bluuebunny/crossref_metadata_2025_split huggingface dataset:
The POISE Study: POcus for Identification of Sarcopenia in Emergency departments
Authors: Collins Bridget , Turcuman Eduard , Umana Etimbuk , Magner Siobhan , Carey Sive , Pender Ciara , Byrne Colm , McDermott Cian , Breslin Deirdre 
Published: September 2024

Abstract

Background
Sarcopenia is a progressive loss of muscle mass and strength, primarily affecting older adults, with a prevalence of up to 20% in &gt;65-year-olds. It is associated with poor outcomes such as fractures, falls, loss of independence and mortality. Recent studies into the use of ultrasonography for sarcopenia diagnosis have yielded promising results, with good validity to estimate muscle mass when compared to DXA, CT or MRI. While point-of-care ultrasound (POCUS) is a commonly used technique in Emergency Medicine, its applicability to sarcopenia diagnosis in an ED setting has not been investigated.

Methods
This was a prospective, cross-sectional, observational pilot study. Patients &gt;65 years were recruited sequentially from the ED triage list. Each subject had a POCUS scan of their thighs, to visualise and measure the thickness of the femoral quadriceps. Subjects’ handgrip was then measured using a digital grip strength dynamometer. Subjects’ gait speed was measured in metres per second using a standard 6 metre walk test. Data was then analysed to examine any correlation between muscle thickness on POCUS and functional measures of sarcopenia.

Results
60 patients were recruited into this pilot study. Of these, 50% had evidence of sarcopenia on functional assessment. There was a statistically significant correlation between muscle thickness on POCUS and performance on functional assessment.

Conclusion
This pilot study demonstrates a possible new application for POCUS in the ED. This could guide therapy for falls prevention and may prevent further morbidity in this vulnerable population. Further research is needed to confirm the results of this pilot study within a wider population. Additional research examining the correlation between POCUS findings, Clinical Frailty Scale, and BMI would also be of benefit.
An Exploration Of Delirium Awareness Amongst Clinical Staff Working On The Acute Floor Of A Level Three Hospital
Authors: Tormey Sarah , Smyth Jennifer , Flynn Aoife , Owens Mary , O'Neill Aisling , Heduvan Karen 
Published: September 2024

Abstract

Background
Delirium is an acute change in cognitive function that has an organic cause and is likely to be reversible or preventable (HSE Delirium Algorithm, 2021). The Frailty Intervention Team (FIT) based in the Emergency Department (ED) & Acute Medical Assessment Unit (AMAU) comprises of Physiotherapy, Occupational Therapy and Dietetics and is supported by an Older Persons Advanced Nurse Practitioner. The 4AT delirium screen is routinely completed by FIT as part of Comprehensive Geriatric Assessment. FIT observed limited use of delirium screening in ED/AMAU therefore we proposed to explore delirium awareness amongst all clinical staff on the acute floor.

Methods
All clinical staff in ED/AMAU were invited to complete an anonymised paper questionnaire to explore their awareness of delirium. Basic statistical analysis of data was completed using Excel.

Results
Over one week twenty-four questionnaires were completed by medical, nursing, allied health and health care assistants. Six questions explored delirium awareness and a seventh question explored the willingness to engage in delirium information sessions if made available to staff locally. On assessment of delirium awareness an average score of 79.3% (range 16.7%-100%) was achieved. Participants scored strongly on potential causes of and screening for delirium. Questions relating to delirium symptoms and potential outcomes of unrecognised delirium had the least correct response rates. 100% of respondents expressed interest in attending delirium information sessions if made accessible to them within ED/AMAU.

Conclusion
This study identified overall satisfactory delirium awareness amongst clinical staff on the acute floor and all participants expressed interest in expanding their knowledge in this area. Compliance with use of delirium screening tools in clinical practice was not assessed and we also acknowledge the limited number of participants. Future plans include audit of the use of delirium screening tools, delivery of delirium information sessions and provision of accessible delirium resources in ED/AMAU.
Potentially Inappropriate Medications and De-prescribing: An Audit of STOPP/START on an Inpatient Rehabilitation Ward
Authors: Kemple Orla , Karpinski Sylvia , Fallon Aoife 
Published: September 2024

Abstract

Background
Polypharmacy is well recognized in older adults with many adverse outcomes. Practical tools, such as the ‘STOPP/START’ criteria, aid clinicians in de-prescribing to tackle medication related morbidity. Current research suggests these tools are insufficiently implemented in clinical practice (1). Many older adults require rehabilitation after acute hospital admissions which can provide an ideal setting for medication review and de-prescribing.

