bluuebunny/crossref_metadata_2025_split huggingface dataset:
47 The knowledge and attitudes of healthcare workers towards sexuality and sexual relationships in older persons
Authors: Shaji A 
Published: September 2023

Abstract

Background
Sexuality is one of the activities of living, and a person’s sexual desire and actions can continue into old age. Even though it is a basic need for a person, organisations can often ignore this activity. Staff in the healthcare sector showed a lack of knowledge and negative attitudes towards sexuality in older persons. Older persons usually keep silent about it due to embarrassment, lack of knowledge and lack of communication. The negative attitude and lack of knowledge regarding sexuality reflects that the staff require education and other interventions to improve their knowledge and attitude towards aged sexuality. The purpose of this literature review is to identify staff knowledge and attitudes towards sexuality in older persons.

Methods
A literature search was conducted in the CINAHL, PubMed, Embase, Science Direct and MEDLINE databases, published from 2007. The number of articles was reduced to 10,123 when the search topic included knowledge and attitudes of staff about sexuality and sexual relationships in older persons. After screening of period, age limited, English language, title and abstract, the result was reduced to 22.

Results
The literature review found very insufficient studies about staff knowledge and attitudes about sexuality in older persons within the last 11 years and could not find any studies conducted in Ireland. The review appears to demonstrate that the knowledge of staff regarding sexuality and sexual relationships in older persons are inadequate. Most of the studies showed that the staff attitude towards aged sexuality remains negative.

Conclusion
It is evident that staff’s positive attitude will resolve one of the leading barriers to expressing sexuality. The studies show that education and training programmes for staff, supported by policies and procedures, are the important interventions that are required. The findings of this review suggest that more research and interventions are needed for health workers towards sexual relations in older persons.
68 The recovery of mobility post hip fracture as measured by the new mobility score and patient perception
Authors: McDaid E , Hewitt J , Walsh M 
Published: September 2023

Abstract

Background
Return to prior mobility after hip fracture is an important patient goal. This study aimed to assess recovery of mobility at 30 and 120 days post fracture using the New Mobility Score (NMS) and patient perception.

Methods
This prospective cohort study included consecutive patients ≥60 years admitted after hip fracture if they could provide informed consent and participate with or without a proxy. Pre fracture mobility was measured using the NMS. Participants were contacted by telephone or in person at both 30 and 120 days to complete the NMS and questions about recovery of mobility. At day-120, EQ-5D-5L was also completed.

Results
Of 82 patients admitted with hip fracture during the study period, 60 were eligible and consented. The mean age of participants was 83.3 years, with 70% (n = 42) being female and all lived at home pre-fracture. All participants (n = 60) completed 30-day follow-up only 83% (n = 50) at 120 days with 3 patients known to have died. The proportion of participants mobile unaided indoors, outdoors and shopping respectively was 78% (n = 47), 63% (n = 38) and 50% (n = 30) pre-fracture; 5% (n = 3), 2% (n = 1), and 0% at day 30; and 42% (n = 23), 20% (n = 10) and 16% (n = 8) at day 120. The mean total NMS score pre-fracture, at 30 days, and 120 days was 7.28 (SD = 2.1), 2.73 (SD = 1.7) and 5.6 (SD = 2.2), respectively. At day-120, moderate to severe problems with mobility (EQ-5D-5L score ≥ 2) were reported by 44% (n = 22). No participant recovered their pre-fracture mobility at day-30. At day-120, of the 28% (n = 14) who recovered mobility (NMS), 64% (n = 9) still reported their mobility as worse than pre fracture.

