bluuebunny/crossref_metadata_2025_split huggingface dataset:
Goals of Care Discussions Among Patients Who Suffer Cardiac Arrest
Authors: Oyuga Michael , McCormick John P , Power Hayley , Ryan Seán , Regan Anne , Trueick Robert , Nally Fionn , Al-Harthi Faisal , O'Boyle Patrick 
Published: September 2024

Abstract

Background
Outcomes following in-hospital cardiac arrest remain poor despite advances in resuscitation techniques. Establishing “goals of care” is crucial to optimizing patient care and avoiding burdensome interventions in those who are unlikely to benefit from resuscitation. Doctors often avoid discussions regarding ‘goals of care’ with patients in whom cardiac arrest is not deemed likely at the time of admission.

Methods
All cardiac arrest team activations for non-pregnant, adult inpatients on medical and surgical wards at our institution from December 2022 – June 2023 were prospectively analysed. Qualitative analysis of inpatient charts was performed to assess; incidence of cardiac arrest, demographic and clinical data, and the degree to which discussions regarding escalation of care had taken place.

Results
66 cardiac arrest team activations were screened, of which 23 calls were included for analysis. The estimated incidence of cardiac arrest was 1.11-1.67 events per 1,000 patient discharges. 18 patients (78.2%) were under the care of general medicine or geriatric teams at the time of arrest call. 12 (52%) patients were older than 70 and 4 (17%) were older than 80. Falls were the most common reason for admission (22.7%) among patients for whom the cardiac arrest team was activated. 2 patients (12.5%) with confirmed cardiac arrest survived to hospital discharge. Discussions regarding goals of care were documented for 8/23 patients (34.7%).

Conclusion
Cardiac arrests were uncommon in our institution. Discussions regarding goals of care were documented in only a third of cases, possibly because many patients presented with issues not typically associated with a risk of subsequent arrest. Given the low survival rates to discharge, routine discussion of goals of care should be considered at the point of admission in all patients who are unlikely to benefit from resuscitation, regardless of the presenting complaint.
Integrated Care in Action: A Case Study of Collaborative Multidisciplinary Approach for Older Adults in Ireland
Authors: Dooley Marie 
Published: September 2024

Abstract

Background
In Ireland, the healthcare landscape is evolving with frameworks which emphasize community-based care, such as Enhanced Community Care and the National Integrated Care Programme for Older Persons. Our Integrated Care Team for Older Persons (ICPOP) service exemplifies this shift by providing intensive, immediate multidisciplinary care to frail adults, aiming to maintain their independence in their homes and communities.

Methods
In the case study we describe service users journey with ICPOP. The case study illustrates the transition from fragmented care to a collaborative, patient-centred approach. ICPOP employs a structured process involving comprehensive assessment, goal setting, weekly multidisciplinary team meetings, stakeholder liaison, and detailed discharge reports. This approach focuses on early supported discharge and close coordination with local MDT teams, fostering effective communication and shared decision-making.

Results
This case study demonstrates the effectiveness of ICPOP's multidisciplinary model. Key factors contributing to this success include physical co-location, shared goals and vision, mutual trust, and established relationships among professionals. Furthermore, the integration of Allied Health Professionals (AHPs) within community teams enriches the care continuum and enhances outcomes for older adults.

Conclusion
To further enhance integrated care delivery, digital solutions are crucial. Implementing shared electronic health records and facilitating access to medical findings can streamline communication and improve care coordination. Additionally, prioritizing written discharge summaries for clients can ensure continuity of care and empower patients and their families in the post-discharge phase. This patient journey underscores the importance of collaborative, patient-centred care models in achieving the objectives of Sláintecare leading to better outcomes for older adults in Ireland.
Predictors Of Handgrip Strength And Its Relationship To Physical Performance In Older Irish Adults
Authors: Fitzpatrick Donal , Laird Eamon , Lannon Rosaleen , Cunningham Conal , Ward Mary , Hoey Leanne , Hughes Catherine F , Strain JJ , McNulty Helene , Molloy Anne , McCarroll Kevin 
Published: September 2024

Abstract

Background
Handgrip strength declines with age and predicts poor physical performance and increased risk of falls and mortality. However, the strength of the relationship between handgrip strength and other physical measures is less well studied. We aimed to explore the predictors of handgrip strength in older Irish adults and its relationship to the Timed and Up and Go (TUG).

