bluuebunny/crossref_metadata_2025_split huggingface dataset:
84 IMPACT OF RELOCATION AND MIGRATION ON THE SOCIAL RELATIONS OF OLDER MEN AND WOMEN OVER THEIR LIFE COURSE
Authors: Sheridan C 
Published: February 2023

Abstract

Background
While there is a recognition in the established literature of the need to investigate life-course factors in the construction of exclusion from social relations and gender pathways, how those pathways intersect with the relocation and migration histories of older people has not been sufficiently explored. Thus, illuminating this intersection is important in understanding major turning points in people’s social connections, and this has particular significance in Ireland given that most older people are likely to have experienced some form of migration.

Methods
Thirty in-depth semi-structured qualitative telephone interviews with older men and women in Ireland, as part of a wider GENPATH study into exclusion from social relations.

Results
There is preliminary evidence to suggest that relocation and migration has a differential impact on the social relations of men and women over their life course. The findings reflect the common phenomenon in Ireland where it was usual for women to move into new communities upon marriage. Also, women’s experience of within-country relocation was often linked to their husband’s working-life trajectories, whereas employment was the motivation behind this form of relocation for the male participants. For those who had experienced emigration, returning to Ireland was driven by a desire to return to their place of origin or to retire in Ireland to be nearer to family in later life.

Conclusion
Findings point to the intersection between relocation and migration life histories and gendered pathways to exclusion from social relations. The impact on social connectivity is experienced differently at different points across the lives of these older men and women. Consideration needs to be given to gender normative roles and structural influences to gain a greater understanding of how these intersect with migration.
106 EDITH (EMERGENCY DEPARTMENT IN THE HOME): AN 18 MONTH AUDIT OF A NOVEL SERVICE
Authors: Davis A J , Delaney A , Doyle C , Sweeney A , Kenny L , Nally S M , Namara R M 
Published: February 2023

Abstract

Background
The EDITH team has provided an alternative care pathway for older adults in need of emergency services. The traditional model, which involved the transport of an older adult to an emergency department has been replaced with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation.

Methods
Data from electronic patient records and OT logbooks were audited from the period 22/02/20 to 09/08/21. Data was gathered regarding attendances, outcomes and conveyance rates.

Results
Since its’ inception the EDITH service has treated 3,137 patients. Following treatment, 2,909 patients remained at home while 228 patients were transferred to hospital. This gives a conveyance rate of 7.2%. Three hundred and thirty six patients were referred to primary care or day hospital services. The average age of patients is 82 years and the average Manchester Triage category is priority 4. The EDITH service has saved the hospital 7.9 years of bed days (2,909 bed days) as these patients have not presented to the emergency department.

Conclusion
There is a growing body of evidence highlighting the detrimental impact a hospitalisation can have on an older adult (Mudge et al., 2019). There is a clear need for health care services to diversify in order to meet the needs of this ageing population. The EDITH service is leading this change in Irish healthcare by providing specialised emergency care and OT intervention for the older adult in their own homes.

Reference
1. Mudge et al. (2019). Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care. Journal of the American Geriatrics Society. 67(2).
107 EMERGENCY DEPARTMENT IN THE HOME, WHO IS THE EDITH PATIENT?
Authors: Davis A J , Doyle C , Delaney A , Sweeney A , Nally S M , Namara R M 
Published: February 2023

Abstract

Background
The EDITH team has provided an alternative care pathway for older adults in need of emergency services. This vulnerable patient population receive emergency medical and occupational therapy treatment and intervention in their home environment. The typical patient profile is assumed to be ‘frail older adults’, but this needs to be more specifically defined within the clinical practice in EDITH.

Methods
A total of 230 electronic patient records were selected at random. Data was audited and analysed with regard to clinical descriptors for this patient population.