Conclusion
Most participants did not recover their pre-fracture mobility by 120 days. There was an associated loss in health-related quality of life, primarily in the domain of mobility. This patient group may benefit from access to physiotherapy up to 4 months after hip fracture.
82 Needs of stroke survivors after acute stroke and early supported discharge (ESD), at hospital discharge, and at 3- and 6-months
Authors: O'Callaghan G , Fahy M , O'Meara S , Chawke M , Waldron E , Corry M , Gallagher S , Coyne C , Lynch J , Kennedy E , Walsh T , Cronin H , Hannon N , Fallon C , Williams D , Langorne P , Galvin R , Horgan F 
Published: September 2023

Abstract

Background
There are gaps in our understanding of the needs of Irish stroke survivors as they return home from hospital, and in the first six months following their stroke.

Methods
We conducted a prospective cohort study in stroke survivors, recruited from three hospital sites across Ireland and profiled their self-reported needs in relation to information, recovery and community re-integration at discharge to home after acute hospitalisation, rehabilitation or early supported discharge, and described ongoing needs over a 6-month period.

Results
72 participants, mean age 70 (SD: 13), 61% female, mean NIHSS score 6.3 (SD 6), were recruited at hospital discharge. Needs were gathered on 59 participants (82%) at 7–10 days post discharge, 54 participants (75%) at 3-months, and 45 participants (63%) at 6-months. 40% of respondents reported no unmet needs at discharge, at 3-months 20% reported no unmet needs. The median number of unmet needs was 3 (range, 1–8). Over 50% of respondents reported not having an opportunity to discuss their transition plan before their discharge home. At hospital discharge, people with stroke reported challenges around mobility and falls (&gt;85%), fatigue (73%), emotional issues (66%), and memory (46%); with emotional problems, fatigue, and memory difficulties rating as highest levels of unmet need. Over 40% needed support with housework. In relation to information after stroke, (80%) needed information about their stroke, support around nutrition (51%), return to driving (40%) and financial concerns (32%). These rehabilitation, information and support needs persisted at 3- and 6- months.

Conclusion
Successful community re-integration after stroke is a complex process for the person with stroke and their family. Our findings concur with those of international-based researchers, that the prevalence of unmet needs is high among stroke survivors. Profiling needs of people with stroke is important to shape the development of therapies to reduce unmet need following a stroke.
112 Barriers and facilitators to data collection for the Irish National Audit of Stroke
Authors: Jonsson A , Jeffares I , Mellon L , Williams D , Hickey A 
Published: September 2023

Abstract

Background
Stroke is an important cause of morbidity and mortality in Ireland and worldwide, with over 7,000 new cases in Ireland each year. The audit of stroke facilitates service evaluation and quality improvement initiatives and is becoming increasingly important as acute stroke treatment is rapidly changing. In Ireland, the National Office of Clinical Audit has managed the Irish National Audit of Stroke (INAS) since 2019. This study is part of a wider project titled ‘Maximising the Quality of Stroke Care in Ireland—Development of a National Stroke Audit’ which aims to further develop INAS.

Methods
As part of the overarching project, semi-structured interviews were conducted with Irish health professionals involved in stroke care and data collection for INAS, including nurses, health and social care professionals and administrators. Qualitative data relating to data collection for INAS were extracted and analysed for recurring themes using NVIVO software.

Results
The most frequently identified barriers to data collection were: 1. Lack of time and resources; 2. Infrastructural challenges (access to computers, desk space and IT systems); and 3. Perceived uselessness of the audit. Identified facilitators were: (1) Systems of organisation (electronic and paper-based solutions) that allow shared responsibility of data input and (2) Leadership from managers and the influence of team members that perceive the data collection for INAS as important and beneficial for the local service. Professionals who valued the audit as an important clinical tool were more likely to have a positive view of the work required to input data for INAS.

