difficult to access in the community. FEES is a gold-standard instrumental assessment delivered by speech and language therapists (SLTs). The aim of this abstract is to report clinical, process and patient-reported outcomes of participants who had a community FEES over a 6-month period.

Methods
A prospective cohort study recruiting adults who accessed community FEES in Ireland's Mid-West. Baseline assessment data (demographics, a range of validated tools and process data) were recorded at index visit. A structured phone interview was completed at six months. The primary outcome was the rate of medical complications potentially caused by dysphagia at follow-up. Secondary outcomes included healthcare utilisation, dysphagia severity, functional status and quality of life.

Results
62 participants were recruited: mean age: 70.98 (SD=15.01), 55.4% were female. At follow-up, 27.42% reported medical complications potentially attributable to dysphagia, 27.4% had attended general practice, 3.23% attended medical assessment units, 6.45% attended emergency departments. 82.26% were diagnosed with dysphagia or modified independence: Dysphagia Outcome Severity Scale (DOSS) ≤6, (M=5.2, SD=1.53). Changes to dysphagia care plans were recommended in 60.94% of cases. There was significant difference in Functional Oral Index Scale (FOIS) scores across time, F (1.75, 106.78) = 5.38, p = 0.008. FOIS scores at 6 months (M=5.92, SD=1.50) were significantly higher than pre-FEES (M=6.42, SD=1.37). Significant differences in quality of life (EQ5D5L-VAS) scores p&lt;0.001 were detected: higher scores at 6-months (M=69.35; SD=20.42) compared to index visit (M=64.52; SD=19.44).

Conclusion
Access to community FEES for older persons may improve outcomes by reducing the frequency of dysphagia-related complications and healthcare utilisation, improving functional swallowing status, enhancing quality of life and contribute to evidence-based dysphagia diagnosis and care planning.
Patient Experience in Older Adults Ambulatory Care services in a large Irish teaching hospital
Authors: Byrne Lisa , Baunta Sam , Byrne Tracy , Crosby Lisa , Fallon Nessa , Hade Dymphna , Joseph Lincy , Kelly Deirdre , Maher Niamh , Mullen Anna , Poulose Bindu , Carroll Claire O , Caraher Jennifer , Mathew Sharon , Oakes Katie , Rice Ciara , Reilly Claire , Steen Georgina 
Published: September 2024

Abstract

Background
Ambulatory care pathways aim to reduce hospital overcrowding, provide multidisciplinary, speciality outpatient care, in a timely and cost-effective manner to older people with complex care needs. The delivery of care is centred on the needs of the patient; obtaining and implementing personalized feedback is essential to upholding the highest standards of care.

Methods
All Patients attending ambulatory care services, at a large teaching hospital in 2023–2024 were offered a 30-question survey covering demographics, hospital access, facility usage, and care delivery, with yes/no responses, 5-point Likert scale and free text comments.

Results
This cohort represents 3.5% of overall service users (n=642). Of the group in question, 55% were between 65 and 85, and 10% were over 85, a quarter were under 65. A quarter of people were seen within a month, a further 38% within four months of referral. 63% of respondents travelled by car, 31% took public transportation, 5% walked, and 1% rode a bike. 68% of older adults commuted by car (12% by taxi). Taxi use was due to inability to conveniently access onsite parking. Over three quarters were accompanied to their appointment. A delay was reported by 24% of respondents, two thirds cited a parking issue on campus, with almost 20% identifying a traffic issue. 4% found the distance from the car park to the department challenging. The majority of concerns related to campus traffic and delays getting parking onsite. When asked to rate communication, the environment, and multidisciplinary care delivery, 99%-100% responded positively.

Conclusion
Care delivery was positively represented in this sample. This patient feedback highlights the need for accessible parking in hospital infrastructure planning. Vulnerable older adults requiring supportive care should be protected from the cost implications of hospital attendance, costly taxi use is indicated in this group. There is a need for national action on this.
Advance Care Planning Practices For Nursing Home Residents Referred To Specialist Palliative Care In An Acute Hospital Setting
Authors: Ruttledge Sarah , Lannon Cian , Minogue Ríana , O'Riordan Julien 
Published: September 2024

Abstract

Background
Advance care planning (ACP) is a structured process of discussion between patients, their loved ones and health care professionals, which aims to establish and record an individual’s goals and preferences for future medical treatment and care. It is of significant relevance to nursing home residents, a comorbid and frail population at high risk of clinical deterioration.

Methods
This prospective, observational study included all nursing home residents referred to an inpatient specialist palliative care (SPC) service in a model four hospital over a six-month period (November 2023 to May 2024). Basic clinical and demographic information as well as data on functional status and advance care planning was anonymised and collated using Microsoft excel.

