bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep In Europe: Changes In Prevalence Of Sleep Disturbances In Middle-aged And Older Europeans
Authors: O'Donovan Mark , Crowley Patrick , Flanagan Evelyn , O'Caoimh Rónán 
Published: September 2024

Abstract

Background
We analysed the prevalence of sleep-related parameters in those aged ≥50 years in 28 countries participating in waves 8 (2019/2020) and 9 (2022) of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Methods
Overall and per country prevalence rates of subjective trouble sleeping, daytime napping/resting and use of medication to aid sleep were analysed. Survey-weighted generalised linear models were used to assess changes between waves 8 and 9.

Results
A total of 34,322 people were included from wave 8 (55% female; mean age 68.27) and 50,670 from wave 9 (55% female; mean age 68.77). There was no statistically significant difference in the overall prevalence of subjective trouble sleeping (both 35%), use of medication to aid sleep (both 7%) or daytime napping/resting (both 47%) between waves 8 and 9. For trouble sleeping, prevalence ranged from 20% (Greece) to 52% (Estonia) in wave 8 and from 16% (Greece) to 50% (Portugal) in wave 9. Statistically significant reductions were observed in Estonia (52% vs. 49%, p = 0.006), Poland (49% vs. 37%, p &lt;0.001) and Slovenia (38 vs. 33%, p = 0.001). A statistically significant increase was observed in Spain (27% vs. 37%, p = 0.004). Similarly for sleep-related medication use, statistically significant reductions were again observed in Estonia (11% vs. 9%, p = 0.028) and Poland (10% vs. 6%, p &lt;0.001) but not Slovenia (both 4%, p = 0.858). The prevalence of daytime napping/resting remained very similar between waves 8 and 9, with the only marginally significant difference being in France (38% vs. 35%, p = 0.033).

Conclusion
This analysis shows the prevalence of subjective trouble sleeping, use of medication to aid sleep, and daytime napping/resting among middle-aged and older adults across Europe. Trouble sleeping remains a prevalent symptom amongst middle-aged and older adults but varies significantly across countries.
Breaking New Ground, Not Bones: A Machine Learning Odyssey in Osteoporosis Treatment Predictions
Authors: Asri Nur Atikah Mohd 
Published: September 2024

Abstract

Background
Delayed or omitted treatment for osteoporosis represents a recognised challenge within orthogeriatric healthcare. Machine-learning (ML) decision support systems offer a potential solution by enabling osteoporosis treatment recommendations without necessitating specialist intervention. This study seeks to evaluate the efficacy of ML in accurately recommending osteoporosis treatment.

Methods
Datasets from January to March 2023 in University Hospital Waterford were sourced from the IHFD (N=85). Osteoporosis treatment decisions were obtained from discharge letters. The dataset was entered into the WEKA 3.8.6 environment for ML processing. The Zero-Rule algorithm is selected as a baseline cross-validation technique to estimate ML performance.

Results
The Correctly Classified Instances (CCI) and Incorrectly Classified Instances (ICI) are 74.12% and 25.86%, respectively. Eight algorithms were selected, with 800 results produced and tested with a paired T-Tester. The significance level is set at 0.05, with the “Percent_correct” metric selected as the performance measure to compare the algorithms. The J48-Tree algorithm showed the best accuracy at 86% and is statistically better than the baseline algorithm; hence, it was selected as the trained model. Application of the trained model on the unseen dataset revealed CCI and ICI of 98.24% and 1.7%, respectively, indicating a high prediction accuracy rate.

Conclusion
In conclusion, this study has shown promising strides in using ML to assist osteoporosis treatment decisions. The resulting model showed notable predictive performance, indicating the viability of ML in decision-making. Future studies should focus on acquiring larger datasets for validation, algorithm refinement and exploring the integration of clinical expertise to bolster the model's applicability and reliability in real-world scenarios.
Alternative Scenarios for Projected Prevalence of Stroke and Post-Stroke Dementia to 2046 in Ireland: A Model-Based Analysis
Authors: Sexton Eithne , O'Flaherty Martin , Hickey Anne , Macey Chris , Williams David , Horgan Frances , Timmons Suzanne , Collins Rónán , Bennett Kathleen 
Published: September 2024

Abstract

Background
Understanding future population need is key for informing stroke service planning. This study aims to evaluate alternative scenarios for future trends in stroke age-specific incidence and case-fatality and estimate impact on projected stroke and post-stroke dementia prevalence in Ireland.

