bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing End of Life Needs of Frail, Older Adults in the Community: The Role of a Hospital-Based Community Outreach Team
Authors: Alcock Megan , Hayes Mary , O'Sullivan Catherine , O'Connor Kieran 
Published: September 2024

Abstract

Background
Our current healthcare systems are designed around periods of acute illness and are ill equipped to meet the needs of multimorbid and frail adults with worsening mobility, cognition and function. According to The Irish Longitudinal Study on Aging (TILDA), Ireland has a high proportion of hospital deaths, indicating inadequate community and home care supports. Recognizing patients who are likely to benefit from supportive and palliative approaches with a goal to die at home can be done using a combination of tools and based on advanced care planning discussions.

Methods
In 2021, our Department for Older Persons Services allocated a team consisting of a Registrar and Advanced Nurse Practitioner in Frailty to form an outreach service. Inpatients who appear nearing end of life who have expressed wishes to avoid further hospitalization and to die at home are identified during their admission. Home visits allow for a holistic assessment and family members are given the opportunity to ask questions. We provide education on end of life, trying to anticipate needs and often see patients and families through periods of deterioration until they stabilize again in a ‘new normal’ or begin the process of active dying. We communicate with Public Health Nurses, General Practitioners and the Community Palliative Care Team.

Results
Families and carers supporting loved ones who wish to avoid further hospitalization and die at home benefit from combined medical and nursing support & specialist expertise the team brings.

Conclusion
Addressing end of life for multimorbid patients living with severe frailty is a global challenge. Hospital admission is an ideal time to begin conversations regarding goals of care and initiate advanced care planning. The outreach team work together with hospital and community colleagues to the common goal of following patients’ wishes at end of life.
Vestibular Assessment In Patients With Self-Reported Dizziness And A History Of Falls
Authors: Merrick Catherine , Alexander Marie , O'Malley Tom 
Published: September 2024

Abstract

Background
World Falls Guidelines recommend that any patient with a history of falls and reporting dizziness should be screened for Benign Paroxysmal Positional Vertigo (BPPV) (Montero-Odasso et al.,2022). Diagnosing and treating BPPV in particular has been shown to reduce the incidence of falls in older adults, however, it is widely underdiagnosed (Li et al., 2023). This audit explored compliance with falls guidelines in a day hospital setting where falls work up assessments take place on older patients (75 years and older). It aimed to identify reasons why vestibular assessments may not have been undertaken and establish methods to improve compliance with the undertaking of vestibular assessments where indicated.

Methods
A retrospective chart was undertaken for patients who attended a day hospital service for older adults between January and April 2023. A Microsoft excel sheet was used to track data. All data was anonymised and stored on a password encrypted HSE networked drive accessed in the day hospital.

Results
A total of 97 charts were reviewed, with 31 patients reporting to have experienced dizziness with falls. For 33% of those patients (n=10), a vestibular screen was not carried out. For 7 out of 10 of these patients a screen was not carried out due to insufficient staff training in the area, with one patient not having been referred to physiotherapy, also secondary to insufficient staff training.

Conclusion
Facilitating adequate access to training in vestibular rehab for healthcare professionals is an essential part of ensuring BPPV and other vestibular disorders are diagnosed and treated in patients with self-reported dizziness and falls. Training as part of undergraduate degrees could be considered to ensure BPPV is diagnosed and treated in a timely manner. Additional staff training was provided in the day hospital setting in question and a re-audit of vestibular screening will take place in summer 2024.
An Evaluation Of Time To Review And Brain Imaging Of Inpatient Strokes: Are We Too Slow When Patients Are FAST?
Authors: Ryan Maeve , Yun John Paul , Adnan Muhammad , Thomas Niju , Moffatt Una , Hickey Paula , O'Malley Grainne 
Published: September 2024

Abstract

Background
Evidence shows that in-patient strokes are more difficult to recognise and treat, often leading to poorer outcomes. There is a recognised delay from symptom onset to stroke alert. 1 The most recent stroke guidelines recommend a time from recognition to imaging of &lt;1hour for acute stroke.

Methods
We used the stroke database in our centre to identify our acute inpatient strokes over a one-year period from January 2023 to January 2024. The number of patients included was 9. We looked at time from first documented recognition of symptoms to medical review. We also looked at time from review to brain imaging. This information was collected using our database which records time-of-onset of symptoms and our local imaging system.

Results
Of the 9 patients identified 5 had symptoms recognised and documented by ward staff prior to medical review. The average time from recognition of symptoms to review was 2 hours and 26 mins. The shortest time to review was 35 mins and the longest was 8 hrs and 45 mins. For the remaining 4 patients, the first documentation of symptoms was the initial medical review. Three patients had initial brain imaging in under 1hour. One patient had brain imaging within 75 minutes. The remaining 5 patients waited between 5 and 7 hours for initial imaging.

