bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial Intelligence-Powered Technologies For Independent Living Among Older Adults: A Review
Authors: Gamble Eugene , Chami Peter , Nancoo Tamara 
Published: September 2024

Abstract

Background
The ageing populations in Ireland and around the world has led to an increased focus on technologies that support independent living for older adults. Artificial intelligence (AI) has emerged as a promising solution, with various AI-powered technologies being proposed to assist their daily lives. This review aims to synthesize the findings of studies exploring AI-powered technologies for independent living among older adults.

Methods
A systematic literature search was conducted using relevant databases, including PubMed, IEEE Xplore, and Google Scholar. The search terms included “artificial intelligence” and “independent living”. Studies published between 2009 and 2023 that investigated AI-powered technologies for independent living among older adults were included in the analysis.

Results
The included studies investigated various AI-powered technologies including tablets, wearable devices like smartwatches, web portals for carers, Internet of Things (IoT) solutions, user-centered design considerations, the integration of AI with sociology and healthcare, smart home technology, and ambient information systems. The pooled results indicated that AI-powered technologies can improve independent living outcomes for older adults. Benefits included real-time monitoring and health deterioration recognition, fall detection, personalised care, cognitive assistance and reduced isolation. User-centered design approaches and the integration of AI with sociology and healthcare were also found to be essential factors in the successful implementation of these technologies.

Conclusion
This analysis provides evidence supporting the effectiveness of AI-powered technologies in promoting independent living among older adults. IoT solutions and smart home technology appear to be particularly promising. However, the successful implementation of these technologies requires a multidisciplinary approach, incorporating user-centered design and the integration of AI with sociology and healthcare. Further research is needed to explore the long-term impact of AI-powered technologies on the well-being and autonomy of older adults.
Development and Implementation of a Venous Thromboembolism Prophylaxis Protocol in the Rehabilitation Setting – A Completed Audit Cycle
Authors: Synnott Pádraig , Hamaty Jeries , Perrira Nicole , Frindunbekov Yuri , Khalid Maryam , McCarthy Frances 
Published: September 2024

Abstract

Background
63% of all Venous Thromboembolic disease (VTE) is hospital-acquired, and 70% of hospital-acquired VTE is potentially preventable with appropriate prophylaxis. NICE recommends a VTE risk assessment for all patients admitted to acute hospitals within 24 hours. Validated risk assessment models for acute hospitals enhance provision of thromboprophylaxis, but no such protocols exist for the rehabilitation setting. The aims of this audit were to determine if VTE risk assessments are occurring on admission and during acute illness in rehabilitation wards, to assess the proportion of rehabilitation inpatients receiving VTE prophylaxis, and to develop and pilot a VTE Prophylaxis Protocol.

Methods
An initial audit was carried out on three rehabilitation wards in May/June 2023. A VTE Prophylaxis Protocol was developed based on the HSE VTE Prevention Program template, incorporated into the admission booklet on 3 pilot wards in February 2024, and practice re-audited in April 2024.

Results
Pre-intervention, 41 patient records were assessed. 0 patients (0%) had a documented VTE risk assessment on admission, 23(56%) had therapeutic anticoagulation continued, and 3(7%) commenced appropriate VTE prophylaxis on admission. 8 eligible at-risk patients did not receive prophylaxis. Post intervention, all patients (n=25) on the three pilot wards were re-audited. 10 patients (40%) had a documented VTE Risk assessment within 24 hours of admission, 9(36%) had therapeutic anticoagulation continued, and 5(20%) received appropriate VTE prophylaxis on admission (2 without a documented risk assessment). 3 at-risk patients did not receive prophylaxis (1 with a completed risk assessment), and 1 risk-assessed patient inappropriately received prophylaxis.