Conclusion
INAS is a crucial instrument for understanding the demographic characteristics and care received by stroke patients in Ireland. Streamlining the data collection procedures is an important part in developing INAS. There are significant resource and time limitations affecting data collection that need to be taken into consideration for any future audit development.
113 Training Gardaí in dementia awareness
Authors: McNally D , Keating J , McGuinn C , O’Neill D , Kennelly S , McElwaine P 
Published: September 2023

Abstract

Background
There is increasing awareness of the need to inform public-facing services, and in particular police services, on dementia awareness so as to meet the differing needs of those living with dementia. While there have been programmes in Ireland such as the Dementia Elevator course, no specific course to date has been implemented for the Garda Síochána. Our experience in a pioneering Integrated Care Programme for Older People (ICPOP) team indicated a need to develop a course. We report on the feedback of community and probationary Gardaí to a dementia awareness course.

Methods
Questionnaire survey on 26 participants in course based on existing dementia support framework, and feedback from Gardaí at ICPOP steering group.

Results
The results indicated a positive (100%) (strongly agree/agree) response to: (a) application of knowledge learned, (b) content organised and easy to follow, (c) good quality of training, (d) trainers were knowledgeable, (e) adequate time given for questions and discussion and (f) participation and interaction encouraged. Overall rating of the course was 100% excellent. Useful feedback was given on improving the course—more up to date videos, and more cross organisational communication.

Conclusion
Police forces have a particularly important role in encountering people living with dementia, and a limited number of international reports exist on their implementation. The finding of this course development and survey point to a useful role for expanding dementia awareness training across the Gardaí at a national level, and consideration of delivery to all first-responders.
131 A review of the implementation of a specialist older persons 7 day service within an acute setting
Authors: Price O , McGreevy L 
Published: September 2023

Abstract

Background
As part of Winter Planning Initiatives 2021–2023 additional funding was allocated to expand the service being offered to older persons within the acute hospital setting, across the disciplines of Occupational Therapy (OT), Physiotherapy (PT) and Nursing. This is aimed at providing a person centred 7 day service, supporting admission avoidance and promoting patient flow through the hospital by enhancing timely discharges and transfers of care.

Methods
Referrals to the specialist older persons service were primarily received from the Homefirst team (Frailty at the front door). Those who were referred had been admitted onto an acute ward and had been identified as requiring specialist therapy input to enhance the quality of their stay in addition to supporting safe and timely discharges home or transfers of care. A comprehensive OT assessment was carried out with all patients. A reduced 7 day service was commenced in order to gather information to assist future service planning.

Results
2 Occupational Therapists were recruited prior to additional team members therefore, initial referrals accepted were those with identified OT needs. All referrals were accepted with a triaging system being developed as the service became more established. All referrals had a Clinical Frailty Score (CFS) of between 3–7. Patient Outcomes included discharge direct to home or transfer of care including rehab, stepdown, nursing home and hospice facilities. These outcomes were impacted by social support systems, availability of community resources and limited access to ongoing specialist team input.

Conclusion
The introduction of a specialist older persons 7 day service working within an integrated model of care, has wide ranging impacts for patients and the organisation. Access to specialist acute older persons services provides targeted assessment and intervention, supporting early decision making, quality and flow.
179 Assessing the effectiveness of the Integrated Care Team for Older Persons: a patient satisfaction survey
Authors: Burke K , Connolly W , Wade R , Devitt A , Ciuba D , Cooney F , Dore F , Bhroin A U 
Published: September 2023

Abstract

Background
The Integrated Care Team for Older Persons (ICPOP) commenced operations in June 2022 with a goal of providing quality and person centred care. To assess the effectiveness of the service and enhance the patient experience a patient satisfaction survey was conducted. This qualitative study aimed to evaluate and reflect on the collected data for improving the ICPOP service.

Methods
The feedback questionnaire was adapted from the ICPOP, Community Healthcare East. It is a seven item questionnaire with an additional section for feedback and suggestion for service development and improvement. This questionnaire was sent to patients discharged from the ICPOP service during the months October 2022 to March 2023 inclusive (n = 30). Completed questionnaires and feedback forms were received and information collated (n = 18). To increase the respondent rate, telephone calls were made resulting in a response rate of 60%. The feedback and suggestion section were analysed using thematic analysis.

