bluuebunny/crossref_metadata_2025_split huggingface dataset:
From Hospital to Home: Applying a Co-design Approach to Determine Key Components of an Intervention to Support Transition-to-Home After Stroke
Authors: O'Callaghan Geraldine , Fahy Martin , Hall Patricia , McCartan Deirdre , Langhorne Peter , Galvin Rose , Horgan Frances 
Published: September 2024

Abstract

Background
When people with stroke transition from the hospital back to their homes, they and their families frequently experience multi-faceted unmet needs and feelings of abandonment. Uncertainty surrounds the fundamental components of an intervention intended to support transition-to-home after a stroke. The aim of this study was to utilise a co-design process to identify key components for a patient-centred support intervention facilitating the transition home after stroke, and to explore what might be feasible within a real-world context.

Methods
The primary researcher, a larger team of researchers, and an individual with lived experience of stroke facilitated a series of three workshops for 12 people with stroke, 6 caregivers, 26 healthcare professionals, and 6 representatives from stroke organisations. World Café methodology and Liberating Structures facilitation techniques were adapted to meet the study aim. Data collection involved making observations during workshops, summarising findings, and reaching group consensus agreement on outputs. The final output was the consequence of facilitated consensus on a prioritisation task. Individuals with lived experience of stroke contributed to study design, ethics, and co-design outputs, providing input for future research and co-facilitating workshops with the research team.

Results
The co-design group identified 10 key intervention components to support people with stroke and their families during the transition from hospital-to-home. These components focussed on enhancing collaboration, streamlining transition processes, and facilitating post-discharge support. While a stroke coordinator was considered a top priority, increased cross-setting information sharing and community-based healthcare staff in-reach, were considered most feasible to implement.

Conclusion
The co-design approach, involving a multi-stakeholder group, was strengthened by patient and public involvement. This ensured that the identified transition-to-home intervention components are meaningful and relevant for people with stroke and their families. To further refine, and feasibility test the components for generalisability within the wider Irish healthcare context, additional co-design workshops are required.
Patient Experience Survey as a Tool to Support Quality Improvement of a Geriatric Service in the Emergency Department (ED)
Authors: Maher Mairin , O'Carroll Susan , Cremin Maria , Carmody Chris 
Published: September 2024

Abstract

Background
The aim of this survey was to valuate patient’s satisfaction with a Frailty Intervention Therapy Team (FITT) and gain insight into their thoughts about the service. Patients’ feedback is a vital component in monitoring and improving the quality of care. The data collected will help develop the service ensuring it’s patient centred and tailored to their needs.

Methods
A qualitative approach was taken in the form of a patient satisfaction survey. To limit bias responses, non-patient facing clerical facilitated the completion of the questionnaire with the patient.

Results
27 surveys were administered over a 5-week period with an 81% response rate (n=22). 91% of patients surveyed felt the purpose of the FITT service was clearly explained to them, the team member had clearly introduced themselves and the team used both written and verbal information well –indicating an effective and efficient style of communication. 100% of patients reported that FITT treated them with dignity and respect. 18% of patients reported they were not involved in decision making relating to the care they received. The ED environment was rated as poor by 14% of patients, long wait time to be seen was also a concern. While some areas of patient concerns cannot be directly targeted by the team alone, we have a duty of care to highlight these concerns to the wider ED staff and hospital group.

Conclusion
A ‘what matters to you’ question has been incorporated into the assessment paperwork, to ensure patients’ wishes are being formally captured and placed centrally within care management planning. Communication to the patient was supported by providing a FITT information leaflet. Additional seating was procured by FITT to promote improvements in comfort and facilitate safe transfers of older patients in the ED. Patient feedback was presented to the ED governance group, including major themes of patient concern.
Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis
Authors: Hayes Christina 
Published: September 2024

Abstract

Background
Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study.

Methods
PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4.

Results
Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established.

Conclusion
Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.
Under Pressure: An Audit of Pressure Injury Documentation in Hospitalised Older Adults
Authors: Meyerkort Claire , Gupta Shivangi 
Published: September 2024

Abstract

Background
Pressure injuries are common in hospitalised older adults. They are associated with adverse outcomes including reduced quality of life, pain, insomnia, mood disturbance and secondary infection. They can negatively affect mobility and prolong hospital stay with financial cost to the health service. Pressure injuries represent a geriatric syndrome with multifactorial risk factors, requiring multidisciplinary communication to optimise management.