Methods
Study participants were from a longitudinal cohort of Irish adults aged &gt;60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Participants on current or long-term steroids, a history of stroke and with MMSE &lt;24 were excluded. Handgrip strength was assessed with a dynamometer and defined as &lt;27 kg for males and &lt;16 kg for females. Abnormal performance in the TUG was defined as &gt;12 seconds. Predictors of impaired handgrip were explored in multivariate logistic regression.

Results
There were 748 participants (68.9% female, mean age 70.2 years), of whom 33.4% had abnormal handgrip strength, which was more common in female’s vs males (39.4 vs 20.2%, p&lt;0.001). Both abnormal handgrip strength and TUG was present in 13.6%. Normal handgrip strength had a negative predictive value of 76.0% for ruling out poor TUG, while abnormal handgrip had a positive predictive value of 62% for poor TUG. Predictors of impaired handgrip strength were older age (P&lt;0.0001), female sex (p&lt;0.0001), lower protein intake (P=0.024) and higher waist hip ratio (p=0.014).

Conclusion
Handgrip strength had a modest correlation with TUG A significant proportion had abnormal TUG but normal handgrip. Changes in lower limb muscle strength (affecting TUG) precede muscle loss in the upper limb. Higher protein intake predicted greater grip strength and supports the recommendation to maintain adequate intakes to prevent sarcopenia. Greater waist hip ratio is associated with reduced lean muscle mass which may explain the negative relationship we identified with handgrip strength.
Retrospective Review of Falls in Medical Inpatients Following Introduction of a Falls Proforma at Wexford General Hospital
Authors: Geraghty Timothy , Boyle Niamh , McNamee Mary , Kelly James , Lucey Kieran , Harkin Eithne 
Published: September 2024

Abstract

Background
Inpatient falls are the largest category of preventable inpatient adverse events in hospitals coming at both great financial and safety cost to a healthcare system. Approximately 30% of inpatient falls result in injury, 4-6% resulting in serious injury with older patients have the highest risk of falling and injury. The aim of this retrospective audit cycle was to improve standards of falls assessments performed by junior doctors.

Methods
We initially conducted a retrospective review of 7 medical inpatient falls in July 2023. Standards were compared against NICE Guidelines on Assessment and Prevention of Falls in older people 2013 and NICE guidelines on Assessment and early management of head injury 2023. 15 key elements were analysed: doctor identifier, date and time, history of fall, confusion, pain, loss of consciousness, amnesia, seizure, vomiting, medication review, hip fracture, wrist fracture, skull fracture, Glasgow Coma Scale and neurological deficit. One point was given for each of the 15 key elements noted in the falls review. Following introduction of a falls proforma, we re-audited 18 falls in February 2024 to analyse differences in scores.

Results
Prior to proforma introduction, 7 falls reviewed had an average score of 3 points. 4 falls were reviewed by SHOs, 1 each by an SpR and Intern and 1 NCHD review was unidentifiable. Mean age was 72. Following proforma introduction, 18 falls in 13 patients were analysed. 2 patients did not have a falls review, 15 were reviewed by SHOs, 1 by an Intern. Average age was 81. Proforma was used in 7 cases with an average score of 12.7, and no proforma was used in 11 cases with an average score of 5.

Conclusion
These findings demonstrate improved quality of falls reviews using proformas in line with guidelines compared to those without. More education is needed to incorporate proformas into standard practice.
Playing Ping- Pong: Keeping Frail Older Adults Out Of Hospital
Authors: Staunton Ruth , Davis Aisling , O'Kane Aoibhean , Smith Finola , Doyle Cliona , Hilery Patrick , Namara Rosa Mc , Boyle Nicola 
Published: September 2024

Abstract

Background
EDITH (Emergency Department in the home) is a rapid response team consisting of a doctor/Advanced Nurse Practitioner and Occupational Therapist who assess patients in their home to avoid an ED attendance. The Integrated Care Team for Older People (ICPOP) is a community-based specialist multidisciplinary team that provides assessment and intervention for frail older adults in order to maintain them living at home. The teams have developed a close working relationship and utilise each other’s services to provide right time, right place patient care with the ultimate shared goal of keeping older adults living well at home.