Conclusion
Implementation of a VTE Prophylaxis Protocol improved VTE risk assessment in rehabilitation. This small sample however did not demonstrate an association between prophylaxis prescription and use of the protocol. Further education and feedback is required to increase use of the protocol as part of this ongoing quality improvement project.
Parkinson’s Disease Medications Prescribing and Falls Assessment in Older Persons Movement Disorder Clinic
Authors: Ragab Inas , Magennis Brian 
Published: September 2024

Abstract

Background
Parkinson’s Disease is a progressive neurodegenerative movement disorder. It is the second most common neurodegenerative condition after Alzheimer’s. The movement disorder clinic for Older Persons is well established in the Mater Hospital for years. Patients are followed regularly, and multiple domains are assessed including UPDRS (Unified Parkinson’s Disease Rating Scale), medications, and falls.

Methods
A retrospective audit of patient’s clinic letters was performed for a sample of 48 patients over a 5months period. Inclusion criteria was; idiopathic Parkinson's Disease and ≥ 65 years old. Exclusion criteria was; atypical parkinsonism and virtual consultations. The audit had two sections; medications profile and falls assessment. A retrospective audit of patient’s clinic letters was performed for a sample of 48 patients over a 5months period. Inclusion criteria was; idiopathic Parkinson's Disease and ≥ 65 years old. Exclusion criteria was; atypical parkinsonism and virtual consultations. The audit had two sections; medications profile and falls assessment.

Results
Of the total number of 48 patients audited, 65% were females and 35% were males. The majority (83%) of patients were ≥75yrs of age, and 17% age 65-75yrs, with mean age of 83years old. 68.8% didn’t have the year of diagnosis documented. 88% were on levodopa/decarboxylase inhibitor, 29% on MAOB-I (6% only on it as first line), 17% on dopamine agonist, 2% on Amantadine. 83% of the patients had assessment of falls reflected on history taking and lying (sitting)/standing BP documentation. Of which 60% had no falls, and 21% had evidence of postural drop.

Conclusion
Most of the patients attending the clinic were 75 years of age or older. Levodopa combined with a decarboxylase inhibitor was the most commonly used medication in this cohort of patients. The majority of patients had falls assessments conducted and documented. However, for most patients, the year of diagnosis was not recorded.
An Audit Of Post Fall Medical Reviews In Older Hospital Inpatients
Authors: Carroll Thomas , Daly Simon , Briggs Robert 
Published: September 2024

Abstract

Background
After an older person falls in hospital, the post-fall medical review is critical to assess injury and to put a plan in place to prevent further falls. We performed an audit to assess the post fall medical review and management of patients ≥65 years in a large university teaching hospital compared to national standard “Service User Falls: A Practical Guide for Review” and NICE Guidelines.

Methods
In a consecutive cohort of patients with falls, the post-fall medical review note was examined for crucial details from the history (mechanism, head/hip strike, loss of consciousness, pain) and examination (confusion, vital signs, joint assessment). In addition, we audited if there was an indication for CT Brain and compared to NICE criteria.

Results
49 post fall medical review notes were audited (Mean age 79 years, range 66-96).
27% of patients who fell had a CT Brain. 6% (3/49) of patients who fell met NICE criteria for CT Brain, but it was not performed.

Conclusion
A significant proportion of post fall medical reviews omit important details that could help diagnostically and to inform a plan to prevent further falls. There is limited guidance for clinicians as to when to order a CT Brain for inpatient falls. We plan to introduce a post fall medical review pro forma/checklist and to standardise a CT Brain decision tool. We will then re-audit post introduction of these to assess for quality improvement.
Identifying the Burden of Inappropriate Prescribing Using Consensus in a Day Hospital Setting
Authors: Walsh Johnny , Gannon Elizabeth , Carroll Joanna , Brewer Linda 
Published: September 2024

Abstract

Background
Inappropriate prescribing (IP) is highly prevalent in older adults and is associated with increased risk of adverse drug reactions, increased morbidity, mortality and healthcare utilisation. Risk factors associated with IP include older age, polypharmacy and having multiple healthcare providers. The aim of our study was to identify the prevalence of polypharmacy and potential IP in the day hospital setting.