Methods
A retrospective audit was carried out of 35 older adults in a gerontological inpatient rehabilitation facility between 8th February and 8th April 2024. Demographic and clinical data was collected using electronic and handwritten patient records. Each patients’ medication prescription was reviewed from date of admission to rehabilitation facility. Number of medications prescribed was recorded. Using the ‘STOPP/START’ criteria, potentially inappropriate medications (PIMs were identified, and de- prescribing was noted for the PIM where taken.

Results
35 patients were included in the study. No patient was excluded. Mean age was 86.14 years and mean number of prescribed medications per patient was 11. The most common presenting complaint was a fall in 57.14% of patients, in which 95% had acute fracture. Other presenting complaints for acute admission included delirium and infection. Mean clinical frailty score was 5.71. 38 PIMswere identified, totalling 10% of all medication prescriptions. Of these, 12 de-prescribing opportunities were taken, one of which was a dose reduction. The most common PIMswere prescribing of PPI at full therapeutic dose (n=12), inappropriate opioid prescribing (n=4) and hypnotics (n=7) in high-risk groups.

Conclusion
Polypharmacy and PIMsare common in older adults and are related to adverse outcomes, especially in frail adults at risk of falls, fracture, and delirium. The rehabilitation setting is an ideal location for use of de-prescribing tools however their implementation varies. This may be improved by education and structured medication review in collaboration with trained pharmacists.
Safer Care for Older People in the Emergency Department
Authors: Brady Antoinette , McMackin Eamonn , Subramaniam Dineshkumar , Quirke Caithriona , Donnelly Teresa , McGlynn Joanna , Hughes Helen , Kennedy Lisa , Morgan Victoria 
Published: September 2024

Abstract

Background
The number of over 75-year-old patients (O75YOs) presenting to our Emergency Department (ED) has increased by 35% since 2020 and continues to rise. It is well documented that older people present more frequently to EDs with a higher level of illness severity, a higher rate of admission or re-attendance and are at a greater risk of adverse outcomes such as falls, delirium, prolonged ED and/or hospital stay and ultimately mortality (Tan et al. 2012). We developed a safety huddle to identify and reduce risks to older people in our ED with a view to improving their outcomes.

Methods
Our 10-minute huddle took place each day at 3pm (peak occupation time of O75YOs). An ED physician, nurse, AHP and Geriatrician/Registrar were required to attend. The huddle script was developed based on feedback from clinicians and a literature review on risks associated with an ED presentation in older adults. The script focused on recording resourcing issues critical to patient care. The primary risk factors recorded included falls risk, delirium, administration of time critical medications and PET times. Following the huddle, HCPs involved in the patient’s care were updated by the relevant member of the MDT in attendance to ensure agreed interventions were completed/in place.

Results
We observed a decrease in the number of falls from 2 to 0. Delirium screening improved from 0% to 26%. Identification and administration of time critical medications improved from 0% to 78%. PET times increased slightly (2%), however admission rates decreased indicating value added to the patients’ journey.

Conclusion
Whilst we acknowledge there is still room for improvement, these results will clearly have a positive impact on patient outcomes.
Engaging with First Line Nutrition Information - Insights from Health Care Professionals and Older Persons
Authors: King Lorna , Devaney Catherine , Sayers Karen , Donnellan Christina 
Published: September 2024

Abstract

Background
Health care professionals (HCPs) working with older persons are often asked nutrition related questions. This study explored how first line nutrition information such as general leaflets are accessed and used by HCPs and older persons. Is there a role for video-based nutrition education?

