bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding “Fear Of Falling” And How It Impacts Older Persons Motivation To Engage In Fall Prevention Exercise Interventions
Authors: Gavin Catherine , Tuite Fiona , Hesnan Alison , McMahon Sarah , Sestak Karolina , O'Malley John , Canavan Michelle 
Published: September 2024

Abstract

Background
Fear of falling can cause older persons to restrict their activities, which drives reduced strength and balance and increases their falls risk. Falls can have a significant effect on older persons in terms of loss of confidence, ongoing falls risk and ultimately, a poorer quality of life (Oliver et al, 2010). Fall prevention exercise interventions can help reduce the risk of falling in older adults by up to 34% (Sherrington et al, 2020). This study aims to explore the prevalence of fear of falling in older adults both before and after attending a community-based fall prevention exercise programme. The programme consisted of an evidence-based Physiotherapy led 10-week strength and balance class, followed by a 16-week exercise instructor led strength and balance class.

Methods
A 2-part qualitative study.
Part 1: Prior to commencing the class each participant completed a rating of their fear of falling measured by ConfBal (a validated 10 item Balance Confidence scale).
Part 2: Questionnaire assessing their experience of the classes and corresponding change in balance scores.

Results
17 older adults completed the programme. Surveys were returned by 8/17 to date (47%). Mean pre-intervention ConfBal score of 20, mean post intervention score of 15 (8/17 participants to date), average 4-point improvement after intervention was statistically significant (p=0.008). Reported benefits of falls prevention exercise classes include peer-peer discussion of functional ability, gaining confidence by exercising in a group environment, practising functional exercises relating to day-to-day tasks, and building social relationships.

Conclusion
Fear of falling amongst community dwelling older adults is common but group exercise improves confidence as well as boosting social interactions. Participation in fall prevention exercise programmes can help to better support older people as they age which may influence better health outcomes in our communities.
Retracted: Risk of Haemorrhage Associated with Direct Oral Anticoagulation Versus Anti-platelet Therapy: A Systematic Review and Meta-Analysis
Authors: Lynch Amy , Coyle Mark , Higgins Maeve , Judge Conor , Reddin Catriona , O'Donnell Martin 
Published: September 2024

Abstract

Background
Among patients with atrial fibrillation, clinicians often prescribe anti-platelet therapy rather than oral anticoagulation which may relate to a concern that direct oral anticoagulants (DOAC) are associated with a higher risk of bleeding. We completed a meta-analysis to determine whether DOAC therapy, compared to single anti-platelet, was associated with an increased risk of major haemorrhage, with a primary focus on intracranial haemorrhage (ICH).

Methods
We searched PubMed and Embase databases up to 7/2/2024. Randomised controlled trials (RCT) that compared DOAC therapy to single anti-platelet agents were included. Trials with follow-up less than 30 days, or sample size less than 200 were excluded. A random-effects meta-analysis model was used to report pooled treatment effects and 95% confidence intervals (CIs). The primary outcome was occurrence of ICH.

Results
A total of 9 RCTs were included (n=45,493). Overall, DOAC therapy was not associated with significantly higher odds of ICH compared to anti-platelet therapy (Odds ratio (OR) 1.14; 95% CI, 0.71-1.82), but there was heterogeneity among trials (I2 = 49.3). In an analysis by DOAC agent, the respective estimates for ICH risk were; Rivaroxaban (OR 2.05; 95% CI, 1.09-3.83); Dabigatran (OR 1.00; 95% CI, 0.61-1.64) and Apixaban OR 0.72; 95% CI, 0.44-1.17). DOAC therapy was associated with higher odds of major haemorrhage compared to aspirin (OR 1.39; 95% CI,1.07-1.80), with the following estimates by agent; Rivaroxaban (OR 1.91; 95% CI 1.22-3.00); Dabigatran (OR 1.21; 95% CI 0.86-1.69); Apixaban OR 1.09; 95% CI 0.73, 1.63). DOAC therapy was associated with higher odds of GI haemorrhage then control (OR 1.39; 95% CI,1.11, 1.73).