Conclusion
Of the 9 acute inpatient strokes identified, average time to review from onset of symptoms was 2 hours and 26 mins. Thirty percent (N=3) received initial brain imaging within 1hour. These results highlight the significant challenge of inpatient stroke management as described in the literature. 1 One intervention identified is the introduction of a stroke alert bleep. After the introduction of this measure, we hope to re-evaluate our times.

Reference
1. Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: From the American Heart Association. https://www.ahajournals.org/doi/10.1161/STR.0000000000000402.
Bouncing Back: Hospital Reliance On Transitional Care Beds – A Disservice To Patients? A Review Of Readmission Rates
Authors: Higgins Meave , Ramjohn Joshua , Chan Kei Yen , Hanrahan Caoimhe , Gorey David , Cashen Aoife , Martin Niamh , Cormican Niamh , Small Cliona , Robinson Stephanie , Canavan Michelle , Costello Maria 
Published: September 2024

Abstract

Background
The Health Service Executive (HSE) developed an Urgent and Emergency Care (UEC) Operational Plan in 2023. One UEC action was an aim to transfer “clinically appropriate” patients to alternative care settings e.g. Transitional Care Beds (TCBs) to relieve pressure caused by high occupancy rates in acute hospitals. Inclusion criteria for TCB use is ill defined and we sought to evaluate their usage.

Methods
Retrospective analysis of characteristics and readmission rates (RAR) of patients discharged from a tertiary hospital to TCB from Oct 1st, 2023 - Jan 1st, 2024.

Results
158 patients were discharged from hospital to TCBs. 49% (n=77) were female, mean [SD] age 77.82 [10.09] years. The median length of stay (LOS) was 15 days. 50% (n=79) were discharged from surgical services, 40.5% (n=64) from medical teams, 8% (n=13) from oncology services, 7% (n=11) from geriatric medicine and 1% (n=2) from ED. 27% (n=43) had a “fall” documented as their discharge diagnosis. 32% (n=51) of patients were readmitted within 90 days, 11% (n=18) within 30 days and 4% (n=6) within 14 days. 30% (n=15) were readmitted directly from TCB. Average time between discharge and readmission was 44.7 days. Median LOS on readmission was 10 (IQR 15.5 days). 9% (n=14) had an eventual discharge to long term care (LTC) either from a subsequent admission or transitioned directly from TCB. 6% (n=10) of patients died.

Conclusion
Of those readmitted, one third were directly from TCBs suggesting discharge to TCB may have been premature and patient selection inappropriate subsequently resulting costly readmissions. Although interventions are needed to relieve capacity pressure in hospitals, greater emphasis needs to be placed on access for patients to designated rehabilitation programmes. We should aim to support older adults following acute hospital admissions by carrying out comprehensive geriatric assessment to maximise independence and reduce likelihood of hospital readmission or transition to LTC.
An Examination of EOL Trajectories and Audit of EOL Documentation In Patients Admitted Under the Department for Older Persons Services
Authors: Alcock Megan , Stanley Eve , McGrath Keith , O'Caoimh Ronan , Maloney Elizabeth , Timmons Suzanne , O'Sullivan Catherine , O'Connor Kieran 
Published: September 2024

Abstract

Background
End of Life Care is a core element of care provided in acute hospitals, with 44% of Irish deaths taking place in the hospital setting. Our audit looks at the quality of documentation around end of life for older patients and looks to characterize these hospitalized patients’ terminal life stages.

Methods
Inclusion criteria were patients over the age of 65 who died under the care of the Department for Older Persons Services in 2023 utilizing a retrospective chart review. The Oxford Audit Assessment Tool for Care of the Dying was used to evaluate end of life documentation for patients recognized as dying in the acute hospital setting using a 1–5-point scale. The hospital courses of patients who died were characterized along one of six in-hospital courses: (1) acutely unwell, (2) end stage organ failure, (3) dwindling trajectory, (4) unexpected cardiac arrest, (5) admission with known specialist palliative care needs, and (6) combination of medical complexity and high dependency. Data points included Clinical Frailty Score and NecPal Score, as well as length of hospital stay, length of dying and specialist palliative care input.

Results
Greater than 90% of patients under the Department for Older Persons service had satisfactory, good or excellent documentation around end-of-life care. One-third of patients who died under the service were acutely unwell, one-fifth of the patients who died in hospital followed a dwindling trajectory, and 15% of patients were admitted with known indication and need for specialist palliative care. Approximately 10% of patients who died suffered an unexpected cardiac arrest.