Methods
We used a probabilistic Markov model to project and track incidence and prevalence of stroke and post-stroke dementia in the Irish population aged 40-89 years to 2046. Using systematic review and observational evidence, we extrapolated trends in stroke age-specific incidence and case-fatality from 1990-2019 to 2016-2046. We defined optimistic, realistic and pessimistic scenarios, including scenarios where trends decelerated over time.

Results
The stable (pessimistic) scenario indicates a projected 95,278 stroke survivors in 2046 (95% uncertainty interval, UI = 91,404-99,487) (30.1 per 1000 pop), an increase of 53% from 2022 to 2046. The most optimistic scenario would involve a 3.2% increase from 2022 to 2046, to a projected 61,000 survivors. More realistic scenarios based on lower rates of incidence/case-fatality decline, or rates of decline slowing over time, imply an increase ranging between 22.9% and 37.2%. There will be a projected 19,430 with post-stroke dementia in 2046 (95% UI 17,182-21,904), an increase of 69.2% from 2022. In the most optimistic scenario, the increase would be 22.6%, with realistic scenarios implying an increase ranging between 38.9% and 53.2%.

Conclusion
Future stroke healthcare needs will vary substantially depending on epidemiological trends. A large increase in post-stroke dementia is projected across scenarios. Further work is needed to identify optimal policies to promote continuing decline in stroke incidence.
A SADMAN With No Plan; Medication Management and Adherence To SADMAN Guidelines In Ambulatory Geriatric Care
Authors: Singh Mikar , Young Conor , Ryan Colm , Morrison Laura , McElwaine Paul , O'Neill Desmond 
Published: September 2024

Abstract

Background
Medication side effects are common causes of ill health, with ‘SADMAN’ medications identified as frequent offenders- sulphonylureas, angiotensin-converting enzyme inhibitors (ACEi), diuretics, metformin, angiotensin-receptor blockers, nonsteroidal anti-inflammatories and sodium/glucose cotransporter-2 inhibitors. Recent consensus recommendation published in the American Journal of Kidney Diseases is that patients on these should omit them if unwell1. We examined SADMAN usage within our Day Hospital, knowledge of this guidance and patients’ confidence in managing their medications.

Methods
All patients presenting for review in one week in our Day Hospital were included. Data collected included age, gender and number of medications including SADMAN. Patients were asked had they been advised to stop SADMAN medications if unwell, whether medications were blister packed and if they would be confident identifying and stopping a particular medication.

Results
27 patients were included. 56% male, mean age 80 years old and mean number of medications 9 (range 0-22). 67% had medications blister-packed. 48% were prescribed one or more SADMAN medications and 15% more than one. Most commonly prescribed were ACEi (30%) and diuretics (19%). No patients had been advised to stop taking a SADMAN medication if they became unwell. Only 19% of patients (31% on SADMAN medications) were confident they could identify/stop a particular medication.

Conclusion
Despite clear guidelines to stop SADMAN medications if unwell, we found that no patients attending our Day Hospital were aware of this. Even if patients were appropriately educated, there was a lack of confidence in medication management. Polypharmacy and blister packing of medications pose significant barriers, leading us to question the feasibility of SADMAN guideline implementation in an Ambulatory Geriatric Care setting.