Conclusion
DOAC therapy was not associated with a significantly higher risk of ICH compared to anti-platelet therapy, but risks may differ among DOAC agents. DOAC therapy was associated with a higher risk of major haemorrhage, mostly related to GI haemorrhage.
Post-Acute Admission Mortality Rates for Nursing Home Residents
Authors: Noonan Claire , Davey Naomi , Farrelly Angelina , Soh Josephine 
Published: September 2024

Abstract

Background
Nursing home residents (NHRs) constitute a vulnerable demographic with intricate healthcare requirements, often burdened by multiple comorbidities. A specialised geriatrician-led acute care team for NHRs was established in a University Teaching Hospital. This service prioritises the unique needs of NHRs, delivering tailored treatments in environments conducive to their well-being, while also striving to mitigate the adverse effects associated with avoidable hospitalizations.

Methods
An analysis of NHR admissions to a University Teaching Hospital in 2023, showed that 307 out of 343 (89.5%) were discharged back to the community. All discharged NHRs were followed up. Their 3 and 6 month mortality rate post discharge was 8% (n=24) and 13% (n=40) respectively. Majority of these frail NHRs survived beyond six months following hospital admissions, indicative of the potential impact of a specialized gerontological care follow-up.

Results
This specialist team has a post-discharge follow-up protocol for all admitted NHR residents, aimed to detect potential deteriorations and offer alternative avenues of review, minimizing unnecessary emergency department visits, particularly in non-urgent cases. Interventions such as the FastTrack Fracture service, direct ED reviews, and facilitating outpatient appointments were instrumental in this endeavour.

Conclusion
In summary, the establishment of this specialised geriatrician-led acute care team for NHRs marks a substantial stride in addressing the multifaceted needs of frail older adults in nursing homes. By leveraging the expertise of gerontologically attuned practitioners and emphasizing person-centered care approaches, these services provide a holistic and individualized solution to enhance outcomes and elevate the quality of life for this vulnerable population. Sustained investment in the development and expansion of such services is paramount for advancing care standards for older adults and fostering a more age-friendly healthcare milieu.
Risk Prediction Models for Adverse Drug Reactions and Adverse Drug Events in Older Adults – A Systematic Review and Meta-analysis
Authors: Cosgrave Nicole , Ong Woei Shan , Saleh Sooad , Frydenlund Juliane , Cahir Caitriona , Williams David 
Published: September 2024

Abstract

Background
Adverse drug reactions (ADRs) and adverse drug events (ADEs) are common and result in significant morbidity, mortality and healthcare costs. As the world’s population ages, the consumption of medications and healthcare will increase. Models predicting ADR risks in older adults have previously been found to lack reliability and validity. The aim of this systematic review and meta-analysis is to provide an updated, comprehensive quality assessment and analysis of ADR-risk prediction tools in older adults.

Methods
Standard computerised-databases and citations were searched (2012 to 2023) to identify relevant peer-reviewed studies. Studies which developed and/or validated an ADR/ADE prediction model for use in older adults were included. Four studies from a previous systematic review were also included. The TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) guidelines were used to evaluate each of the included studies. Random effects models were used to derive a pooled discrimination estimate (area under the receiver operation curve; AUROC) for model development studies and model validation studies. The prediction model risk of bias assessment tool (PROBAST) was applied to evaluate bias.

Results
Five out of 11,481 titles, plus four previous studies, met all inclusion criteria and underwent TRIPOD evaluation. Meta-analysis resulted in a favourable pooled AUROC 0.75 (95% CI 0.57, 0.87; I-squared= 96.65%) for model development studies and 0.70 (95% CI 0.57, 0.80; I-squared= 90.53%) for model validation studies but there was substantial heterogeneity. Studies had poor adherence (range 32-50%; median 44%; IQR 11.5%) to TRIPOD guidelines. The overall risk of bias was high for all included studies.

Conclusion
Seven risk prediction models were identified, all exhibiting poor adherence to TRIPOD guidelines which may question the investigational rigor of the studies and their usability. This underscores the need for the development of a validated, robust and reliable tool worthy of implementation and testing in a real-world setting.
The Use Of Simulation To Develop, Test And Implement A Multidisciplinary Team Care Pathway Bundle For Inpatients With Parkinson’s Disease
Authors: Hennessy Susanne , Forbes Rebekah , Fleming Emma , Woulfe Cliona , Patel Tariq , Jennings Emma 
Published: September 2024

Abstract

Background
Hospitalised PD patients experience poorer outcomes. Model-2 hospitals lack onsite subspecialty neurology services whilst frequently managing PD inpatients. Aiming to enhance care of PD inpatients our multidisciplinary team (MDT) utilise simulation to design and deliver a new PD care pathway bundle.