Results
Of the 230 patients treated, 26 were referred to hospital or rehabilitation facilities. This is a conveyance rate of 11% which is above the average rate of 7.2% for this service.
The Rockwood Clinical Frailty Scale (CFS): 22% had a CFS of 5 (mildly frail), 37% had a CFS of 6 (moderately frail), 22% had a CFS of 7 (severely frail), 3% had a CFS of 8 (very severely frail).
Living Status: 26% living alone, 48% living with family, 4% sheltered living accommodation and 22% in nursing homes.
Formal Supports: 37% have no formal supports, 18% have &lt;10 hours per week, 19% have between 11–21 hours, 4% have 24-hour care and 22% reside in nursing homes.
Presenting complaint: 41% medically unwell, 23% fall, 14% functional decline, 9% pain, 5% infection, 5% orthopaedic and 2% confusion.
Ages range from 61 years to 100 years with an average age of 82 years.

Conclusion
It is imperative to identify the type of patient that uses this service, in order to plan for future service needs and ensure their current clinical care needs are being met. Of note, a significant proportion of patients are living alone, have high CFS scores and have no formal supports in situ.
108 COMBATTING CONFUSION: SIMULATION-BASED MEDICAL EDUCATION FOR DEALING WITH DELIRIUM
Authors: Duff E , Moran J , Doyle M , O'Gorman M , Ryan M D , Finucane P , Cooke J , Pope G , Mulcahy R , O’Regan N 
Published: February 2023

Abstract

Background
Delirium is a complex, costly, and common clinical syndrome. Simulation-based medical education has been shown to be effective in enhancing the confidence, knowledge and skills of healthcare professionals in the management of delirium. We piloted an inter-professional education simulation on delirium in an acute hospital setting. The session’s design was informed by participating in ‘Sim Stars’, a regional simulation development competition.

Methods
We iteratively developed a low-fidelity simulation scenario on the recognition, prevention and management of delirium. The resulting simulation was piloted during an hour-long multidisciplinary departmental teaching session in a lecture hall setting. A candidate was asked to review an acutely confused patient (played by a ‘confederate’) on call. The candidate was expected to screen for delirium using the 4AT tool; assess for possible causes of delirium; and implement an appropriate management plan. After the session, qualitative feedback from the participants and audience was sought.

Results
This pilot simulation included one candidate (medical Senior House Officer); two confederates (Consultant Geriatrician, Advanced Nurse Practitioner); two facilitators (Consultant Geriatrician, Advanced Nurse Practitioner); and an audience of 17 members. Feedback indicated that learners and trainers found this a helpful and enjoyable pedagogical method. Areas for improvement were highlighted, including providing advance notice for learners of the topic to be simulated; a more structured introduction defining the learning outcomes and declaring a ‘blame free’ environment; improved script for the patient confederate; and that having a team of learners (rather than specialists) to play ‘confederates’ may help improve team-building and reduce learner anxiety.

Conclusion
This pilot simulation received positive appraisals from the team, and plans are underway to incorporate simulation more regularly into departmental teaching. Suggestions to improve future simulations were welcomed. Given its low-fidelity, this scenario can easily be used at any site for simulation-based training.
110 TO IDENTIFY WHETHER THE CURRENT SEATING AVAILABLE IN AN IRISH EMERGENCY DEPARTMENT MEETS THE NEEDS OF THE OLDER POPULATION
Authors: Maher G 
Published: February 2023

Abstract

Background
A recent campaign in the NHS highlighted that sitting in a chair can help to prevent deconditioning such as the loss of muscle strength, as well as helping to maintain a patient’s dignity (NHS improvement).
The aim of this audit was to review whether the current seating available in our Emergency Department (ED) meets the needs of the older population who attend.

Methods
A prospective audit was completed over 6 days. It captured the number of patients who were seated in chairs in the morning and early afternoon, and if not, why.

Results
Total number of patients reviewed: 62.
Total number of patients on a trolley: 50/62.
Average CFS: 6.
Average age: 83.
Sex: 25 male, 37 female.
• 54% not appropriate due to ongoing medical issues.
Of the remaining 46%;
• 17% lacked appropriate seating.
• 47.8% who were appropriate to sit out did not for a number of reasons i.e. presentation surges in ED, demand outstripped capacity in terms of 1:1 care.
• The remainder either declined to sit out, required specialise seating or no clear reason reported.
• Only 10% of those who were in bed had no medic.