Methods
HCPs working with older persons completed an online survey. An older person’s reference group participated in a virtual focus group. Participants were asked about knowledge seeking, accessing and providing nutrition information, and engaging with videos on nutrition topics. Results were analysed using descriptive statistics and thematic analysis.

Results
Ninety five HCPs completed the survey (44% Nursing, 27% Physiotherapy, 14% Occupational Therapy, 6% Speech & Language Therapy and 9% other (doctors, social worker, pharmacist and care needs facilitator).Eighty-eight (90%) HCPs reported being asked nutrition related questions, topics included poor appetite (n=77, 83%), weight loss (n=68, 75%) and constipation (n=66, 72%).Twenty HCPs (21%) reported confidence answering questions, while 28 (29%) reported low confidence. Forty-three (44%) had little or no awareness of available first line information and 37 (39%) rarely or never provided information. Eighty-two (86%) HCPs agreed that nutrition education videos would be used if available. Three themes emerged from the HCPs survey: (i) importance of nutrition for HCPs (ii) barriers to use of first line information and (iii) support systems. Fourteen persons (64% women, 36% men) attended the focus group. Two themes were identified: (i) access to health information and (ii) barriers to access. Discussions included difficulty in proactively seeking information, joined up sharing and that education videos would be beneficial, but the distribution needed consideration.

Conclusion
Timely access to information is empowering for the older person. HCPs were identified as a resource for seeking nutrition advice. The communication of and access to nutrition information merits consideration. Following these findings, nutrition videos are currently being developed.
Audit of Lithium Monitoring in a Mental Health for Older Persons (Dublin North City Central) Service
Authors: Murphy Fiona 
Published: September 2024

Abstract

Background
Lithium is a psychotropic medication used for the treatment of bipolar affective disorder and augmentation for treatment resistant depression. Lithium monitoring is essential due to the narrow therapeutic range of serum lithium and the potential for toxicity. Other medications with similar risk profiles, such as warfarin, have established monitoring programmes. Older adults receiving lithium therapy are at an increased risk of adverse events, given the prevalence of medical co-morbidities and changing pharmacokinetics. The authors of this audit identified the lack of formalized lithium monitoring programme in the Mental Health Service for Older Persons (MHSOP). The aim of this audit to compare monitoring practices in the MHSOP against the current gold standard Irish Medication Safety Network (IMSN) for Prescribing and Monitoring of Lithium Therapy.

Methods
A survey of all community medical charts identifying patients attending the service receiving lithium therapy was completed. Data collected pertained to diagnosis, treating consultant, lithium dose, if the patient received educational material, compliance with ECG and blood monitoring.

Results
The MHSOP active case load was 682 patients, 14 patients were prescribed lithium therapy. Cycle 1 of the audit demonstrated poor compliance of lithium monitoring against the gold standard. A lithium pack was inserted in patient files to prompt all clinicians to follow the recommended standardized monitoring of lithium therapy as per the IMSN guidelines. In cycle 2 of the audit there was an improvement in recording blood monitoring across the patient group.

Conclusion
The audit demonstrated improvement in compliance with international guidelines following the intervention. It was recommended that a formalized Lithium Clinic was a needed resource for the MHSOP. The lithium monitoring pack will continue to be added to clinical files, included in Non-Hospital Consultant (NCHD) induction and multi - disciplinary teaching sessions. It is proposed that the audit be repeated in one year to longitudinally assess compliance.
Evaluation of an Occupational Therapy led Cognitive Stimulation Therapy Programme in an Integrated Care Programme for Older Persons
Authors: Campbell Judith , Cosgrove Julie , Fitzmaurice Cliodhna , McDonnell Ciara , Rogan Mary , McClean Fiona , Geoghegan James , Canavan Michelle , Costello Maria 
Published: September 2024

Abstract

Background
Cognitive Stimulation Therapy (CST) is a non-pharmacological, evidence-based approach specifically designed to support people with dementia to maintain their cognitive functions e.g. reminiscence, higher executive skills, sensory integration, orientation, memory strategies and day-to-day activities.