Methods
The developed care bundle aims to facilitate i) screening for causes of PD deterioration, ii) identification of time sensitive and contraindicated medications and iii) prioritisation of timely MDT referral within the first 24 hours of admission. Using simulation of the NPO PD patient, usability of the bundle was tested through correct medication conversion (via Parkinsons calculator) and MDT clinical review for NG tube insertion with patient inclusion.

Results
Simulation delivery and structured debrief thereafter, further enhanced development and improvement of the simulation. It reinforced how the care bundle initiated early MDT referral and highlighted the pros/cons of MDT discussion with and without the patient. Once deemed satisfactory by all team members, ward-based simulation facilitated staff education and awareness of the new tool.

Conclusion
Simulation in the test and clinical environment facilitated implementation of a new MDT care pathway bundle at hospital level. Evaluation of effectiveness of the new care pathway require future audits and additional simulation campaigns.
Outcome Measures And Analysis Of Memory Movers- An Exercise Programme For The Brain, Body And Mind
Authors: Lafferty Regina , Boyle Mairead 
Published: September 2024

Abstract

Background
Memory Movers is a six-week early intervention specialist programme designed for implementation in community settings to meet key healthcare needs for individuals experiencing memory difficulties/dementia and their family carers. This programme provides individuals with the knowledge, skills and education to care for their overall health and well-being. It supports mental health and well-being by utilising cognitive stimulation exercises in conjunction with physical health exercises and providing information and basic exercises in mental health.

Methods
The Specialist Mental Health Service for Older People collaborated with an Acute Hospital, local Council, and Sports and Wellbeing Partnership in designing a suitable, accessible programme to promote Mental Health and well-being in the community. The programme incorporates the following aspects of health: Memory, Movement, and Mental Health.

Results
Pre- and post-assessments were undertaken with results highlighting the following: The Life Satisfaction Scale improved by 6%; the Mood Rating Scale improved by 19% and the overall rating of experiencing feelings of anxiety was reduced by 14% within the final week. There was also a 101% increase in the average engagement in physical activity. A range of positive comments received from attendees were recorded on feedback questionnaires.

Conclusion
Findings highlighted that remaining active supports both physical and mental health. According to the HSE (2020), physical exercise can cause chemical changes in the brain, which can help improve mood. Cognitive stimulation is beneficial to brain health and cognition (Schulz 2015). These contribute to the overall well-being of individuals, promoting cognitive functioning and movement, as well as overall mental health and well-being. This programme also provides opportunities for social connection and integration with services.
Impact of a Stroke Physician-Provided Loop Recorder Implant Service in a Model 3 Hospital Investigating Embolic Stroke of Undetermined Source:
Authors: Zeeshan Muhammad , O'Sullivan Ciara , Coghlan Roseann , Flahive Ann , McCormick John , Cotter Paul 
Published: September 2024

Abstract

Background
When Embolic Stroke of Undetermined Source (ESUS) is investigated with an Implanted Loop Recorder (ILR), Atrial Fibrillation (AF) may be detected in about 25%. In Ireland this is usually undertaken by a cardiology service. Non-traditional implanters are now well accepted, though few stroke physicians perform this service. Understanding the expected numbers and workload will allow service planning.

Methods
The study is a prospectively cohort at a model 3 institution. A stroke physician and CNS-provided implant service was initiated in 2017. The Irish National Audit of Stroke and Hospital Inpatient Enquiry was used estimate the numbers of infarcts. The hospital patient management system was used to evaluate the follow-up provided per case. Consultant time was calculated at 45, 30, 30 and 20 mins per implant, explant, in-person review and tele review respectively. CNS time was calculated at 60 and 45 mins per implant and explant. Descriptive statistics were used.