Conclusion
54% of patients who remained on a trolley were medically unwell and not fit to sit out. However 47.8% of those medically fit to sit were not sitting out as per reasons discussed above. More education is needed for all staff about the importance of sitting patients out. Future plans should include staff education sessions and the development of a standard operating procedure to assist with identifying patients on arrival to the ED who could safely sit out. This could help in preventing patients’ cascade to dependency at the front door.
112 INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE (ICPOP) IN A RURAL SETTING—ROLE OF ADVANCED NURSE PRACTITIONER (ANP)
Authors: Shiel E , Costello M , McCarthy C , Murphy R , McDermott C , Geoghegan J , Mannion E , Conry M , Flanagan L , Moroney E , Bhaoill C U , Walsh C , Coffey K , Waters R , Robinson S , O'Donnell M , Canavan M 
Published: February 2023

Abstract

Background
Sláintecare advocates for right care, in the right place at the right time. ANPs for Older Persons in the community are uniquely placed to deliver care as close as possible to the older person’s home and to lead a holistic, flexible model of care minimising admission to acute care and maximising existing local resources. A pilot programme aimed at providing ANP led comprehensive geriatric assessment (CGA) (with Geriatrician support) to older people in a defined area commenced in June 2019. This pilot was part of a larger Hub and Spoke model funded by Sláintecare which gave additional MDT support.

Methods
A referral template was designed. Criteria for referral included; age &gt; 75 years, Rockwood Frailty Scale 4–6 (focusing on Falls, Cognitive Impairment and Complex Frailty). Older people on the cusp of requiring long term care (LTC) were also prioritised. A prospective database of patients was maintained by the ANP to evaluate the service.

Results
From June 2019 to August 2021, 156 patients received an ANP led CGA, mostly conducted in the home. 247 reviews were conducted at the local spoke clinic and 46 joint ANP/Geriatrician home visits. Majority of referrals were from GP (n = 69), hospital (n = 30), LTC reviews (n = 22) and Community Nursing Units (CNUs) (n = 19). 449 outpatient appointments have been removed from the tertiary referral centre. Independent case load management from the ANP includes further appointments, telephone follow up/advice and she is a point of contact where crises arise before referral to acute services. 99% of patients surveyed reported satisfaction with the service especially the ease of local access and home visits.

Conclusion
Older Persons’ ANP can provide longitudinal care pathways for older adults in the community in conjunction with ICPOP and local CNUs, intervening before crises emerge and providing continuity of care and an alternative to acute care.
114 FALLS AND SYNCOPE GUIDELINES APPLIED TO EMERGENCY DEPARTMENT ATTENDEES—HOW DO WE PERFORM?
Authors: Merron G , Lyons C , Dockery F 
Published: February 2023

Abstract

Background
Falls and syncope are one of the most common presentations to emergency departments amongst older people. European Society of Cardiology (ESC) guidelines describe investigation of suspected syncope to assist care.

Methods
Following a previous audit we delivered an education program to Emergency Department (ED) staff, on assessment of fallers and syncope. This was a repeat cycle audit on consecutive patients aged who presented with a fall/faint/collapse/blackout/syncope, to assess impact of education sessions. We also conducted a survey of n = 23 ED staff members, on role of orthostatic blood pressures and ECGs in falls assessments.

Results
Of 80 consecutive attendees with a fall, n = 41 (51%) had possible syncope as documented in the history. ECG was done within the ED in 88% vs. 51% on baseline audit however only 14% (11/80) had lying and standing blood pressure checked vs. 15% on baseline audit. This is despite our survey showing that 17/23 (74%) of ED staff felt that orthostatic BP checks were essential in all fallers, and 44% stating they measure it themselves. Brain imaging was conducted in 44% vs. 40% in baseline audit, rationale for which was unclear in some. 31% (n = 25) were admitted compared to 42% previously. Of the n = 23 admitted, 24% (n = 6) had telemetry or Holter monitor, 20% had an echocardiogram.