Conclusion
Overall, documentation at end of life was quite good and specialist palliative care services were frequently involved. Older patients frequently experience a complex interplay of high dependency, medical complexity and palliative care needs at end of life, highlighting the need for skilled serious illness communication.
Establishing a Specialist Physiotherapy service with a Regional Specialist Memory Clinic
Authors: Kimmage Evelyn , O'Dowd Seán , Kennelly Seán 
Published: September 2024

Abstract

Background
Patients with complex motor-cognitive syndromes (E.g. Dementia with Lewy Bodies, Corticobasal syndrome, Progressive Supranuclear Palsy and Huntington’s disease) present with a wide variety of symptoms. Accordingly, these patients have traditionally been managed under different services from Neurology-led movement disorder clinics to age-related services, without dedicated access to specialist physiotherapy input. Recognising this, the Model of Care for Dementia in Ireland recommended that all regional specialist memory services (RSMC) should have a dedicated Clinical Specialist Physiotherapist. The aim of this study was to provide an overview of clinic activity in the first six months of operation.

Methods
Physiotherapy referrals were collected from September 2023 to March 2024. Referral details were captured using Microsoft Excel and included patient demographics, reason for referral, diagnosis and previous physiotherapy input. Following triage of referrals, patients were placed in one of the following three care pathways:

Results
63 referrals were generated. Of these, 15 patients were referred for pre-diagnostic assessment, 46 were referred for rehabilitation, and 2 were referred for secondary prevention. Of those referred for rehabilitation; 18 patients had a diagnosis of DLB, 27 had another form of atypical Parkinsonism, 1 patient had HD. 22 patients had previous physiotherapy input.

Conclusion
This is the first specialist physiotherapy service in Ireland within a RSMC. This presents a challenge as there is no specific physiotherapy care pathway established for this service elsewhere, but also opportunity for service development and innovation. This overview will help with strategic and service planning and enables KPIs to be established to ensure patients receive a quality service.
Acute Bed Avoidance, Direct Admissions from Frailty at the Front Door to Rehabilitation Beds in Partnership with the ICPOP Team
Authors: Dowling Ciara , Dineen Sal , Coogan Mary , Purcell Roisin 
Published: September 2024

Abstract

Background
A key priority outlined in the Programme for Government is to support older people to live in dignity and independence in their own home. In line with the Slainte care vision for easier access of Right Care, Right Place and Right Time Clontarf Hospital have developed a pathway with the ICPOP Team/ FITT Team admitting patients directly from the front door of the acute hospital into a more appropriate environment, thus avoiding Acute Hospital admission or admitting directly from the community thus avoiding the Emergency Department presentation. The patients are over 65 years of age with multi comorbidities and complexities.

Methods
Both pathways have been developed and embedded. The ICPOP Consultant Geriatrician and the Patient Flow Teams in both Clontarf Hospital and the Mater Hospital collaborated to establish a seamless FITT to Rehab pathway which is person centred. At least 1 Rehabilitation bed is offered by Clontarf Hospital to the FITT ED Team 5 days a week Monday- Friday. An electronic communication group was instated to refer patients directly from the Emergency Department MMUH to Clontarf Hospital. The Comprehensive Geriatric Assessment Tool is utilised to refer and handover all patients. The data is collected on Clontarf Hospital Electronic Dash Board since the introduction of the service including:

Results
Since the start of the service mid-2022, 174 patients have been admitted saving acute hospital bed days. The MLOS is 22 days and ALOS is 27 bed days. Over 72% of patients are discharged directly home. There has been significant positive feedback from patients and families.

Conclusion
The establishment of a direct admission pathway from the Emergency Department and the community to a rehabilitation hospital has demonstrated positive patient outcomes and overall benefits to the healthcare system.
“Into the Abyss” – Exploring Healthcare Professionals Experience of Transitions of Care from Stroke Early Supported Discharge Services in Ireland
Authors: Shine Niamh , McDonough Suzanne 
Published: September 2024

Abstract

Background
Early Supported Discharge (ESD) is a key component of the stroke rehabilitation pathway. Evidence suggests that ongoing needs persist for people with stroke at the end of ESD, however little is known about the transition from ESD to other services. As such, the aim of this study was to explore healthcare professionals’ (HCPs) experiences of transitions of care from ESD services, in the Republic of Ireland. This was achieved through the following objectives: 1) Discussion of HCPs experience of transition from ESD, including ongoing needs of people with stroke and referral pathway utilisation; 2) Exploration of barriers and facilitators to ESD transition; 3) Discussion of potential solutions to barriers experienced.

Methods
A qualitative descriptive design was implemented using semi-structured interviews with HCPs working in ESD. Interviews took place online from November 2023 to January 2024 and were audio and video recorded and transcribed, via Microsoft Teams. Analysis of interview transcripts utilised an inductive coding approach through implementation of Braun and Clarke’s six step approach to thematic analysis.