Methods
Retrospective audit over three months in adults over 65 years, admitted to a geriatric rehabilitation ward. Audit aims were (1) Review medical staff pressure injury written documentation and (2) Review medical staff written communication and handover regarding pressure injuries. Data were gathered from medical records including written notes and discharge letters.

Results
Twenty-six patients had thirty-six individual pressure injuries. The mean age was 83 years, 53% female and 47% male. Total length of stay mean was 50 days (range 16 – 147 days). Thirty-nine percent of pressure injuries were stage 1, 42% stage 2, 3% stage 3, 6% suspected deep and 11% unstageable. Documentation in the medical admission occurred in 21% and medical notes in 33%. Documentation in multidisciplinary team (MDT) meetings occurred in 17% and discharge letters in 22%. The mean time between nursing pressure injury identification, and medical and MDT documentation was 17 and 16 days respectively.

Conclusion
Medical team written documentation of pressure injuries was low. Only one-fifth to one-third of pressure injuries were recorded. Although pressure injuries benefit from multidisciplinary management, they were documented in MDT meetings in under one-fifth of cases. Delays of more than two weeks between nursing and medical documentation occurs. Improving documentation and communication between the MDT can optimise pressure injury management, highlighting the need for ongoing medical education and more effective documentation processes.
Consolidating Integrated Care: A Joint Falls Prevention Initiative between Community and Hospital Based Physiotherapy Services
Authors: Gormley Geraldine , Drury Theresa , Quinn Therese , Cooney Hazel 
Published: September 2024

Abstract

Background
Physiotherapists from Primary Care, Integrated Care Programme for Older Persons (ICPOP) and hospital-based Frailty Intervention Team services came together to establish a community working group with the aim of reducing the incidence of falls of those in their collective catchment area. The agreed objective being to pilot a 6 week falls prevention initiative between community and hospital-based services.

Methods
7 Physiotherapists across 3 services formed a community working group. A 6-week physiotherapy led, multifaceted intervention program involving exercise, education and an opportunity for socializing was developed. The class was accessible to persons over the age of 65 years who had or were at risk of falling. Participants were recruited from the caseloads of the physiotherapists involved. Objective assessments of gait speed, grip strength and balance were carried out via hand grip dynamometry, Timed Up and Go (TUAG) and Short Physical Performance Battery (SPPB). Subjective measures of participant’s quality of life were assessed via the EQ 5D 5L, Falls Efficacy Scale (FES) and Sarc-F. On completion of the intervention participants were retested.

Results
10 participants were recruited to the pilot from both community and hospital based, out-patient services. Over 80% of participants attended 4 out of 6 sessions. Participants grip strength improved by 3.4kg, TUAG by 6.43% (1.03 seconds) and SPPB by 13.3%. EQ 5D 5L scores improved by 15%, FES score improved by 17.81% and SARC-F scores improved by 6%. 40% of participants went on to engage with a follow-on exercise group delivered by the local Sports Partnership.

Conclusion
Overall, there was a notable improvement in participant’s physical function and quality of life and self-efficacy scores post intervention. This highlights the positive impact of multimodal group interventions, which incorporate both exercise and education to promote self-efficacy within frail older population at risk of falling.
Improving Recruitment Of Older Patients For Patient And Public Involvement And Engagement Work (PPIE): Ensuring A Representative Voice
Authors: Liu Lilly , Taylor Nathan , Partridge Judith , Dhesi Jugdeep 
Published: September 2024

Abstract

Background
Older people are under-represented in research, despite this demographic being the biggest users of healthcare resources. Service design needs to be patient-centred and therefore engaging this underserved group is crucial, albeit challenging. We describe a quality improvement project aimed at improving recruitment of patients into a local PPIE group in a perioperative geriatric service.

Methods
Clinicians opportunistically consent patients for the PPIE group during their perioperative geriatric clinic consultations. A baseline level of recruitment was established before implementing a series of PDSA cycles. The interventions were firstly, to adapt the paper clinic proforma making the consent section clearer, secondly to give weekly reminders to clinicians, and finally discussing PPIE with patients while they wait for their appointment. A focus group with clinicians was run using nominal group technique to explore barriers and potential solutions to recruitment.