Reference
1. Watson KE et al. Consensus Recommendations for Sick Day Medication Guidance for People With Diabetes, Kidney, or Cardiovascular Disease: A Modified Delphi Process. Am J Kidney Dis. 2023 May;81(5): 564-574.doi: 10.1053/j.ajkd.2022.10.012.
To Print or Not to Print - Sustainable Practice in Geriatric Integrated Care Clinics
Authors: Murphy Dearbhla Edwards , Cashen Aoife , Chan Kei Yen , Reddin Catriona , MacLoughlin Roisin , Ramjohn Joshua , Martin Niamh , Memon Muhammed Sajjan , Conlon Chloe , Okon Mary , Burke Shona , McDermott Clodagh , Stankard Aidan , Higgins Meave , Geoghegan James , McCleane Fiona , Neachtain Maire Ni , Mannion Karen , Shiel Edel , Small Cliona , Robinson Stephanie , Waters Ruairi , Costello Maria , Canavan Michelle 
Published: September 2024

Abstract

Background
The Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric medicine and is frequently carried out in integrated care clinics using a paper document (1). The expansion of integrated care services occurs alongside climate change, an increasingly challenging public health crisis at a local and national level (2). Paper waste is a contributor to deforestation and carbon emissions. We aimed to assess the environmental impact of paper use within our geriatric integrated care service.

Methods
12 months of Geriatric Integrated Care attendances were included between 1st January 2023 to 1st January 2024. We measured the number of CGAs performed and A4 pages used in documentation. Environmental impact was evaluated based on carbon emissions per A4 page (3).

Results
A CGA was completed on 780 patients in a 12-month period which included in-hospital, frailty at the front door and 2 community specialist teams' assessments. This resulted in 11,700 pages of A4 paper in documentation. Estimated carbon emissions are 70.2kg CO2 emissions for the 12-month period. Extrapolating this solely to the 32 ICPOP teams in geriatric medicine in Ireland it would result in the equivalent of 22 trees per year, emitting 1,123.2 Kg of CO2 emissions per year from these assessments alone or equivalent to driving 8028.6km (4).

Conclusion
The benefits for patients and staff of integrated digital healthcare records are well established. The environmental impact of how we provide healthcare is not. Paperless solutions are required for both patient safety, seamless record keeping and environmental sustainability in keeping with UN sustainable development goals.

References
1. Pilotto A, Polidori MC. The comprehensive geriatric assessment: Goal-oriented, patient-centered care. Practical Issues in Geriatrics. 2017 Aug 11;273–86. doi:10.1007/978-3-319-61997-2_26.
2. Climate Change [Internet]. [cited May 2024]. https://www.publichealth.ie/climate-change.
3. CO2 neutral printing [Internet]. 2024 [cited May 2024]. https://www.ezeep.com/co2-neutral-printing/.
4. CO2 Converter [Internet]. [cited May 2024]. https://www.openco2.net/en/co2-converter
Malnutrition Management in Older Adults Referred to Integrated Care Program for Older People (ICPOP) Service
Authors: Devitt Aoife , Sadeghi Fatemeh , Connolly Warren 
Published: September 2024

Abstract

Background
Older adults are at increased risk of malnutrition, and it is estimated that 70,000 Irish people over 65 years old are malnourished or at risk of malnutrition. The ICPOP service provides access to community-based treatment for eligible older people for a period of up to 6 weeks. The aim of this study is to review the nutrition care provided by our ICPOP service and identify current gaps.

Methods
Data was collected by retrospective chart review of 80 patients who received dietetic input from June to December 2023; from two ICPOP teams, with 0.5 WTE dietitians per team. Demographic data, supplement usage, intervention provided, and discharge destination were recorded. Malnutrition screening tool (MST) and Mini Nutritional Assessment – Short Form (MNA®-SF) were used to assess nutritional status.

Results
The charts of 80 patients referred to ICPOP dietitians were reviewed. Patients’ mean age was 83 years old (range: 65-97yrs). 55 (68%) patients were malnourished or at risk of malnutrition. 30 (37.5%) patients were taking oral nutrition supplements (ONS) to meet their dietary requirements. Personalised dietetic intervention was provided to all patients. 44 (55%) patients required more than one dietetic review and 87.5% of initial dietitian assessments were domiciliary visits. At the end of the 6 weeks of intervention, 25 (31%) patients required follow-up dietetic care, however, for 6 (24%), who required ongoing dietetic care, and no community dietetic service was available.