Methods
A high frequency service user was identified, and a retrospective chart review was completed between the two teams. Outcome measures such a CFS, 4AT, medical status, social supports and environment set up were noted. Patient journey was conceptualised and handover of medical responsibility from team to team was explored along with identifying other factors that maintain older adults living well in their homes.

Results
Over a 12-month period, patient X case was “ping ponged” between the two services. The patient attended ED with EDITH review in the home facilitating a direct discharge home. The ICPOP team provided ongoing interdisciplinary and specialised intervention. ICPOP also identified changes to medical status that warranted timely EDITH review and thus negated the need for ED attendance. Patient X avoided a hospital admission during that period due to co working and open communication between both teams.

Conclusion
Rapid access, timely communication and team work between the EDITH/ICPOP yielded a positive result for patient X and allowed them to remain at home, despite a high level of frailty and low threshold for hospital admission. It appears that having services working with a collaborative approach affords better outcomes for this vulnerable population and reduces pressure on hospital resources.
Appropriate Prescribing of Antipsychotic Medication Amongst Long-Term Care Facility Residents Admitted to Hospital
Authors: O'Mahoney Niamh , Power Leslee , Mello Sarah 
Published: September 2024

Abstract

Background
In Ireland, it is estimated that up to 45% of long-term care facility residents (LTCR) living with dementia are prescribed antipsychotic medication1. Although antipsychotics have moderate benefit in treating neuropsychiatric symptoms, their use must be carefully weighed against an adverse side effect profile. This study aims to describe the prevalence of antipsychotic usage in LTCR admitted to hospital, and to determine the appropriateness of the prescription as outlined by the National Clinical Guideline 21. This study describes the efficacy of a new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) in reducing inappropriate prescribing.

Methods
Hospital admissions were screened daily to identify LTCR. Medical chart and drug kardex review was performed to collect demographic data, dementia diagnosis, and antipsychotic prescription. Anticholinergic burden was calculated using the ACB score. If the indication for antipsychotic was not clear post review, the NHL service obtained collateral history to determine reason for prescription, making recommendations to wean and stop the medication where appropriate.

Results
Data was prospectively collected on 50 consecutive LTCR, 28 (57%) were male and the average age was 81years. 26 (51%) of patients had a diagnosis of dementia. A total of 11 (22%) patients were prescribed antipsychotics; of these, seven (64%) had dementia and the rest had psychiatric diagnoses. The mean anticholinergic burden was 2.4 (range 0-7). Five (45%) of the antipsychotic prescriptions were not justified as per Guideline 21 or were no longer needed. These were amended as per the advice of the NHL service.

Conclusion
This study highlights rates of inappropriate prescribing of antipsychotics among LTCR, resulting in high anticholinergic burden and the associated risks. Medication review and advice from a specialist NHL service, was effective in reducing inappropriate prescriptions. Further education and dissemination of Guideline 21 is prudent to ensure proper prescribing and de-prescribing practices.
Silver Fast Track – Prioritising People Over 75 in the Emergency Department (ED)
Authors: Sankey Ciara , Linehan David , Latoza Wendelene , Carville Michelle , O’Neill Siobhan , Hart Dominic , Marks Marian 
Published: September 2024

Abstract

Background
The National Emergency Medicine Programme prioritised the care of older adults in a three-year Unscheduled Care Improvement Programme, coinciding with the “Integrated NCAGL Acute Operations and Older Persons body of work on Older Adults with Frailty in Acute hospitals”. In May 2023 a three-month pilot in the ED commenced to reduce the time for people over the age of 75 awaiting assessment by a doctor. Using the Manchester Triage system, a separate filing box on triage (Category 3+) was created to identify all people aged over 75 years who would then be prioritised to be seen within 4 hours of arrival. In addition, if a person aged over 75 years was waiting over 4 hours to be seen they would be re-triaged and seen within 15 minutes (Category 2).