Results
An average of three patients were being recruited per month from April 2022 to September 2023. Two weeks following the first intervention, no new patients were consented. Two weeks following the second intervention, this improved to two new patients. Following the third intervention, five new patients were recruited after two clinic sessions. From the focus group, the top three barriers to recruitment were forgetting, clinical responsibilities taking priority, and lack of awareness by new staff. The highest rated solution was utilising non-clinical staff to recruit patients in the waiting room.

Conclusion
During busy clinics, it is easy for clinicians to forget about issues not directly related to the patient in front of them. However, PPIE is vital in co-designing healthcare. There are both staff and patient-related barriers in recruiting and maintaining a PPIE group in older patients. From our project, we found a combination of passive (e.g. a tickbox proforma) and active recruitment by dedicated staff the best way to improve PPIE.
Assisted Decision Making in the Acute Hospital Setting – Staff Experiences of Working with Older Adults
Authors: Casey Amanda 
Published: September 2024

Abstract

Background
The Assisted Decision Making (Capacity) Act 2015 was fully implemented in April 2023. This brought changes to how health and social care staff work with patients who may lack decision making capacity for certain decisions. The most significant group impacted by these changes in the acute hospital context is Older People with cognitive impairment. Staff working with these patients have been navigating the complex balance between embracing the guiding principles of the Act, testing the practical requirements of the Act on behalf of patients who require formal decision supports, all in the context of continued demand on unscheduled care.

Methods
The newly developed role of Principal Social Worker for Assisted Decision Making and Adult Safeguarding has enabled regular access to frontline staff working across 11 hospitals in a large hospital group. Both formal and informal feedback was gathered from a cross section of staff via focussed discussion at local implementation meetings and via individual qualitative interviews with key stakeholders from a broad range of professions.

Results
Staff were generally very positive about the introduction of the Act and its rights-based approach to providing health and social care. Themes which emerged from the interviews included the need for further education and training, continued forums for case discussion and review, clarity re roles and responsibilities and improved pathways for patients requiring support.

Conclusion
The enactment of the Assisted Decision-Making Act did not, as many feared, bring the healthcare system to a standstill. However, its impact on resources and time should not be underestimated. Increased investment in staffing, training and supports are needed to ensure continued integration of the Act in the acute hospital setting.
The Lived Experience of Frailty: Are Frailty Intervention Teams Adding to Patient Quality of Life?
Authors: Donlon Kate , Cooney Hazel , Burke Sandra , O'Mara Gerard 
Published: September 2024

Abstract

Background
Numerous clinical tools are used to identify and quantify frailty, but the lived experience of frailty is not consistently measured or considered in clinical practice. The project aim was to understand the health perceptions of older adults treated by the Frailty Intervention Team (FIT) and establish if the team has an impact on care burden.

Methods
Participants were recruited from a hospital based, out-patient Frailty Intervention Clinic over a 4-month period. Older adults were classified as frail by the Clinical Frailty Scale (CFS). The lived experience of frailty was assessed via the EQ 5D 5L a self-rated quality of life measure with a visual analogue scale (EQ VAS). The impact of frailty on carers was examined by the Carer Strain Index (CSI). These subjective measures were recorded on initial assessment and 2 months post intervention.

Results
31 individuals were assessed (male n=13, female n=18). The average CFS was 4.98 (4.91 male, 5.05 female), indicative of ‘Living with Mild Frailty’. 74.19% of participants (male n=9, female n=14) responded to the follow up questionnaires. Pre-intervention, EQ VAS average responses were 42.5/100 for males and 49.33/100 for females. Two months post intervention improvements were observed in both males and females with scores of 72.77/100 and 62.5/100 respectively. CFS ratings remained unchanged post intervention. 29% of carers reported a CSI of greater than 7/12 pre intervention – indicating high level of carer burden. Post intervention this figure reduced to 9.6% of carers.