Conclusion
Despite an education program on assessment of older fallers, embedding it to alter practice is challenging. While the education program resulted in some improvements, it supports a dedicated team for assessing fallers in the ED. Given the low rate of further investigations into causes for those admitted, a rapid access out patient pathway is warranted. Brain imaging is carried out relatively frequently though we cannot conclude on appropriateness in this limited audit.
123 ACUTE-PHASE BED-REST DURATION WAS ASSOCIATED WITH LOWER GRIP STRENGTH IN A POST-COVID-19 COHORT
Authors: Monaghan A , Jennings G , Xue F , Knight S , Rizzo R , Davis J , Duggan E , Kenny R A , Romero-Ortuño R 
Published: February 2023

Abstract

Background
Though age-related muscle loss is traditionally associated with older cohorts, strong evidence suggests a life-spanning precipitation of decreasing muscle mass and strength beginning as early as the fourth decade of life, with established deleterious consequences for later-life morbidity and mortality. Periods of low activity and bed rest (LA/BR) can further compound this depletion of muscle strength. Our aim was to examine such associations in a post-COVID-19 cohort.

Methods
Participants reporting ongoing symptomatology and fatigue post COVID-19 underwent assessments of grip strength via hand-held dynamometry (2 measures on each hand). Demographics of COVID-19 illness, including time since diagnosis, duration of LA/BR during acute illness, and levels of fatigue were captured via self-reported questionnaires. Independent predictors of mean grip strength were investigated using a linear regression model.

Results
Forty-nine participants underwent assessments (69% female, mean age 44(12) years). At the time of assessment, days post COVID-19 diagnosis ranged from 39–522 (mean 262(140)). The mean self-reported period of LA/BR during the acute illness was 15(18) days. In general, participants reported significant levels of fatigue (median Chalder Fatigue Scale score 22(8)). Mean grip strength was 41.3(6.3) Kg for men and 22.8(6.7) Kg for women. When predictors of grip strength were investigated, an increased duration of LA/BR was found to be associated with lower grip strength, independently of age, gender, time since COVID-19 diagnosis, and self-reported fatigue (Beta = −0.158, 95% Confidence Interval − 0.242 to −0.074, p = 0.001).

Conclusion
In this cohort, every day of LA/BR during acute COVID-19 illness was independently associated with subsequent lower grip strength of approximately 150 g. These results underscore the importance of early mobilization and discouraging bed rest in the acute phase of COVID-19. Patients who are isolating should be encouraged to maintain physical activity and muscle strength as part of a modified isolation-friendly rehabilitation programme.
131 A REVIEW OF FRAILTY AND PATIENT DISCHARGE OUTCOMES IN A NEWLY FORMED PHYSIOTHERAPY TEAM IN A LEVEL 4 TEACHING HOSPITAL
Authors: Magner S , Collins L , Quaid S , Burke P , Lynch A , Horan E 
Published: February 2023

Abstract

Background
The clinical frailty score (CFS) is a 9 point validated outcome measure used to measure function, mobility, cognition and co-morbidities in patients aged 65 or older. The physiotherapy department was restructured due to COVID-19 pandemic. This resulted in the formation of a mixed specialty team which consisted of Frailty Intervention Team (FIT), Medical Respiratory, Acute Medicine Service, Orthopaedics, General Rehabilitation and Care of the Older Person (COTOP). This service review aimed to identify frailty using the CFS across services and to compare CFS versus age, length of stay, falls history and discharge outcomes.

Methods
The CFS data was collected over two weeks. Inclusion criteria included patients who scored ≥4 on the CFS. Exclusion criteria included patients aged under 65. Variables such as age, history of falls, LOS and discharge destinations were compared across all services using Microsoft Excel.

Results
166 patients were included, the average CFS was 5.24 and the average age was 77.2 years. COTOP had the oldest (Av. age 85.4), frailest (Av. CFS 6.1) and longest avLOS (25.3 days) across all services. Frailty was prevalent across all services, with 81% of patients on the medical respiratory service classed as frail. Patients who scored a CFS of ≥4 had higher falls risk and greater LOS. Of the medical respiratory cohort only 12% were discharged to rehabilitation with 77% discharged home. Orthopaedics had the highest percentage of patients discharged to rehabilitation (44%), followed by the general rehabilitation (34%). Only 14% of the COTOP patients were transferred to rehabilitation.