Conclusion
Malnutrition is common in older adults referred to the ICPOP service, and the continuation of care is crucial for treating malnutrition as a chronic condition. However, current limitations in available dietetic services may affect malnutrition management and should be considered in older person care pathways. Therefore, additional investments in community dietetic services in our area, are required to ensure the successful management of malnutrition.
Adverse Drug Reactions in an Ageing PopulaTion risk Prediction (ADAPTiP) tool: development of a prediction model related to hospital admissions
Authors: Frydenlund Juliane , Cosgrave Nicole , Moriarty Frank , Wallace Emma , Kirke Ciara , Williams David , Bennet Kathleen , Cahir Caitriona 
Published: September 2024

Abstract

Background
Older patients are at an increased risk of developing adverse drug reactions (ADRs). The aim of this study was to develop a risk prediction model (ADAPTiP) for ADR-related hospital admissions in older populations, based on predictors available at the time of hospital admission.

Methods
Using the Adverse Drg reactions in an Ageing PopulaTion (ADAPT) cohort (N=798; 361 ADR-related admissions; 437 non-ADR-related admissions), a cross-sectional and prospective cohort study designed to examine the prevalence of and risk factors for ADR-related hospital admissions in patients aged ≥ 65 years, twenty predictors (categorised as sociodemographic-related, functional ability-related, disease-related and medication-related) were considered in the development of the model. A multivariable logistic regression model was developed using statistically significant univariate associations and/or clinically relevant predictors to estimate adjusted odds ratios and 95% confidence intervals (CI). Calibration and discriminative performance of the model was assessed by the Hosmer-Lemeshow test and by calculating the area under the receiver operator characteristic (AUROC) curve.

Results
The multivariable model (ADAPTiP) included ten predictors; age, frailty, chronic lung disease, antithrombotic agents, diuretics, renin angiotensin aldosterone system (RAAS) drug classes, primary presenting complaints of respiratory, bleeding, gastrointestinal disorders and syncope on hospital admission. Antithrombotic agents, diuretics and RAAS drug classes and the primary presenting complaints of bleeding disorders, gastrointestinal disorders and syncope and frailty were significantly associated with an ADR-related hospital admission. Whereas, increasing age and presence of chronic lung disease were significantly associated with having a non-ADR-related hospital admission. The AUROC was 0.78 [95%CI:0.75;0.81] with sensitivity and specificity values of 59% and 83%, respectively.

Conclusion
ADAPTiP has the potential for use as a risk prediction model for ADR-related hospital admissions. Future research will validate this model in other settings.
The Aftermath: Investigating Readmission And Mortality Trends In Older Adults
Authors: Heywood Sarah , Weadick Ciara , Moledina Ameera , Bradfield Robyn 
Published: September 2024

Abstract

Background
Acute hospital readmissions have significant implications for both the patient and the health service. Research has shown that up to 70 percent of hospital readmissions may be avoidable, while patients who are readmitted to hospital have a higher in-hospital mortality risk. The Health Service Executive has set a Key Performance Indicator of a readmission rate within 30 days of less than 11.1 percent. The purpose of this study is to identify the number of patients aged 75 years and older readmitted to a busy model four hospital within 30 days of their discharge. It will also quantify the number of deaths within this patient group. We aim to identify key areas where pathways for older adults could be developed to improve quality of care and reduce the overall burden on both the patient and acute hospital service.

Methods
Data was collected retrospectively for patients admitted between September 1st, 2023, and September 30th, 2023.

Results
In total 272 patients aged 75 years and older were admitted within a one-month period. 47 patients were admitted under the geriatric medicine service. The mean length of stay for all patients was 12.41 days. 160 patients were discharged directly home while 27 were discharged to long term care. The remaining patients were discharged to rehab, convalescence or hospice. 28 patients died during their inpatient stay. 6 patients died within one month of discharge. In total 13 patients were readmitted to hospital within one month following their discharge. 23 percent of patients died following readmission. The most common reason for readmission was a respiratory illness.