Methods
Patients attending our day hospital over two months were included. Consensus was reached between two Geriatric medicine SpRs and the day hospital pharmacist regarding various categories of potentially IP, and a proforma was agreed. We gathered demographic data, number of medications and subjective medication burden. We recorded data in Excel, and we quantified potentially inappropriate medicines and categorised all identified IP.

Results
179 participants were included, mean age 83 (range 68-98). 80% of patients were taking ≥5 medications, overall, 40% perceived they were taking too many. 79% of participants had at least one example of IP, 25% had ≥3. The commonest example of IP involved PPIs, involving 26% participants, followed by antihypertensives involving 21% of participants. Overall, 48% of potentially inappropriate medications were identified due to ‘inappropriate indication’, and 37% related to side-effects. People aged 65-69 and 90-94 were the most likely to report they were taking too many medicines, 75% and 46% respectively. This correlated with the same age brackets having the highest number of average IP, 2.75 and 2.2 respectively.

Conclusion
Despite the well-known associated risk of harm, our study confirms ongoing high prevalence of polypharmacy and IP amongst older adults. Prescriber vigilance is key in reducing harm. Regular presence of a pharmacist, liaising strongly with medical staff, is invaluable in the day hospital setting.
Ending Pyjama Paralysis; Physical Steps In The Right Direction For An Irish University Hospital
Authors: Nugent Michael , O'Neill Christine , Shae'n Lim Chad , Chen Shi , Haydar Ibrahim , O'Brien Úna , Bambrick Pádraig 
Published: September 2024

Abstract

Background
The risk of hospital-associated deconditioning for frail older adults (i.e. reduced functional performance after acute hospitalisation, due to low activity levels during an admission) is well recognised, yet continues to occur commonly. This quality improvement project aimed to promote a cultural change within two acute medical wards, in line with the principles of “End PJ Paralysis”, which aims to “get patients out of bed, dressed in their own clothes and when possible, moving rather than lying in bed”.

Methods
A multidisciplinary committee was formed to oversee this project. An initial audit on observed levels of patient activity was performed, along with a root cause analysis to identify points of action. A multicomponent intervention was designed and implemented over an 8-week period (Oct to Nov 2023), with weekly re-audit of activity levels. Data on the monthly incidence of falls & pressure areas, as well as average length-of-stay, was also collected, with the results for the intervention period (Q4) compared with the monthly averages for the nine months prior (Q1-3).

Results
A total of 570 Patients were included. Improvements were observed in all outcomes. The proportion of patients dressed in their own clothes increased from 28.5% (18/63) to 51.8% (263/507), those sitting out in a chair increased from 50% (32/63) to 64% (326/507), and those mobilising at the time of audit increased from 60% (38/63) to 71% (360/507). Average falls (Q1-3 vs Q4) fell from 14.8 to 12.6 per month, average pressure sores from 5.5 to 5 per month, and average length of stay from 11.20 to 10 days.

Conclusion
This project demonstrates that a ward-based multidisciplinary initiative can lead to an increase in the proportion of patients on an acute medical ward being dressed in their own clothes, sitting out, and mobilising, without an increase in the incidence of falls.
Detecting Delirium: The Missed Medical Emergency
Authors: Chakkittakandy Deepthi , Kelly Louise , Farrelly Angelina , Wall Catherine , Regi Cicily , Hayden Derek 
Published: September 2024

Abstract

Background
Delirium is among the most common of medical emergencies with approximately 1 in 5 patients aged 65 and above presenting with or developing delirium, during their acute hospital admission. Delirium is more common in certain patient groups including those with hip fractures, dementia, previous delirium, frailty and other comorbidities. It is associated with poorer outcomes and complications. Delirium also has the potential to cause significant patient and carer stress. Despite the significance of delirium, it is frequently underdiagnosed. It can be prevented and treated if it is identified early. As per the National Dementia Office all acute Hospitals have to complete the Delirium care algorithm for all patients aged 65 years and above, admitted to hospital or who have any known risk factors for delirium.