Results
All participants reported a positive experience following ICPOP intervention and would wish to receive input again. 61% rated their overall experience as ‘excellent’, 23% as ‘very good’ and 16% as having had a ‘good’ experience. 94% of respondents agreed that the treatment they received was effective and would recommend to another older person. 78% of respondents also provided written feedback. 12% of the feedback received provided recommendation for communication and integration with home care applications and service development. 66% of the feedback expressed gratitude and appreciation for the Multi-Disciplinary Team (MDT) service.

Conclusion
Older persons who received input from the Integrated Care Team for Older Persons reported a positive experience and expressed their gratitude for the timely service delivery. Receiving feedback on this new service promotes service development and enables the team to understand the impact and experiences of older persons who received ICPOP intervention and support.
182 Pharmacists’ opinions on deprescribing Fall Risk Increasing Drugs in older people
Authors: Kalim R , McMahon N , Ryder S 
Published: September 2023

Abstract

Background
Falls are prevalent in older adults and can be associated with medication use. Pharmacists play a role in deprescribing Fall Risk Increasing Drugs (FRIDs) and fall prevention. The aim of this study was to explore the factors that prevent or influence the process of deprescribing of FRIDs in older adults, from a pharmacist’s point of view.

Methods
Individual online semi-structured interviews, involving clinical pharmacists (CPs) who work with older adults in hospitals, were conducted. The interviews were steered by an interview guide based on the Theoretical Domains Framework (TDF) and interviews continued until saturation. The transcripts were coded using NVivo 12. Challenges and enablers were matched with possible behavioural change techniques, to identify potential future intervention strategies.

Results
Twelve senior CPs participated in the study (11 female and 1 male; years of practice range 5–30 years). Common challenges included: deprescribing FRIDs not being prioritised by medical teams; medication review is time-consuming; written recommendations to doctors not always read/actioned; fear of withdrawal symptoms; and follow up on patients after discharge is difficult. Deprescribing enablers included: building good team relationships, the belief that medication review is a shared responsibility, verbal being the most effective method of communication, medication review being a core part of pharmacists’ workload, and having the opportunity to review medication and monitor during the inpatient stay.

Conclusion
Work environment challenges and concerns about safety after discharge were considered significant barriers to deprescribing FRIDs in hospitals. Involving pharmacists in multidisciplinary teams in hospitals may facilitate deprescribing.
191 Intermittent: an audit of venous thromboembolism prophylaxis on our stroke unit
Authors: Young C , Sori I F B Mohd , James K 
Published: September 2023

Abstract

Background
The National Clinical Guideline for Stroke for the United Kingdom and Ireland recommends immobile stroke patients receive Intermittent Compression Stockings (IPCs) to prevent Venous Thromboembolism (VTE) from days 3 to 30 of admission. We set out to audit IPC usage on the stroke unit in our hospital.

Methods
Data was collected for all 31 stroke unit patients on a single day by two NCHDs. We documented age, gender, length of stay, and mobility status. We recorded completion of the VTE risk section of the medication chart, and if the patient was prescribed single antiplatelet (SAPT), dual antiplatelet (DAPT), direct oral anticoagulant (DOAC) or IPCs. We also noted if the patient’s stroke was ischaemic or haemorrhagic.

Results
16 patients were male (52%). Mean age was 72 years old. Median length of stay was 29 days. 23 patients had ischaemic strokes (74%), 8 had haemorrhagic strokes (26%). 21 patients had their VTE risk section completed (68%). 9 ischaemic stroke patients were on DOAC, 9 on SAPT, 4 on DAPT, and 1 was on no therapy. 19 patients (61%) were immobile (assistance of one or higher dependency). Of these, 9 had been admitted for between 3 and 30 days. None had IPCs prescribed and only 1 (11%) had them in situ. 3 were on DOAC therapy (33%). One other patient (admitted 41 days prior) had IPCs in situ but not prescribed.

