bluuebunny/crossref_metadata_2025_split huggingface dataset:
61 Dietetics addition to a frailty intervention team—an analysis
Authors: McGuinness A , Julian S 
Published: September 2023

Abstract

Background
A Frailty Intervention Team (FIT) for those &gt;75 years was established at Wexford General Hospital (WGH) Emergency Department in 2018 comprising Nursing, Physiotherapy and Occupational Therapy.
In January 2022 support from Dietetics and Speech & Language Therapy were added. We aimed to analyse the first 50 dietetic contacts as part of this service improvement, as limited data is available about nutritional needs of the older population presenting to the ED.

Methods
This study was a retrospective service analysis which received audit committee approval. Comprehensive Geriatric Assessment (CGA) was performed. The Mini Nutritional Assessment-Short Form (MNA-SF) was used as a screening tool. Referral occurred if MNA-SF ≤11/oral nutrition supplements (ONS)/wound healing concerns.

Results
Participants were aged 72–99 years (30% &gt; 90 years). Clinical Frailty Scale was 4–7. 13 (26%) were advised in ED. 19 (38%) necessitated hospital admission: assessment/care plan implemented in ED. 8 (16%) discharged before seen: 7 received telephone consultation &lt;1 week, 1 non-responder.
10 (20%) queries: consultation not necessary (known to dietitian, or concerns but stable/improving). On Assessment (n = 50), 41% were malnourished/risk of malnutrition, BMI where available 16-30 kg/m2, 5% pressure sore. 27% ONS already prescribed. Intervention (n = 39) included dietary advice adaptations indicated included energy dense (87%)/meal provision (57%)/constipation (30%)/renal (30%)/dysphagia (15%)/eat well (10%). 72% had ONS review/commencement. Admission care plans included recording of intake/management refeeding syndrome risk (10%)/prescription of appropriate diet or ONS. Outcomes included (n = 39): 19 (49%) inpatient follow-up, 13 (33%) referred to GP care, 4 discharged and 3 discharged to usual dietitian.

Conclusion
This analysis confirms the extent of malnutrition/malnutrition risk in this cohort (41%), comparable to the UHL OPTI-MEND study (36.6%). Dietetic needs in this population are diverse. Those categorised as queries where dietetic consult not indicated highlights new service education needs. This development facilitates prompt access to dietetic assessment/advice, ensures early implementation of appropriate nutrition care plan for the high numbers necessitating admission, and enables admission avoidance.
62 Falls prevention is everyone’s business
Authors: Mangan B , McDonnell C , Nunan M , Daly C , Gannon E 
Published: September 2023

Abstract

Background
Falls among inpatients are the most commonly reported incident within the HSE and HSE funded services (NIMS). For older persons with multiple comorbidities and frailty, even a ‘minor’ injury following a fall can have a significant effect in terms of impaired or delayed rehabilitation, loss of confidence, longer stay in hospital and ultimately, a poorer quality of life. In our Hospital as part of our fall prevention strategy, an education programme for all Staff was launched to raise awareness of falls prevention and management of patients post falls.

Methods
In 2021 Ward A, a post -acute care rehabilitation ward had a high incidence of falls N = 56. In collaboration with Ward A’s Clinical Nurse Managers, Falls Prevention Committee, Quality Improvement and Practice Development Department a plan of action was developed to reduce the number of patients’ falls. Formal Monthly Education Awareness training for all Staff and informal Ward based training were implemented which included: Overview of falls risk factors, Information on the impact of patient falls, A review of the Hospital’s falls prevention programme and policy, Roll out of a new Multifactorial Falls Risk Assessment form which addresses risk factors and interventions to reduce falls, Reviewing the link between falls and frailty, Promoting safe mobility and activity for patients, Falls Safety Cross—to raise awareness within the team and others regarding the falls/near misses being tracked monthly and Post-fall management of patients.

Results
In 2021 Ward A recorded N = 56 patient falls. Following the above interventions, the number of patient falls reduced to N = 37, 34% by Quarter 42,022. Staff evaluation highlighted that staff knowledge and awareness of falls prevention and post fall management had increased.