Conclusion
A high incidence of frailty and falls history was identified across all services. Patients who scored lower on the CFS resulted in reduced LOS and were more likely to be discharged directly home. Proactive screening and detection of frailty allows for targeted interventions that may improve outcomes and inform early discharge planning.
135 VITAMIN D FORTIFIED MILK—EFFECT ON VITAMIN D STATUS IN OLDER ADULTS
Authors: O'Flaherty N , Moloney K , Ahmad R , Laird E , Hughes C , McNulty H , Ward M , Strain J J , Molloy A M , Cunningham C , McCarroll K 
Published: February 2023

Abstract

Background
Vitamin D fortified milk is used by some older adults to boost vitamin D status. Combined vitamin D/calcium supplements often cause gastrointestinal upset which reduces adherence. Consumption of fortified milk may be a more consistent and reliable way of increasing serum 25 hydroxyvitamin D [25(OH)D], though studies of it’s efficacy in older adults are limited.

Methods
We examined the vitamin D status of users of vitamin D fortified milk in participants of a longitudinal study of community dwelling Irish adults aged &gt;60 yrs. Patients taking vitamin D supplements were excluded and independent effects were explored in multinomial regression models. Vitamin D deficiency was defined as a 25(OH)D level &lt; 30 nmol/l.

Results
2496 participants were identified: mean age was 70.5 ± 7.0 years (range 60–96 yrs) and 145 (5.8%) reported using vitamin D fortified milk. In those who consumed fortified milk, there was a lower prevalence of vitamin D deficiency (17.9 vs 34.5%, P &lt; 0.001). Vitamin D fortified milk also predicted less deficiency after adjusting for age, gender, season, BMI and physical frailty (OR 0.30. CI 0.19–0.48, P &lt; 0.001).

Conclusion
Vitamin D fortified milk was associated with a 70% reduction in the risk of vitamin D deficiency in older adults not taking vitamin D supplements. Findings support the use of vitamin D fortified milk as an effective means of improving vitamin D status. Fortified milk also contains additional calcium and so can be used to augment daily calcium intake.
139 OLDER PERSONS REHABILITATION: A SIX MONTH PATIENT PROFILE
Authors: Black C , Joyce O , Armitage D , McDermott J , Flynn B , McDonald M , O'Hara C , Costello M 
Published: February 2023

Abstract

Background
For quality improvement to be assessed in a healthcare setting, understanding the specific patient profile is vital. Only then can system performance and service development be reviewed accurately. The purpose of this review was to analyse the patient profile of a 20 bed older persons rehabilitation unit.

Methods
Data was collected weekly for patients admitted and discharged to a sub-acute rehabilitation unit over a six month period (January to June 2021) by a multi-disciplinary team (MDT). Information collected included; age, clinical frailty scale (CFS, revised 2008, Rockwood et al., 2005), MDT involvement, care needs on discharge, onward community referrals and length of stay.

Results
62 patients were included (25 males and 37 females) with an average age of 81 (range 61–99). The CFS was measured for 58 patients and ranged from 1 to 7. On examination, 9% of patients had a CFS of 1–2, 38% a CFS of 3–4, 46% a CFS of 5–6 and 7% a CFS of 7.
Of the 62 patients included, all received physiotherapy and occupational therapy, 28 speech and language therapy, 25 dietetics and 48 medical social work.
The average length of stay was 42 days (range 10–162).
On discharge 42% of patients went home with existing supports, 50% went home with increased supports and 8% went to a residential care facility. Referrals to community services were sent for 65% of patients.

Conclusion
53% of patients admitted to an older person rehabilitation unit had a CFS of 5 or more, indicating they were at least mildly frail. The average length of stay was six weeks and all patients required a minimum of two MDT members during their stay. This highlights the presence of frailty and the importance of effective MDT working in the sub-acute rehabilitation setting.