Conclusion
89% of appropriate stroke patients did not have IPCs in situ, and 56% had no VTE prophylaxis at all. The VTE risk section of the medication chart was blank in 32% of cases. Based on these results we are conducting a root cause analysis as to why guidelines are not adhered to. This will guide a planned quality improvement initiative.
195 Enhancing the care of the older adult with delirium in the emergency department: the implementation of non pharmacological strategies
Authors: Mitchell M , Riches R , Breslin D , Byrne C , Magner S , Carey S , Binions L , Cashman S , Bowden H , Laguna R , McAteer C , O'Caheny C , McKenzie L 
Published: September 2023

Abstract

Background
Frail older adults presenting to an acute setting are vulnerable to the adverse effects of hospitalisation including the risk of developing in-hospital delirium. Last year in Ireland the average ED waiting time for the &gt;75 adult was over 13.8 hours and a stay 3 times longer than those &gt;65. A stay of ten hours or more within the ED for the older adult will double the risk of developing in-hospital delirium within the following 72 hours. This can potentially result in the further risk of mortality, morbidity, and dependence for long term care. National Clinical Delirium Guidelines state that the management of delirium is primarily non-pharmacological. However, adequate access to these types of interventions is limited with in the ED.

Methods
The Frailty Intervention Team (FIT) completed Comprehensive Geriatric Assessment (CGA) with everyone over the age of 65 years old that attended the Emergency Department within hours of work. The 4 AT (Assessment Test for Delirium and Cognitive Impairment) was used to identify those who were delirious or at high risk of delirium. Once identified non-pharmacological strategies (orientation, early mobilisation, and comfort measures) were used to support the management of delirium. This was achieved by provision of seating, orientation clocks and a comfort trolley.

Results
Over 3-month period 64 patients reviewed by the FIT were highlighted as delirious or at risk of delirium. Once a patient was identified delirium protocol was followed and orientation, early mobilisation and comfort measure was provided by the FIT. 30 patients were facilitated to sit out in the ED through new provision of chairs.

Conclusion
A delirium friendly environment, appropriate seating and access to non-pharmacological therapies promotes quality of care, education and best practice in delirium management within the Emergency Department.
215 Including dementia simulation in caregiver education enhances knowledge, confidence, empathy and caregiving approach
Authors: O'Reilly S , Murphy F , McCabe D , McGlynn B , Clarke C , Kennelly S 
Published: September 2023

Abstract

Background
An estimated 64,000 people currently live with dementia in Ireland, with this number expected to rise to 150,000 by 2045. For every one person with dementia, there are approximately three others providing support and care. Caregivers can often undergo a decline in physical and mental health and experience feelings of isolation and loneliness. Caregiver education and support can help to mitigate these challenges. Lecture based programmes on their own have a limited effect on understanding the lived experience of the person with dementia, whereas including simulation based empathy building elements can lead to better quality outcomes for caregivers and the person with dementia. A multi-component education programme for family caregivers incorporating dementia simulation, was devised and implemented over 7 weeks. Topics included dementia awareness, delirium, communication, non-cognitive symptoms, self-care, and accessing practical community supports.

Methods
A survey measuring Person-reported outcomes (PROMS) and Person-reported experience (PREMS) was conducted with 14 caregivers attending two pilot groups.

Results
100% of participants felt that the group enhanced their knowledge of dementia and increased their confidence in supporting their loved one as dementia progresses and in relation to non- cognitive symptoms. 100% of the participants found that peer support was extremely beneficial. They also felt that the group was welcoming and felt comfortable sharing in the group. All participants indicated that dementia simulation helped increase understanding of what it is like to have dementia, often reframing their relationship with their loved one.

Conclusion
The benefits of peer supports and dementia awareness education for caregivers are well documented and this survey supports these assumptions. However, for caregivers the addition of dementia simulation scenarios and role play enhanced their understanding of the lived experience of people with dementia, building empathy and confidence in their role, decreasing stress and leading to changes in caregiving approach.