Conclusion
Falls awareness training had a positive impact on reducing falls in a Rehabilitation ward.
88 An audit of the quality of documentation during the end of life phase of older adults in acute hospital settings
Authors: Plant R , O'Flynn F , Rubel M 
Published: September 2023

Abstract

Background
End of Life Care (EoLC) is commonly provided to Older Adults presenting to acute stroke or medical services. Death is considered a ‘poor medical outcome’ but a ‘good death’ is of medical, cultural and spiritual significance for patients and families. Our audit aimed to examine how well medical staff document quality indicators of the EoLC phase of hospital care in a cohort of older adults who died on the geriatric and stroke medicine services.

Methods
Inclusion criteria were patients who died under the care of the Stroke or Acute internal Geriatric Medicine department between May to October 2022 aged &gt;75. We collected data using the BMJ Support Palliative Care Journal ‘Guidance for completing End of Life Structured Judgement Review’. Data points included recognition of dying, communication with patients and their families, palliative interventions and pastoral care.

Results
28 patients were identified with a diagnosis of stroke. 17 patients were identified from AIGM. Data described as Stroke vs AIGM. Recognition of dying was documented in 92.9% (26/28) vs 94.1% (16/17). DNAR was documented in 100% (26/26) vs. 100% (16/16). An escalation/de-escalation plan was documented in 84.6% (24/28) vs. 75% (13/17). Risk of dying was communicated to: the patient 3.6% (1/28) vs. 0% (0/12); family 75% (21/28) vs. 59% (10/17). Anticipatory medicine were: prescribed; 94.1% (26/28) vs. 92.9% (16/17); administered: 85.7% (24/28) vs. 82.4% (14/17); evaluated for effect; 78.6% (22/28) vs 70.6% (12/17). Documentation of spirituality: 17.9% (5/28) vs. 5.9% (1/17). Documentation of available chaplaincy service 17.9% (5/28) vs 5.9% (1/17). Patient’s wishes around dying documented: 7.1% (1/28) vs 0% (0/17). Palliative Care services were consulted in 14.3% (4/28) vs 29.4% (5/17).

Conclusion
Further improvement, via education and awareness, is needed around the documentation of EOLC by medical staff, particularly in regard to communication to families and referral to pastoral care services.
91 Audit of percentage of stroke patients having swallow screen performed within 4 hrs of diagnosis on the stroke ward in OLOL Hospital Drogheda
Authors: Clancy C 
Published: September 2023

Abstract

Background
The swallow screen has become an imperative method of identifying those post-stroke patients in the hyperacute setting who are high risk for developing a swallowing abnormality which confers a higher risk of aspiration pneumonia and the associated morbidity and mortality effects of same. The HSE’s National Guideline for Swallow Screening 2017 states that swallow screen should occur within 4 hrs of diagnosis and so we compared our attainment levels in OLOL Hospital Drogheda stroke ward to the national standard.

Methods
We looked at 1 calendar month (January 2023) and collected data from HIPE records based on the number of patients discharged from the stroke ward within that month who had confirmed stroke diagnoses by the time of discharge. Within this number, we looked at not only those who had a documented stroke screen within that period within the medical notes but also those who attained national standard of assessment within 4 hrs.

Results
We found that there were 29 stroke confirmed patients discharged from the stroke ward within the month of January. Of these 29 patients, 24 had a documented swallow assessment done during the admission, with only 3 patient having that screen done within 4 hrs of diagnosis.

Conclusion
This study highlights the poor compliance in this level 3 stoke ward with national swallow screen guidelines in the hyperacute setting. The much improved overall screening numbers show that the majority of swallow screen assessments are taking place within hours, most likely by allied health professionals, senior nursing staff/ward managers or stroke specific medical staff. Therein lies a great opportunity to educate on-call NCHDs and Resus nursing/stroke ward staff nurses about the importance of early swallow screening with allocated teaching sessions and reminder charts, which will be the focus of my quality improvement project around same.
101 An audit of falls risk assessment in older adults in an Irish general practice
Authors: Fitzgerald A , Daly B , Dukelow T , Foley T 
Published: September 2023

Abstract

Background
Falls in older adults are common; 30% of over 65 s fall at least once a year, increasing to 50% in the over 80s. Falls are associated with significant morbidity and mortality. By 2020 the national economic burden of falls related injury is expected to exceed €2 billion. International guidance recommends annual screening for falls risk in older adults. The Chronic Disease Management programme (CDM) was introduced into Irish General Practice in 2020, but does not include falls risk assessment. The aim of our audit was to evaluate whether GPs are following international guidelines by routinely assessing falls risk in older adults.