Results
Nine HCPs took part in this study. A variety of ongoing needs and current referral pathways were described. Three key themes were identified: 1) “Into the Abyss”: Lack of a coordinated care pathway after ESD, 2) Role of communication and integrated information sharing in transition of care from ESD and 3) Facilitating care transition from ESD: current practices and future solutions.

Conclusion
This study highlights that at present, services in Ireland appear insufficient to cater to the ongoing needs of people with stroke after ESD. The roll out of community neurorehabilitation teams nationally and developing integrated communication systems are key areas for development, which warrant consideration by relevant stakeholders in order to optimise patient-centred care for this cohort.
Longitudinal Frailty Transitions in Adults Aging with Intellectual Disability
Authors: McFeely Aoife , McCarron Mary , Romero-Ortuno Roman , Connolly Eimear , McCallion Philip , Fitzpatrick Darren , Kennelly Sean 
Published: September 2024

Abstract

Background
Adults with Intellectual Disability (ID) are a vulnerable population, experiencing high rates of polypharmacy and multimorbidity, and experiencing early mortality. Lifelong functional and intellectual disability can complicate frailty measurement. To date, no studies have examined long term frailty transitions in this complex group. The aim of this study was to examine longitudinal frailty transitions, with the hope of distinguishing frailty from disability.

Methods
This study was conducted using The Intellectual Disability Supplement to the Irish Longitudinal Study of Aging (IDS-TILDA). It followed 745 adults with ID across 4 waves of data collection between 2010 and 2021. Frailty was measured at each wave using an ID-specific Frailty Index. Scores were classified into the following states: Non-Frail, Pre-Frail, Frail, Missing and Dead. Transitions are demonstrated visually using alluvial plots, created using the ggalluvial package in R. Multistate Markov Modelling was used to calculate transition probabilities between states across subsequent waves.

Results
Frailty transitions were common across the 4 waves. Both positive (decreasing frailty) and negative (increasing frailty) transitions were seen. There was a 6.8% probability of transitioning from Frail to Pre-Frail, and a 10.5% probability of transitioning from Pre-Frail to Non-Frail. The probabilities of negative transitions were higher than positive transitions. The probability of transitioning to death was higher in higher frailty states: Non-Frail = 2.6%, Pre-Frail = 5.1%, Frail = 19.3%. Compared to the general population, positive transitions were less likely.

Conclusion
This is the first study to demonstrate transitions in frailty states in adults with ID. To date, singe time-point studies of frailty in ID have faced the struggle of distinguishing frailty from underlying disability. For adults with ID, lifelong disability is expected to be relatively static. The dynamism captured here points to frailty as a distinct entity experienced by this group. Efforts are needed to better manage frailty in this vulnerable cohort.
A Pathway for Advance Care Planning Co-Developed by Service Users and Interdisciplinary Healthcare Professionals in Older Persons Mental Health
Authors: Allen Jennifer , Donnelly Sarah , Murphy Sinéad , Morton Sarah 
Published: September 2024

Abstract

Background
Advance Care Planning (ACP) has been recognised as an effective mechanism for decision-making, maintaining autonomy, and ensuring that end-of-life care is aligned with an individual’s will and preference. However, healthcare professional's (HCPs) lack of confidence and knowledge has been cited as a barrier to practice. Furthermore, there are currently no widely accepted guidelines for ACP in health service settings (Barnett et al., 2024[1]). A key aim of the second stage of a three-stage action research study was to co-design a pathway to support ACP practice in a Mental Health Service for Older Persons.

Reference
[1] Barnett, M.D., Bennett-Leleux, L.J. & Guillory, L.A. (2024) End-of-life treatment preferences and ACP among older adults, Death Studies, 48:2, 95-102.

Methods
The pathway was developed through cooperative inquiry (CI), a collaborative research approach. The CI group involved three service users (one with dementia family carer experience), and six interdisciplinary HCPs coming together as co-subjects and co-researchers. Five in-person CI meetings were convened.

Results
The CI group co-developed a person-centred pathway encompassing a tiered approach to ACP, which would be a source of guidance and support for service users, family carers and HCPs. Key components include training and education for HCPs to enhance confidence and skills; a Padlet online platform to host resources for service users and family carers; and facilitated interventions based on the individual needs of service users, including potentially additional accompanying documentation to capture mental health needs. An interdisciplinary approach to facilitating ACP engagement, with social work taking a lead role was also suggested.

Conclusion
The pathway was identified as an effective approach to embedding ACP practice in older persons mental health, through a tiered person-centred framework catering to the needs of both service users, and the training needs of staff. The pathway is proposed as potentially adaptable to other older persons services to support ACP engagement.