Results
Between March 2017 and February 2024, a total of 63 ILR (Reveal LINQ, Medtronic) were implanted by the team, of which 58 were for ESUS; mean age at implant 66.4 years, 39.6% female. Implants as a proportion of the total infarcts in the years 2017-2023 was 6.51%; range from 3.1-9.9%. Excluding the disrupted Covid years and 1st year the average was 8.8%. Of the implants, 34 (60.3%) have been explanted to date. The total median (IQR) time per implant was 120 (100-150) mins and 105 (60-105) mins for consultant and CNS respectively [145 and 105 mins respectively for explanted (completed) cases]. AF has been identified in 17 cases to date (29.3% of implants).

Conclusion
Implementing an ILR service requires about 2hours of consultant time and 1hour 05 mins of CNS time per case. Expected numbers of implants can be estimate at 8-10% of all infarcts, and a considerable proportion will have AF detected.
Characterisation of Patients with Self-Neglect – `Room to Improve' with a New Potential Geriatric Giant?
Authors: Stanley Eve , O'Connor Kieran , O'Sullivan Catherine , O'Caoimh Ronan , Moloney Elizabeth , McGrath Keith , Alcock Megan , Hayes Mary , Maher Sharon 
Published: September 2024

Abstract

Background
Self-Neglect is an under-reported and often veiled diagnosis which is defined as ‘an adult’s inability due to physical or mental impairment or diminished capacity to perform essential self-care tasks. Self-Neglect is an independent risk factor for death and is associated with morbidity, heavy utilisation of healthcare services and safeguarding issues. Self-Neglect affects more older persons and is more commonly seen in people with cognitive deficits and social isolation.

Methods
Using HIPE data, patients were selected for a Descriptive Retrospective Chart Review with a diagnosis of Self-Neglect and under the care of a Consultant Geriatrician within a 2-year timeframe from April 2022 to April 2024. Data was compiled and demographics were collated. Charlson Co-Morbidity Index, Adult Comorbidity Evaluation-27 and Clinical Frailty Scores were employed.

Results
Twenty patient's charts were reviewed retrospectively. Of the twenty patients 65% were male, 40% are rural dwelling and 70% live alone. 95% of patients have an underlying cognitive impairment, and over 90% have a current or remote history of substance abuse. All 20 patients had significant concerns highlighted about their housing and 60% of patients required alternative accommodation while their home was updated or cleaned. All 20 patients required discharge planning with many requiring complex multi-disciplinary input regarding their safe discharge and had prolonged inpatient stays.

Conclusion
Recognition and resourcing ‘Self Neglect’ pathways will remain an issue in the health service in Ireland and worldwide. Patients presenting to hospitals with Self-Neglect are multi-morbid, socially complex and tread the line between autonomy and public health issues. Creating a service pathway that puts this vulnerable cohort at the centre and that could span both inpatient and community streams would be beneficial to the over-stretched health service but most importantly to the patient.
Enhancing Delirium Recognition: Assessing The Impact Of Educational Interventions In A Model Three Hospital - A Retrospective Analysis
Authors: Scully Padraig , Drumm Breffni , Casey Mary 
Published: September 2024

Abstract

Background
Delirium is a common medical emergency which is well-known to be associated with adverse outcomes but often remains under-recognised in the acute care setting. In recent years, efforts have been made by our gerontology department to increase awareness of the importance of recognising delirium as a medical condition. Initiatives carried out included the roll-out of education sessions at ward level, medical and nursing grand rounds. Utilising HIPE (Hospital Inpatient Enquiry) data, we assessed whether such interventions have translated into increased recognition of delirium in hospital inpatients.

Methods
We collated data from the HIPE department in our hospital. HIPE assessed all hospital inpatient medical charts for patients that were discharged each year to assess whether delirium was recorded as a diagnosis in such patients. The data for each discharge year spanning from 2018 to 2022 inclusively was compared. We assessed the number of patients discharged during those years that had a diagnosis of delirium recorded in their chart. Additionally, in conjunction with the frailty team, we reviewed all formal interventions made in our hospital since 2018 to promote awareness around delirium.

Results
A year-on-year increase in the number of cases of chart-recorded delirium among hospital inpatients between 2018 and 2022 was observed. In 2018, there were 308 diagnoses of delirium made in patients being discharged from hospital that year. This was followed by 342 in 2019, 424 in 2020, 501 in 2021 and 609 in 2022. There were nine different initiatives identified to have been carried out by the gerontology team to increase education around delirium.