Methods
A full audit cycle was completed in a large Irish general practice with a mixed population. Cycle 1: October 2022. Cycle 2: April 2023. Audit Standard: Opportunistic case finding as per the September 2022 World Guidelines for Falls Prevention and Management in Older Adults: A Global Initiative. Criteria: All patients 65 years of age and older should be asked 3 Key Questions (3KQ): (1) Any falls in the last year? (2) Any unsteadiness when standing or walking? (3) Any fear of falling? All patients meeting referral criteria should be referred. Falls prevention advice should be given routinely. Inclusion criteria: Patients aged 65 years and over attending for routine CDM GP review. Intervention: Practice education session, falls algorithm in every room, consensus meeting.

Results
Cycle 1, 34 patients: (a) 3KQ 0% (b) appropriate referrals 75% (c) falls risk advice 9%; Cycle 2, 32 patients: (a) 3KQ 50% (b) appropriate referrals 89% (c) falls risk advice 22%.

Conclusion
This audit shows that a targeted falls risk assessment, completed as part of the CDM reviews, leads to a significant improvement in adherence to international falls guidelines. We suggest that this is a feasible intervention, and recommend the incorporation of a falls risk assessment in the chronic disease management template.
156 Capturing older adults’ rehabilitation needs and complexity in a rehabilitation hospital
Authors: Fenton L , McDaid E 
Published: September 2023

Abstract

Background
The Rehabilitation Complexity Scale Extended (RCSE) can measure both the rehabilitation needs and complexity of a patient group as well as the services and resources required to meet their needs. The tool is now used in Ireland to identify rehabilitation needs for both trauma and neurological rehabilitation. This pilot explored its application in an older adult’s rehabilitation unit to measure both rehabilitation complexity and outcome.

Methods
The RCSE was completed on admission and discharge for all older adults admitted to the unit during the pilot (March–May 2023). An analysis of the RCSE scores was completed using Microsoft Excel. Paired T Test was used to measure change in RCSE from admission to discharge.

Results
Forty-four patients were admitted during the RCSE pilot. The mean admission RCSE score was 10.5, median 10. The highest scoring domain was therapy need (mean 2.6, median 3) indicating 4–5 HSCP disciplines were required to meet their rehabilitation needs. The mean therapy intensity score was 2 indicating that daily individual therapy sessions was required to meet their rehabilitation needs. The mean nursing need score was 2 indicating most patients required nursing staff who were training or experienced in rehabilitation. Discharge RCSE was completed on 20 patients (mean score 1.7) and there was a significant decrease in mean discharge RCSE score (p &lt; 0.0001) compared to admission. On discharge most patients had minimal rehabilitation needs, the mean therapy need score was 0.7 (median 1) reflecting those referred onward for low-intensity or maintenance rehabilitation input.

Conclusion
The RCSE was feasible to use as an outcome measure in an older adult’s rehabilitation unit. The primary domain of complexity in this sample was the number of disciplines needed and the high intensity of intervention required. This highlights the need for appropriately resourced and skilled rehabilitation services for older people in Ireland.
162 Establishing a geriatric friendly Emergency Department in Ireland with a checklist and gap analysis
Authors: Hay A , McCabe A 
Published: September 2023

Abstract

Background
The population is ageing rapidly worldwide and in Ireland there has been a significant year on year increase of patients over sixty five presenting to the Emergency Department (ED). With the complexity of older patients, there is a focus on the creation of a department that caters to their needs.

Methods
A scoping literature review was performed to identify a checklist that could be utilised for establishing standards for a Geriatric Emergency Department. It was decided to use the ‘The Geriatric Emergency Department Guidelines’ written by the American College of Physicians et al1 as a model. This was then adapted to the Irish ED. Subsequently we applied this checklist to analyse the components that were in place within our own department.