Methods
A Prospective analysis of waiting times for people aged over 75 years, assessing: (1) time to be assessed by the Older Persons Assessment and Liaison (OPAL) Team; (2) time to see the ED doctor and (3) time to discharge.

Results
Four months prior to commencement, the median time from arrival to be seen by OPAL was 10 hours 58 mins. Following commencement, for the remainder of 2023, the median time from arrival to seen by OPAL was 6 hours 36 mins. The time to see the doctor reduced by 49 mins and time to discharge reduced by 1 hour 19 minutes.

Conclusion
The category 3+ for patients aged over 75 years is now an established feature in the ED. It has enabled the OPAL team to undertake earlier assessment of the patients journey alongside the medical team ensuring a more collaborative discharge pathway. In the future, we hope to further reduce the time to be assessed by OPAL through the introduction of clinical frailty scoring at ED triage & expanding the team.
A Profile of Patients Undergoing Comprehensive Geriatric Assessment Though Irish; An Bhfuil Gaeilge Níos Fearr?
Authors: Neachtain Máire Ní , Fitzmaurice Cliodhna , Abed Aishling , Brehony Alma , McCleane Fiona , Canavan Michelle , Costello Maria 
Published: September 2024

Abstract

Background
The CSO 2022 reported that there were 1,873,997 Irish speakers in Ireland &gt;3yrs of age. Of those, 71,968 speak the language daily. The highest proportion of those who speak Irish in Ireland live in the West of the country. Within our catchment area, we are able to provide an ANP led comprehensive geriatric assessment (CGA) in the Irish language.

Methods
The aim of this study was to characterise participants referred to an integrated care for older persons (ICPOP) service who had CGAs conducted in Irish from the period of September 2023 to April 2024 and to determine if the patients felt better represented if their CGA was conducted through Irish. Two questions were asked, 1. Do you prefer to have healthcare interaction through Irish? 2. Do you feel better represented by having had your CGA conducted in Irish?

Results
Over a six-month period 34 patients referred to ICPOP underwent CGA or review through the Irish language. 35.2% (n=12) had their CGA conducted at home. 23.5% (n=8) of those were referred for frailty, 23.5% falls (n=8) and 53% (n=18) for assessment of cognition. Of this cohort 32.3% (n=11) were female, had a median age of 81.5 years and a median clinical frailty score of 5 (range 3-7). The average age of education completion was 14.8yrs. 3% (n=1) had no literacy skills, 23.5% (n=8) had limited and 73.5% (n=25) had good literacy skills. 56% (n=19) gave feedback on their experience. For 23.5% (n=8) it strongly mattered that they had this option. For the remainder, they were indifferent, as they were fluent in both languages.

Conclusion
We identified that for a proportion of our patient cohort having CGA conducted through Irish was of importance. Ancillary benefits included better understanding of interventions such as deprescribing and brain health techniques when communicated through their primary language.
Hypertension in Older Frail Adults in an Integrated Care Hub -What is the Guidance for Management in this Cohort?
Authors: Ryan Siobhan , Ryan Sheila , Lynch Paula , Mathai Vimal , Alamin Mohammed , Shanahan Elaine , Bourke Bill 
Published: September 2024

Abstract

Background
The current European Society of Hypertension (ESH, 2023) guidelines suggest specific recommendations for very old or frail patients; to maintain an office systolic blood pressure (OSBP) between 140 to 150 mmHg. A reduction of treatment could be considered in these patients with a low OSBP (&lt;120 mmHg) or in the presence of severe orthostatic hypotension or a high frailty level.

Methods
We completed a retrospective chart review of patients 80 years and older, who were referred for frailty and a falls assessment, from November 2021 to April 2024. During the chart review we examined the OSBP recordings for these patients to examine our practice. We explored the medication profile of patients who had an OSBP &lt;120mmHg and &gt;150mmHg. The agents used were ACE inhibitors, Angiotensin Receptor Blockers, Calcium Channel Blockers, Beta Blockers, Diuretics and Alpha Blockers.