Methods
The Delirium Multidisciplinary Care Bundle was rolled out across the hospital with education provided both face to face and via eLearning. Using the Quality Care Metrics (QCM) delirium indicator and a locally developed audit tool, medical and nursing records where reviewed to identify the level of concordance with the Delirium Multidisciplinary Care Bundle.

Results
The gradual increase in the compliance in use of the care bundle reached up to hundred percent. The bundle use was audited utilising the Quality Care Metrics (QCM) with the delirium indicator showing an improvement of an average of 60-80% hospital-wide. The hospital-wide audit on the compliance of the delirium care bundle was conducted and identified that compliance on the bundle had improved to 60-100%.

Conclusion
Continuous evaluation, monitoring and improvement plans are in place. This will be further supported by providing multiple methods of education delivery throughout the organisation to meet the needs of all learners. Ultimately continuing to improve delirium detection and management for our patient group.
End Of Life Care in Nursing Home Residents Supported Through a Nursing Home Specialist Liaison Service
Authors: Saric Denis , Kennelly Siobhan 
Published: September 2024

Abstract

Background
Advance Care Planning (ACP) is a crucial aspect of ensuring that nursing home residents receive care aligned with their preferences and values, especially as they approach the end of life. Supportive end of life care planning involves discussion with the person and/or their support person, symptom management and multidisciplinary collaboration. Evidence shows that even where an ACP has been recorded there can be significant barriers to enabling end of life care in the nursing home. We examined the role of a nursing home specialist liaison team in supporting implementation of ACPs towards end of life.

Methods
Retrospective analysis of medical and nursing care records from deceased residents referred to the liaison service in 2023 across four nursing homes in the hospital catchment was examined. Data included recording and/or reviewing of ACP at time of liaison consultation, anticipatory medication prescribing, cause and location of death.

Results
41 resident reviews conducted by Registered Advanced Nurse Practitioner and/or Consultant Geriatrician. 16 (39%) of residents had an ACP in place at the time of initial review. 18 (26%) residents had anticipatory medications prescribed prior to liaison service consultation. Following consultation ACP documentation in residents increased to n=40 (97%). A further 11 (26%) residents were charted anticipatory medications at time of review as they were actively dying. Five (12%) residents required referral to specialist palliative care services for complex symptom management. All 41 residents passed away in the nursing home. Cardiac related issue was documented in 63% of reviews as cause of death.

Conclusion
Documentation of ACPs was low in this cohort of nursing home residents towards end of life. Input from the nursing home liaison service supported resident’s end of life care through consultation, support with ACP and anticipatory medication prescribing.
Enhancing Physiotherapy Services within a Community Specialist Team for Older Adults: An Evaluation Study
Authors: Wade Ruth , Nash Karen , Cooney Freda , Ciuba Damian , Cahill Theresa , Connolly Warren 
Published: September 2024

Abstract

Background
An aim of Community Specialist Teams (CSTs) is to provide integrated multidisciplinary services to older people closer to home. Physiotherapy is a key component of this service. This evaluation aims to describe current physiotherapy practices within a specific CST and identify potential areas for improvement. The CST under examination maintains a physiotherapy staffing level of 1.2 Full-Time Equivalents.

Methods
An evaluation was completed of the physiotherapy input provided to 71 older adults who underwent a Comprehensive Geriatric Assessment (CGA) with the CST between July and December 2023. Data encompassing service user demographics and physiotherapy specific information were anonymised and analysed using Microsoft Excel.

Results
The median age of clients was 84 years (range 66-95), with 84.5% aged over 75 years. 70% were female. The median Clinical Frailty Scale (CFS) was 5 (range 3-7), with 75% being classified as frail. The reasons for referral were community rehabilitation (43%), admission avoidance (20%), early supported discharge (17%) and other (20%). Median time to CGA was 18 days (range 1-64 days). 64 (94%) patients were referred to physiotherapy and received an average of 4.4 sessions. Time to physiotherapy assessment following CGA ranged from 0-41 days with a median of 6 days. 83% of clients had physiotherapy intervention in their homes, 14% attended community hubs and 3% both. Analysis of delayed discharge revealed a range of 0-99 excess days beyond the estimated discharge date, with a median delay of 6 days.