Conclusion
This FIT model adds positively to the lives of older adults in a holistic manner. The average participant rated their health positively post intervention despite being classified as ‘Living with Mild Frailty’. This underscores that the patient is the expert of their own experience and challenges the negative perceptions of frailty. Highlighting the need for a holistic understanding of frailty beyond classification scales.
A Bibliometric Review of the Utilization of TILDA Data in the Literature
Authors: Stavolo Agostino , Cavrini Giulia , Romero-Ortuno Roman 
Published: September 2024

Abstract

Background
The TILDA dataset refers to the data collected as part of The Irish Longitudinal Study on Ageing. It is a nationally representative longitudinal study of aging in Ireland, focusing on people aged 50 and older and it includes information on demographics, health status, cognitive function, psychological well-being, social support, lifestyle factors, and use of health services.

Methods
Bibliometric methods are used in several research domains to assess the impact of the field, specific researchers, papers, journals, and to identify knowledge inputs, research gaps and future opportunities. The study examines 609 scientific documents from 2011 to 2023 published on Web of Science (WoS) utilizing “TILDA” as keywords, aiming to identify prevalent themes and their evolution over time. Through thematic maps, clusters were generated to visualize thematic shifts. The Sankey plot illustrates temporal trends, revealing significant themes and their development.

Results
We defined three different time slices to clearly distinguish the themes present in scientific production. Initially (2011-2015), there's a focus on treating frailty, orthostatic hypotension, and physical interventions. Emerging themes include the analysis of cognitive functions and return migrants. In the second time slice (2016-2019), mental health concerns like depression, anxiety, and loneliness gain prominence. Essential aspects of aging such as mobility, self-care, and cognitive decline are also explored. Alcohol consumption and retirement experiences become significant topics. In the latest time slice (2020-2023), quality of life and biomarker studies emerge as prominent themes, along with continued exploration of frailty and fundamental health aspects like cancer and diabetes epidemiology.

Conclusion
The analysis shows the shifting research priorities evident in scientific output utilizing the TILDA dataset. These findings contribute to a deeper understanding of the dataset's implications and inform future research directions, emphasizing its significance in advancing scientific knowledge.
Skip The Dip For Urinary Tract Infection in over 65s. A National Initiative To Reduce Antibiotic Prescribing In Older Persons
Authors: Shah Mala , Clancy Aisling , Regan Mary , Armitage Shirley , Ryan Callum , Sheehan Patricia , Mannion Catherine , Gallagher Olivia , Foran Roisin , Donnelly Margaret , Dwyer Nora 
Published: September 2024

Abstract

Background
Urinary tract infection (UTI) is the most common reason for antibiotic use in older persons in residential care. Dipstick urinalysis for UTI is an ingrained practice. Inappropriate use of dipstick urinalysis can lead to inappropriate antibiotic prescribing, contributing to adverse effects and antimicrobial resistance. The ‘Skip the Dip for UTI in over 65s’ quality improvement initiative (QI) aims to raise awareness of best practice for diagnosis and management of suspected UTI to reduce unnecessary antibiotic use. It supports implementation of national guidance stating dipstick urinalysis is not recommended for assessment of evidence of UTI in people 65 years and over.

Methods
Focus groups with nursing staff in older persons residential care facilities (OPRCFs) identified barriers and facilitators for implementing national guidance on dipstick urinalysis for UTI. Supporting resources developed included a resident leaflet on UTI, staff handbook and webinar recording, hosted on www.antibioticprescribing.ie. Antimicrobial pharmacists delivered workshops on improving assessment of suspected UTI in the HSE OPRCFs from September 2023 to March 2024. Monthly monitoring of antibiotic use for UTI was established in all 119 HSE OPRCFs. Surveys to establish dipstick urinalysis practice in the OPRCFs were administered in March 2023 and March 2024.

Results
A baseline survey in 2020/21 indicated 98% HSE OPRCFs (133/135) performed dipstick urinalysis for residents with symptoms of UTI, reducing to 53% (57/107) in March 2023, and 24% (25/103) in March 2024 following this QI. Prevalence of antibiotics for treatment of UTI in the HSE OPRCFs decreased by 38%, from a baseline of 2.6% (114/4,446 residents) in 2020/21, to 1.6% (66/4,222 residents) in March 2024.

Conclusion
The ‘Skip the Dip for UTI in over 65s’ QI has resulted in a change in practice, with the majority of HSE OPRCFs now reporting dipstick urinalysis is not performed for UTI assessment, with a considerable reduction in antibiotics prescribed for UTIs.