Results
This study took place in a tertiary university hospital which sees over 50,000 patients per year. Within the ED there is a multi-disciplinary Geriatric Emergency Department Intervention Team (GEDI) in place and an Age Related Assessment Unit (ARAU) has recently been opened. Upon performing the gap analysis the majority of items on the checklist are in place with these resources. Those that are missing include certain members of the multidisciplinary team due to national issues with staffing and environmental constraints secondary to overcrowding within the ED. Despite these universal challenges, areas of improvement that are achievable in both the short and long term were identified.

Conclusion
An Emergency Department that caters to the older population is increasingly important. With the creation of a checklist and gap analysis demonstrating ease of use, essential components of care can be identified and readily implemented to create a department suitable for the older person.
181 The experiences and perceptions of community volunteers in providing nutrition care supporting older adults: a qualitative evidence synthesis
Authors: Griffin A , González B M , Escárcega P S 
Published: September 2023

Abstract

Background
Nutrition care is crucial for the well-being of older adults but can be complex. It involves many healthcare professionals, family, carers and community supports. In numerous situations, volunteers are involved in community and social support initiatives that could have an impact on nutrition care and malnutrition. This study aimed to synthesise and explore the perceptions and experiences among community voluntary service providers of their role in supporting nutrition care among community-dwelling older adults.

Methods
A systematic search of seven databases (Scopus, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and PsycINFO) was conducted with the following 4 key terms, ‘Community voluntary providers’, ‘Nutrition care’, ‘Older adults’ and ‘qualitative’ using Boolean operators. There was no restriction on publication date or language for this search, each database was searched from its origin to the present. Meta-ethnography was used to synthesise data in a descriptive-integrative approach. NVIVO was used to create codes for the selected articles.

Results
The systematic database search resulted in the identification of 275 articles and one more article through reference list filtering. For this qualitative evidence synthesis, two publications were included after applying an exclusion process. Four themes were identified from the first and second-order data: (1) providing social interaction, (2) supporting independent living, (3) benefits for all, and (4) early warnings of health changes. These themes describe the positive experiences for the volunteer and the client, and the impact of volunteering.

Conclusion
The interactions between older adults and volunteers, as well as the connections they form through frequent contact, enable volunteers to identify issues or sudden health changes in individuals. Volunteer meal delivery schemes allow older adults to continue living independently in their own homes. However, there is a need to assess the impact of these interventions on older adults health outcomes and experience.
188 Characteristics and outcomes of long-term care facility residents acutely admitted to hospital
Authors: Power L , Rana W , Coen N , Bambrick P , Mello S 
Published: September 2023

Abstract

Background
Long-term care facility (LTCF) residents represent the frailest members of society and are three times more likely to attend the Emergency Department (ED) than older persons residing in the community. They are also more likely to suffer adverse events when admitted to hospital. This study aims to describe the profile of LTCF residents admitted to hospital in order to inform the implementation of a new nursing home liaison service as part of the Enhanced Community Care program.

Methods
All LTCF residents with acute admission to a model four hospital in 2022 were identified through the Hospital In-patient Enquiry (HIPE) database, and address of residence was verified using the Integrated Patient Management System (IMPS). Demographic and outcome data including International Classification of Diseases (ICD-10) diagnosis, Length-of-Stay (LoS), in-hospital complications, and mortality were analysed retrospectively.

Results
There were 724 ED attendances, resulting in 447 acute admissions by 327 residents. The majority of residents (63%, n = 281) arrived to the ED outside of normal working hours. The average age was 84 (range 46–102), and 60% (n = 194) were female. Most were admitted with infection (50%, n = 225), followed by fall with a fracture (16%, n = 70). The median LOS was 8 days (range 0.5–112), and 11% (n = 37) of residents died in hospital. Complications were common with 27% (n = 120) suffering from delirium, 8% (n = 37) falling, and 7% (n = 33) contracting Covid-19 in hospital.