Methods
Participants referred to a community specialist ICPOP team were identified for CST following Comprehensive Geriatric Assessment (CGA), where cognitive impairment or dementia was identified. Inclusion criteria: Rockwood Clinical Frailty Scale ≤5, Barthel Index of Activities of Daily Living ≥11, Lawton Brody Instrumental Activities of Daily Living Scale (IADL) ≥4, Montreal Cognitive Assessment (MoCA) ≥10, and ability to consent to participate. Addenbrooks Cognitive Examination (ACE-III) scores were obtained pre and post CST, alongside post CST feedback questionnaires.

Results
5 CST programmes of seven weeks duration were conducted over a ten-month period. 31 (male=16, female=15) participants completed the programme. 3 participants dropped out due to lack of transport/interest. The average ACE-III score pre-CST was 68.3 +/- 14.31; post-CST was 76.1 +/- 11.4. 28 participants completed feedback questionnaires. Positive feedback included “Got a great sense of achievement with each session, and eagerly looked forward to the coming weeks”, “Each session topped the previous session” “Gave me a reason to get out, a routine to my week”. 45 % commented that they felt safe sharing difficulties/problems with the group. 71% reflected that CST provided an opportunity to meet others in a similar situation. 100% would recommend CST to others.

Conclusion
Experience of CST was overwhelmingly positive demonstrating benefit not only from a cognitive perspective but from informal peer support and connections made in group settings. Participants commented on lack of follow-on programmes, identifying the need to develop maintenance CST programmes led by trained community stakeholders which would sustain these benefits long-term as well as increasing awareness and knowledge of dementia within communities.
Trauma Presentations To The ED, Are We Improving With Frailty Initiatives?
Authors: Kennedy Lisa , Barnes Annemarie , Hughes Helen , Brady Antoinette , Morgan Victoria , Kelly Patricia , Kazi Durriya , Donnelly Teresa , Eager Robert 
Published: September 2024

Abstract

Background
An emergency department serving as a regional Trauma Centre for the Midlands, now has a Rapid Access Frailty Team (RAFT) which provides timely assessments of all Frail patients over 75. The department has an approximate trauma attendance of 111 (2023 figures) annually within this age cohort. In line with our NOCA guidelines we performed a retrospective review of our trauma presentations since the introduction of the RAFT initiative, looking at the patient’s presentations and how interventions can improve our Trauma management.

Methods
This was a retrospective review of FRAIL positive patients in from January/February 2023 and January/February 2024 based on NOCA 2021 subsets of trauma data. Data was collected using examination of IPIMS and ED notes obtained for review. We compared both years to see we could see if RAFTT interventions improved our trauma triage and care.

Results
The predominant mechanism of injury remains to be a fall (85% in 2023 and 74% in 2024), and the majority of traumas being in the home setting (70% in 2023 and 78% in 2024). By the early involvement of a nurse specialist, physio/OT and doctor, time to be seen has reduced by 23% since the introduction of the team, time to imaging has improved by 51% and time to bed if admitted has improved by 19%. Pre alerts remain low, similar to national data findings (10% in 2023, but up to 15% in 2024).

Conclusion
Data points to the team’s provision of timely, patient-focused assessments and interventions for the older person are improving outcomes. The unique assessment skills that the team deliver aids rapid assessment, supports timely decision-making and referral as appropriate; improving the patient’s journey by either facilitating early discharge or providing early goal-setting therapy interventions at the start of the hospital journey.
Dietetic Needs in a Memory Assessment & Support Service (MASS) – A Retrospective Analysis
Authors: McGuinness Aideen 
Published: September 2024

Abstract

Background
Nutrition issues can occur in all stages of cognitive impairment, but individual needs may not always be promptly identified.

Aim
To evaluate dietetic needs of this cohort.

Methods
Retrospective service evaluation of first 50 referrals to a MASS Senior Dietitian, including comparison of nutrition-screening tools validated for older persons: Mini Nutritional Assessment-Short Form (MNA-SF)1 and Malnutrition Universal Screening Tool (MUST)2.