Results
The charts for 52 patients met the criteria and were retrieved for review. The average age was 87 years (range 80-96). 3/52(6%) had a SBP &lt; 120mmHg. 27/52(52%) had OSBP between 120 and 149 mmHg. 22/52(42%) had an OSBP &gt;150mmHg. We examined the medication profile of those patients who had an OSBP &lt;120 mmHg. 2/3 patients were on three agents and 1/3 patient was on two agents. Looking at the OSBP profile of those patients who had an OSBP &gt;150mmHg. 6/22(27%) patients were on three agents, 3/22(14%) were on two agents, 12/22(54%) were on one agent and 1/22(5%) were on no antihypertensive treatment.

Conclusion
From our data we found 6% of our patients were over treated for blood pressure while 42% had uncontrolled OSBP readings. We are conscious of deprescribing in older fallers, but further prescribing may be necessary to achieve published targets as per the ESH guidelines. Further research needs to examine the prevalence of white coat hypertension in our cohort.
As Fit as a Fiddle
Authors: Davis Aisling Jane , Doyle Cliona , O'Kane Aoibhean , Smith Finola , Doran Arthur , Hilery Patrick , Namara Rosa Mc 
Published: September 2024

Abstract

Background
The EDITH (emergency department in the home) team is an alternative pathway for older adults requiring emergency care. The team consists of an occupational therapist (OT) and a doctor who provide specialized geriatric care in patients' homes thus negating the need for an emergency department (ED) presentation. The patients' profile is typically frail older adults however this service can be accessed by any person over 65 years within the catchment.

Methods
Clinical frailty scales (CFS) are routinely completed as part of the OT assessment process. A review of the OT logbooks and electronic healthcare records was completed over an 18-month period. The average CFS was 6 however 11 patients with a CFS of 1 or 2 were identified. The health care records was analysed to identify similarities in this subset patient population group.

Results
It was found that none of these patients had formal supports, and none were living in residential care. The age range was 65 to 90 years old. None of these patients required an onwards referral to community services or provision of OT equipment. Presenting complaint breakdown: explained falls (2), DVT (2), Blood pressure issues (2), pain (2), catheter (1), covid (1), INR problems (1). At 3 months post EDITH review it was found that no patients had a re attendance to ED.

Conclusion
Patients with a low level of clinical frailty make up a very small sub set of the general EDITH patient population. These patients appear to be living independently within the community and do not require extensive OT input. Their presenting complaints appear to be predominately isolated medical events as opposed to chronic medical issues.
Long Term Care As An Outcome Of Community Integrated Care Team Intervention: A Review
Authors: Bradley Eoin , Kenny Blaithin , Clarke Enda , Hogge Eilish , O'Neill Niamh , Higgins Aislinn , Quinn Aoife , O'Shea Joan , Keating Sharon , Kovalyshyn Volodymyr , Laycock Berneen , O'Toole Ronan , Nee Rory 
Published: September 2024

Abstract

Background
Over 65’s occupy over 55% of inpatient hospital bed days. Assessment of average length of stay for patients awaiting long term care (LTC) in the acute hospital setting was found to be 122 days. My aim is to assess the number of patients transferred to long term care (LTC) from the community post referral to an Integrated Care for Older Persons (ICPOP) service, therefore bypassing inpatient admission.

Methods
Retrospective analysis of patients notes managed by the ICPOP team from January 2023- January 2024. Comprehensive geriatric assessment data as to frailty markers, plus duration of engagement with service and over all discharge destination were assessed. Patients were identified based on unique identifying number but also using date of birth and name to avoid missing cases.

Results
59 patients were discharged to a nursing home from the ICPOP service, mean age 80. Sex differentiation 56% female. On average at least 3 out of 8 possible frailty indicators were identified per patient. Most prevalent -67% polypharmacy, 47% memory impairment and 45% carer stress were identified as key concerns on initial assessment. 96% of cases were initially referred for complex case assessment/admission avoidance. Average length of engagement with service 5 weeks.

Conclusion
The ICPOP service is highly effective at managing complex cases in the community. The multidisciplinary nature of the team facilitates comprehensive assessment and patient centred care which enables a smooth transition through supportive strategies available to the patient and their family. In total 7198 bed days were saved due to direct transfer to nursing home from the community setting. If the patients care needs warrant LTC the ICPOP service is an invaluable tool which could further reduce pressure on hospitals and facilitate appropriate transfers to nursing home care.