Conclusion
This evaluation underscores the prevalent need for physiotherapy input among the service users engaged with this CST. Concerns arise regarding the breach of the of the National Integrated Care Programme for Older Persons (NICPOP) guideline for CGA timing (2 weeks) and target discharge date (6 weeks). The findings of this review will inform future service planning and the development of integrated physiotherapy pathways for older people.
Nutritional Analysis Of The “Regular” Hospital Menu In A Model-2 Hospital
Authors: Forbes Rebekah , O'Shea Katherine , Dennehy Anne , Jennings Emma 
Published: September 2024

Abstract

Background
Hospital malnutrition is associated with adverse clinical outcomes, particularly for older adults with pre-existing frailty. In our Model-2 hospital, the majority of inpatients are older (≥65 years) and at higher risk of developing malnutrition. Protein recommendations for older adults with acute or chronic disease are 1.2-1.5 g/kg/day. The amount of protein consumed per meal is also important.

Methods
Nutritional analysis of individual components comprising the 7-day regular hospital menu cycle was completed using Nutritics software for all foods and beverages available to inpatients. The results were then compared to nutrition standards as set for the regular hospital menu in the national “Food, Nutrition and Hydration Policy for acute hospitals 2018”.

Results
The “regular” menu of the hospital provided: mean 2056 kcal/day versus national standards 2100-2400kcal/day, protein 84 g/day versus national standard 90g/day. These values equate to 100% consumption of all foods offered on the “regular” menu. Energy distribution across the menu shows breakfast providing 29%, lunch 31%, supper 19%, tea & snack rounds 21% of total energy. Protein distribution showed breakfast providing 29%, lunch 41%, supper 18% and tea & snack rounds 12% of total protein. Of 37 surveyed patients 53% reported consuming less than their usual intake at home with actual menu intakes ranging from 50-60% of total food offered.

Conclusion
Nutritional analysis of meals offered on the “regular” menu revealed 98% adherence to the recommended daily intake (RDI) for energy and 94% of the RDI for protein requirements as per national standards. These results are based on actual servings rather than actual consumption, implying potential discrepancies. Consequently, there is a clear need for recalibrating the menu to achieve more consistent caloric and protein intake across each dish. This study also highlighted the need to develop an “energy dense” menu for patients with poor nutritional intakes and frailty.
Going Against the Flow: Impacts of Effective Streaming on Older Adults on the Acute Floor
Authors: Kelly Louise , Davey Naomi , Widdowson Matt , Doran John Paul , Cullen John , Soh Josephine , Byrne Mary , Hayden Derek 
Published: September 2024

Abstract

Background
The development of a dedicated Age-related acute medical unit, with a Registered Advanced Nurse Practitioner (RANP) in Gerontology, targeting older adults with complex health states/Geriatric syndromes presenting to unscheduled care, commenced in Q4 of 2022.

Methods
An age attuned 4-cubical Age-Related Assessment Unit (ARAU) was created and co-located with the Acute Medical Unit (AMU). The RANP in Gerontology for ARAU operated under the guidance of the AMU consultants, providing comprehensive geriatric assessment to older medical patients presenting to unscheduled care.

Results
With the establishment of ARAU, the commencement of the RANP in Gerontology, and the additional focus on streaming and management of acute medical gerontological presentations through the ARAU, there has been a 63% increase in patients aged 75+ treated via the AMU in 2023 (378 patients aged 75+ -2022 vs 618 Patients aged 75+ - 2023). A key area of focus in this patient population group, Patient Experience Times (PET) in decision to admit vs discharge within a 6 hour time frame, showed marked improvement (25% increase 2022 vs 2023 in PET targets met), highlighting the impact of a dedicated age attuned assessment space and RANP in gerontology on the acute floor.

Conclusion
The RANP in ARAU provides advanced specialist geriatric nursing skills and knowledge to positively impact on 75+ flow and PETs while addressing the medical, psychosocial and functional needs of older adults who present to unscheduled care.