Conclusion
4.7 percent of patients aged 75 years and older were readmitted to hospital within one month of discharge. This falls below the national target set by the HSE. However, there was a high mortality rate amongst those readmitted to hospital.
8 Year Follow up of Patients Diagnosed with Dementia in a Tertiary Memory Service
Authors: McHale Cathy , Fallon Aoife , Knight Graham , Kennelly Sean 
Published: September 2024

Abstract

Background
Approximately 64,000 people live with dementia in Ireland with an expected increase to 150,000 by 2045. Time to presentation with symptoms of cognitive decline varies between cases. The heterogenous nature of dementia makes estimations of an individualised trajectory of decline challenging.

Methods
Retrospective analysis was undertaken patients (n=17) of those diagnosed with dementia in 2016 whereby outcomes were discernible from records of the organisation. Data were extracted from the clinic Excel database, Patient Information Management System and Electronic Patient Record portal. Diagnosis was verified using the clinic letter at time of diagnosis. Data was processed using Microsoft Excel.

Results
Mean age was 77 (range 64-84). Diagnostic breakdown was AD 35.2% (n=6); AD/VaD 41.1% (n=7); VaD 23.5% (n=4). Average survival was 64.8 months (range 16-100). The group averaged 6.2 medicines and 4.3 comorbidities – most common cited were Hypertension (13%) Osteoporosis (8.3%); Hypercholesterolaemia & IHD (6.9%); Hypothyroidism & T2DM (5.5%). Average Emergency Department admissions was 2.5 episodes with average 5 admissions. 5 remain alive, 12 RIP – 6 (LTC); 5 hospital and 1 at home. Two live at home, 3 in LTC. Average time living within their own home was 61.1 months (those who died in LTC) and 43.4 (those who died in Hospital). Longest length of admission pre death was 18 days (3-18).

Conclusion
A diagnosis of dementia affords a level of anxiety with regard to the future. The provision of a roadmap of decline is difficult as the journey of each patient is unique. Within this cohort, patients tended to live at home for long periods of time regardless of their age and despite multiple co morbidities. Where patients were admitted prior to their death, this was usually close to the end of their life. A valuable focus of hope should be placed on enjoying and living the years of possible life after diagnosis.
Effect of a National Stroke Awareness Campaign on Ambulance call-outs and Paramedic Diagnosis of Suspected Stroke
Authors: Doyle Patrick , Donnell Cathal O , Collins Rónán 
Published: September 2024

Abstract

Background
The Irish Heart Foundation and National Clinical Programme for Stroke ran the Face, Arm, Speech, Time (FAST) public awareness campaign in January and July 2023, to raise awareness of stroke symptoms and the need for rapid response. We aim to evaluate the impact of this campaign.

Methods
Interrupted time series (January 2021 to December 2023) assessed the impact of the campaign on: calls received by ambulance control triaged as suspected stroke and provisional stroke diagnosis made by paramedics at time of leaving scene. Means were compared using Kruskal-Wallis test.

Results
Pre-campaign, the mean calls per month triaged as suspected stroke was 1060, which rose to 1130 and 1165 following the January and July bursts of the campaign respectively (p&lt;0.0017). There was a baseline trend for increasing ambulance calls for suspected stroke (β= 0.01, 95% CI 0.008 to 0.0121; p &lt; 0.001) and paramedic provisional stroke diagnoses (β=0.0083, 95% CI 0.006 to 0.0110; p&lt;0.001). The January burst of the campaign was associated with a reduction in ambulance calls (β= -0.014, 95% CI -0.022 to -0.007; p &lt;0.001), whereas the July burst of the campaign showed a slight increase in calls compared to no campaign (β=0.031, 95% CI 0.016 to 0.047; p &lt;0.001). Conversely, there was a trend towards an increase in paramedic-suspected strokes following the January burst of the campaign and a trend towards a decrease after the July component.

Conclusion
The mean number of callouts and paramedic provisional diagnosis of suspected stroke increased following the 2023 FAST campaign (9.91 percent and 12.18 percent). Overall, the study suggests the campaign led to more suspected stroke calls, but the immediate impact on call volume during the campaign periods themself was complex. These results prompt the need for further analysis.