Conclusion
Interventions made have shown to increase the recognition and diagnoses of delirium. With diagnoses increasing by nearly 98% over a five-year period, this shows that interventions to improve awareness of delirium can have significant impact. Recognising delirium is the first step to improving outcomes for patients.
The Development and Impact the First Irish Nurse-Led Lumbar Puncture Clinic in a Regional Specialist Memory Clinic
Authors: Crosby Lisa , Garcia-Gallardo Angela , Hutchinson Siobhan , McKenna Mary Clare , Byrne Lisa , Reilly Claire , Oakes Katie , Robinson David 
Published: September 2024

Abstract

Background
A Regional Specialist Memory service assesses complex cases of cognitive impairment, requiring a comprehensive diagnostic assessment. Lumbar punctures (LP's) are the definitive procedure to identify Alzheimer's Disease. The highest limitation to LP access is shortage and availability of specially trained medical staff. Cognitive centres across Europe have been training nurses (Advanced Nurse Practitioner) to perform LPs since 2006. A nurse led service was established in April 2023 in a large Irish teaching hospital.

Methods
This analysis data represents a preliminary 5-month audit of an ANP Led LP service (ALLPS) compared to prior service provision (ALLPS n=40, pre-ALLPS n=20). Waiting time for LP prior to ALLPS averaged 25 weeks, which reduced by over 50% (12 weeks).

Results
CSF results were identified in half the time with ALLPS (3 weeks versus 6 weeks). The initiation of the ALLPS reduced the timeframe to diagnosis from 12 weeks to 5 weeks. This led to an average wait time reduction from date of CSF result to disclosure of diagnosis of 53% (15 weeks pre-ALLPS to 8 weeks). The ALLPS is pioneering the use of a seated upright LP procedural position, reported to be comfortable by this cohort. Analysis of the nurse led LP procedure is comparative with medical LP services. Almost 40% were achieved on 1st attempt, a further 28% on 2nd attempt, with 18% on 3rd attempt. The ANP successfully completed 75% of LPs in this initial cohort with 9 patients requiring supervisor LP performance. One case required x-ray guided LP.

Conclusion
Appointment of a dedicated ALLPS service has reduced waiting times for diagnostic intervention, leading to early diagnosis, accessing post diagnostic support, meeting best practice guidelines outlined by the National Dementia Office.
Symptoms and Psychosocial Factors on Quality of Life and Life Satisfaction in People with Parkinson’s Disease
Authors: Gaiera Fran , O'Shea Emma , O'Keeffe Gerard , Timmons Suzanne 
Published: September 2024

Abstract

Background
Parkinson’s disease (PD) is one of the most common neurodegenerative diseases estimated to touch 9.3 million people worldwide by 2030. Motor and non-motor symptoms of PD have a debilitating effect on people with PD’s quality of life (QoL) and life satisfaction (LS). This study aims to explore the factors influencing people with PD’s lives in Ireland.

Methods
The sample comprised 827 participants, recruited through crowd-sourcing and snowball sampling. Participants were asked to complete a 30-minute survey online or on paper. The survey collected data on motor and non-motor symptoms, social connectedness, self-efficacy, stigma, QoL and LS. A series of linear and multiple regressions assessed the relationships between people with PD’s symptoms, psychosocial factors and their QoL and LS.

Results
Low self-efficacy and high levels of stigma were predictive of low QoL and LS, while low social connectedness was associated only with low QoL. Results showed reduced dexterity with hand/eye coordination, anxiety, apathy, pain and fatigue contributed to LS, whereas reduced dexterity with hand/eye coordination, shaking/tremors, stiffness of movement, freezing of gait, cognitive problems, hallucinations, apathy, compulsive behaviours, sleeping disorders, pain and urinary incontinence were contributors of QoL.

Conclusion
This study can provide insights into the factors influencing people with PD’s QoL and LS. Data can promote the development of therapeutic interventions targeting PD non-motor symptoms, which are often dismissed by clinicians. Finally, findings can inform the development of health and social policies and educate the general public to dissolve the stigma associated with PD.