Results
36 patients (mean age 79 years) were recruited. 36% (n=13) were referred within 48 hours of admission. The average Australia-modified Karnofsky Performance Scale score was 40 on admission. 94% (n=34) had a clinical frailty score of ≥7 on admission. 72% (n=26) had an advance care plan in the nursing home. However, 22% (n=8) had not recorded their wishes pertaining to hospital readmission and 3 patients were admitted despite documenting a preference to remain in the nursing home. 53% (n=19) had not documented their preferred place for end-of-life care. 69% (n=25) died in hospital.

Conclusion
Most nursing home residents referred to the inpatient SPC team had severe frailty and died in hospital, reflecting the prognostic implications of severe frailty. Crucial components of the advance care plan were omitted in a significant proportion of patients, which may have influenced their referral to hospital. Provision of increased support to staff caring for older, frail adults in the residential care setting should be considered to enhance ACP.
Bridging the Gap: A Competency Framework for Hospital Doctors Caring for Older Adults
Authors: Buckley Emily , Barrett Aileen , O'Tuathaigh Colm , Bennett Deirdre , Cooke John 
Published: September 2024

Abstract

Background
Our ageing population has resulted in an increasing number of older adults requiring healthcare services. This growing demand within a population of varying needs requires that all hospital doctors, regardless of specialty, possess fundamental Geriatric Medicine competencies. However, a consensus on these competencies is lacking with no overarching competency framework available. We aimed to address this gap by synthesising a competency framework for all hospital doctors caring for older adults.

Methods
Our first step involved a comprehensive scoping review of international literature identifying the proposed competencies for hospital doctors caring for older adults. These findings were validated and expanded through a national group concept mapping study inviting multiple stakeholders. An iterative process refined the identified competencies, categorising them into domains, and synthesising a final competency framework using Microsoft Excel.

Results
This study synthesised 110 Geriatric medicine competencies within seventeen competency domains. The scoping review highlighted medication, cognitive, and chronic disease management and the group concept mapping identified interpersonal communication, medicolegal, and delirium management as most critical. The iterative process further refined the framework, emphasising competencies pertaining to cognitive impairment, depression, falls, and acute inpatient management of older adults.

Conclusion
This synthesis highlights the broad range of competencies necessary for effective care of older adults by all hospital doctors. The identified competencies reflect the heterogeneous nature of the older adult population, encompassing both fundamental but also specialised skills. Further research is now essential to determine the optimal educational interventions for ensuring all hospital doctors are equipped with these essential competencies.
Profile of Vertebral Fracture Cases in the First Full Year of an ANP led Fracture Liaison Service
Authors: Steen Georgina , Fallon Nessa , Maher Niamh , O'Carroll Claire , Caraher Jennifer , Byrne Lisa , McCarroll Kevin , Lannon Rosaleen 
Published: September 2024

Abstract

Background
A specialist osteoporosis and bone health service was founded in 2003 in our institution. It see’s a range of patients from providing DXA alone to giving specialist opinion on complex cases. The Irish Fracture Liaison Service Database (FLS-DB) commenced in 2020 and aims to target those who’ve just fractured with the aim of reducing risk of further imminent fracture by screening for osteoporosis and initiating bone protection measures.

Methods
Cases of vertebral fracture screened by our FLS ANP were extracted from the FLS database. Case finding for vertebral fracture remains dependent on referral to the service.

Results
We screened 53 patients with vertebral fractures through our FLS in 2023. 64% female, 36% male. Median age 81 years; range 56-99 yrs. Of these 32 (60%) were inpatients with 2 inpatient falls. 17 (32%) were on osteoporosis treatment. We noted 25 (47%) with previous fragility fracture including 9 (17%) with previous vertebral fracture – just over half of these i.e. 5 patients were on bone protection treatment. After FLS assessment of those on treatment 10 were changed to denosumab, 2 to teriparatide, one continued oral bisphosphonate by choice, rest changed to IV zoledronic acid. Those newly started on treatment a range of PO and IV Bisphosphonate, teriparatide and denosumab was recommended depending on patient factors. One declined. All were prescribed vitamin D +/- calcium supplements.

Conclusion
The UK FLS-DB estimated that the number of ‘clinical’ vertebral fractures roughly equates to that of hip fractures, so this denominator has been used for the Irish FLS-DB. This would correlate with our service assessing 29% of expected clinical vertebral fractures in 2023. Appointment of a dedicated ANP for fracture liaison has streamlined bone health assessment for acute fractures attending our hospital. Further work on case finding needed to ensure we are assessing all patients at increased risk of further fracture.