Conclusion
LTCF residents frequently present with acute unscheduled care episodes. Around 40% of LTCF residents attending ED are not admitted, but those who are have a significant LoS fraught with complications. This study will inform the implementation of the nursing home liaison service with strategies aimed at reduction in potentially avoidable admissions, and alternative provisions of care targeted at common reasons for hospitalisation in this group.
190 Catheterisation and its effects: observations from an acute hospital point prevalence study
Authors: Murphy E , Callaghan N O , Leonard S , Titiloye A , Naqvi S , O’Connor M 
Published: September 2023

Abstract

Background
Catheterisation is associated with negative health outcomes most importantly a 2.8-fold increase in mortality. We examined the duration of and indications for urinary catheterisation insertion in all admission in a Model 3 hospital.

Methods
At a single timepoint data were gathered on all inpatients in the hospital, excluding the Emergency Department and the Intensive Care Unit. Biographical data, admission diagnosis, diagnoses of dementia, delirium and urinary incontinence, use of diuretics and urinary incontinence medications, toileting plans, continence care bundles and mobility status were gathered from medical and nursing documentation.

Results
6% of the study population had indwelling catheters prior to admission. On the day of data collection 21% of patients were catheterised. 24% of these newly catheterised patients had a documented trial of void performed. Of the 31 patients who had been catheterised within the last 15 days, only 16% had a trial of void. 30% of the newly catheterised had been so for longer than 15 days, only 55% of whom had ever had a trial of void. Reviewing admission diagnoses, 20% of the newly catheterised had had a hip fracture, and 4% had another reasonable indication for catheterisation. Of the 32 patients that did have a trial of void during their admission, 47% had failed, and remained catheterised, 31% were continent and 22% were newly incontinent. 42% of patients who required assistance of two for mobility were catheterised and 60% of those hoist dependent were catheterised.

Conclusion
There was a high prevalence of catheterisation in our study population. Despite evidence that early removal of a catheter is beneficial for future continence, trials of void were uncommon. Only 1 in 4 newly catheterised patients had a clear and reasonable indication for catheterisation recorded in the medical or nursing notes. Dependent mobility was a predictor of catheter use.
201 Prevalence of osteoporosis based on DXA criteria in large sample of older Irish adults attending GP or outpatient services
Authors: Fitzpatrick D , Lannon R , Laird E , Ward M , Hoey L , Hughes C F , Strain J J , Cunningham C , McNulty H , Molloy A M , McCarroll K 
Published: September 2023

Abstract

Background
Osteoporosis has a markedly increased prevalence in older adults with an associated risk of fragility fractures that can significantly impact on morbidity, quality of life and mortality. Despite this, osteoporosis is both underdiagnosed and undertreated and its true prevalence in older Irish adults is not known. In this study, we evaluate the prevalence of osteoporosis in Irish adults aged ≥60 years and also examine its determinants.

Methods
Participants were from a large cross-sectional study of older Irish adults aged ≥60 years. We excluded those with a known diagnosis of osteoporosis and on pharmacological treatment for same. We also excluded participants with major risk factors for osteoporosis (history of any previous fracture, aromatase inhibitors, androgen deprivation therapy and current or long-term glucocorticoid therapy &gt;3 months). We used logistic regression to assess the relationship between osteoporosis (defined by WHO criteria—DXA T-score &lt; −2.5 at lumbar spine, total hip, or neck of femur) and potential predictor variables.

Results
There were 1,089 participants. Mean age was 70.0 ± 6.2 and 59.8% were female. 15% had osteoporosis and 47% osteopaenia. The only positive independent predictors of osteoporosis were body mass index (p &lt; 0.0001) and 25-hydroxyvitamin D (p = 0.007) while negative predictors were female sex (p &lt; 0.0001), older age (p = 0.037) and glomerular filtration rate (p = 0.028).

Conclusion
Almost one in six older adults with no history of fracture or major risk factors for bone loss had osteoporosis. However, half had osteopaenia and overall, two thirds had low bone density. The major predictors of osteoporosis were consistent with other studies. As the mean age in our sample was 70, the prevalence may be much greater with advancing age. The findings support international guidelines which recommend routine DXA screening for women aged ≥65 years and men ≥70 years or at a younger age if risk factors for low bone mass.