Results
The first 50 dietetics referrals (total 126 consults) representing 16% of MASS clients in this period.
Nutrition screening:
MNA-SF MUST
≤ 7 18% malnourished/high risk ≥ 2 34%
8-11 72% at risk of malnutrition 1 32%
12-14 10% not nutritionally at risk 0 34%
So MNA-SF identified 90% as malnourished or at risk, while this was 66% with MUST.
Individually tailored advice included:
Resolution of key issue and discharged (17), 2 clients deceased.
Remainder (31) ongoing dietetic follow-up.

Conclusion
For those with memory impairment early and regular nutrition assessment is important, and the MNA-SF tool is appropriate. Expert Dietetic advice is necessary at all stages of memory impairment.
ICOP Dietetics – The First Year
Authors: McGuinness Aideen 
Published: September 2024

Abstract

Background
All clients referred to Integrated Care for Older Persons (ICOP) for falls, frailty or functional decline have a Comprehensive Geriatric Assessment (CGA) including nutrition screening, which may trigger dietetic referral.

Methods
Retrospective analysis of initial year of a Senior Dietitian (0.5WTE).

Results
172 referrals - representing 28% of ICOP clients. 14 did not engage. Age 56-95, Clinical Frailty Scale 3-8 (median 5). 304 consults: 40% one consultation, 40% 1-2 reviews, 20% 3-6 reviews.

Nutrition screening
Mini Nutritional Assessment-Short Form (MNA-SF)1 score ≤ 7 16% malnourished, 8-11 55% at risk of malnutrition, 12-14 29% not nutritionally at risk. So, 71% categorised as either malnourished or nutritionally at risk. While not assessed in all cases, probable sarcopenia2 was documented in 42% clients using grip strength. Individually tailored advice included (n=158):
141 discharged after individualised dietetic advice. Seven clients deceased. Remainder (nine) ongoing.

Conclusion
Those attending ICOP have a high prevalence of nutrition concerns, nutrition screening is important, and expert dietetic advice is essential to ensure guidance is evidence-based and resources are appropriate.
Angiotensin Receptor Blockers, But Not Angiotensin Converting Enzyme Inhibitors, Improve Bone Mineral Density: Results From The TUDA study
Authors: Fitzpatrick Donal , Laird Eamon , Lannon Rosaleen , Ward Mary , Hoey Leanne , Hughes Catherine F , Strain JJ , McNulty Helene , Cunningham Conal , Molly Anne , McCarroll Kevin 
Published: September 2024

Abstract

Background
Both hypertension and osteoporosis are common in older adults and frequently co-exist. The renin angiotensin system has been implicated in osteoclast activation and bone loss. Several studies have previously examined the relationship between various inhibitors of RAS and bone mineral density (BMD). In this study we examined the relationship between angiotensin receptor blockers (ARBs) and angiotensin converting enzyme ACE inhibitors and BMD.

Methods
Study participants were from a cross-sectional study of adults aged &gt;60 years; Trinity Ulster University Department of Agriculture (TUDA) study. We excluded participants on treatments for osteoporosis. In users and non-users of ARBs and ACE inhibitors, we compared least squares means BMD measured by densitometry at the neck of femur, hip, and lumbar spine adjusted for age, sex, body mass index, timed up and go, vitamin D, parathyroid hormone, eGFR, diabetes mellitus, smoking, alcohol consumption, dairy intake, glucocorticoid exposure, thiazide, and loop diuretic use.

Results
There were 2218 participants (mean age 70.1±6.5 years, 58.3% female, 23.4% (n=519) on ARBs and 30.9% (n=686) on ACE inhibitors). In both univariate and multivariate analysis, ARB users had higher BMD than non-users were associated with higher BMD at the neck of femur (0.860 g/cm² vs. 0.846 g/cm², p=0.016); at the total hip, (0.938 g/cm² vs. 0.919 g/cm², p=0.004); at the lumbar spine, BMD was 1.106 g/cm² vs. 1.074 g/cm² p&lt; 0.001). No significant relationship between ACE inhibitors and BMD at any site was observed after multivariate adjustment.

Conclusion
ARBs were associated with improved BMD while ACE inhibitors were not. Similar results have been found in other studies but the mechanisms but there is substantial uncertainty regarding the mechanisms underlying these relationships. These findings could be important in the choice of antihypertensive agent in older patients at risk of fracture and further research is warranted.