bluuebunny/crossref_metadata_2025_split huggingface dataset:
255 A QUALITATIVE STUDY OF OLDER ADULTS’ EXPERIENCES OF EMBEDDING PHYSICAL ACTIVITY WITHIN THEIR HOME CARE SERVICES
Authors: Galvin R , Burton E , Cummins V , O'Sullivan M , Swan L , Doyle F , Sorensen J , Skelton D A , Townley B , Rooney D , Jackson G , Warters A , Horgan N F 
Published: February 2023

Abstract

Background
Physical activity programmes have been shown to improve older adults’ functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the ‘Care to Move’ (CTM) programme. The aim of this qualitative study is to explore older adults’ experiences of the CTM programme.

Methods
We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery.

Results
Four themes emerged: i) ‘I’m feeling good about it’, ii) ‘safety and security is the name of the game’, iii) ‘we’re a team as it stands’, iv) ‘it’s [COVID] depressing for everybody at the moment’. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA’s in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery.

Conclusion
Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.
27 A COLLABORATIVE QUALITY IMPROVEMENT PROJECT BETWEEN AN NHS TRUST AND INDEPENDENT PROVIDER TO DEVELOP A CARE-HOME SPECIFIC TREATMENT ESCALATION PLAN
Authors: Trolan C 
Published: February 2023

Abstract

Background
The COVID19 pandemic highlighted deficiencies in information exchange around treatment escalation plans (TEP) in an intermediate care unit, based in a 30 bed independent care home, into which the hospital organisation assigns medical, pharmacy, physiotherapy, occupational therapy and social work teams to provide post-acute care rehabilitation for adults. Mean length of stay is 20 days and &gt; 75% return home. Weekly bed turnover is approximately 15%.
TEP documentation is a component of RESTORE2 use, as recommended in the British Geriatric Society Good Practice Guide for Managing COVID19 in Care Homes.

Methods
Semi-structured interviews with nursing leaders and a weighted questionnaire for the whole nursing team were used to determine baseline levels of confidence around aspects of TEP.
An Ishikawa diagram analysed factors contributing to poor documentation and communication. The ‘Chain Of Care’ vision for care home environments incorporated the need for a TEP. Three iterations occurred. A post-implementation weighted questionnaire collated qualitative information on confidence change.

Results
Areas of greatest ‘swing’ towards INCREASED or SLIGHTLY INCREASED confidence around...: 90%, Cardiopulmonary Resuscitation (CPR) status clarity; 90%, treatment ‘ceiling of care’ e.g. ‘conveyance to the Emergency Department in any situation that the clinical team deem necessary’; 40%, conversations with out-of-hours services/external clinicians around appropriate actions; 30%, conversations with nominated persons around appropriate actions.

Conclusion
The TEP incorporates more than just CPR status and contributed to increased nursing team confidence in responding to the acutely deteriorating adult appropriately in a care home environment. Clear documentation of: capacity assessment; patient prioritisation (using ReSPECT principles); and agreed treatment escalation and limitation, enabled information exchange. Standardisation of language, and cross-fertilisation with Nursing Handover, facilitated conversations with external clinicians and nominated persons.
Tailoring the TEP to the care-home environment and rendering it generalisable to non-intermediate care, non-geriatrician supported care home microsystems was considered in the iterations.
47 DOSING OF DIRECT ORAL ANTICOAGULANTS IN OLDER ADULTS
Authors: O'Riordan F , Murphy J , Egan G , Murphy C , Ahern E 
Published: February 2023

Abstract

Background
Direct oral anticoagulants (DOACs) are approved for a variety of uses including prevention of stroke in non-valvular atrial fibrillation and treatment and prevention of deep vein thrombosis and pulmonary embolism. Adjustment to DOAC dosing may be required for age, weight and renal impairment. Incorrect lower dosing puts patients at risk of thromboembolic events whereas inappropriate higher dosing increases the risk of bleeding. We compared current DOAC dosing for patients admitted to our hospital and compare this against HSE best practice to determine if patients were receiving the correct dose [1].

Methods
A prospective single-centre study. Patients admitted to our hospital following a fracture and reviewed by the Orthogeriatric team between August–October 2020 were eligible for inclusion. We recorded admission DOAC dose, age, weight and renal function. We also obtained data including sex and Clinical Frailty Scale (CFS).

Results
Thirty-one patients were included. Mean age was 86 years [range 66–99] and 21(68%) were female. Apixaban was the most commonly used DOAC; 25(81%). Stroke prevention in non-valvular atrial fibrillation was the most common DOAC indication; 29(93%). Twelve patients (39%) had an inappropriate DOAC dose prescribed. Eight patients (67%) had an inappropriately low dose and 4 patients (33%) had an inappropriately high dose. The mean CFS was 5 [Range 2–7] classifying our cohort as mildly frail.

Conclusion
Our study has shown that over one-third of our patients were on an inappropriate DOAC dose on admission with the majority (67%) due to under-dosing. Many factors may have influenced dosing choices by clinicians but our findings highlight the challenges in dosing, monitoring and the overall management of DOAC therapy in older people. Further studies and research are required to establish the most accurate and effective dosing strategies for DOACs in older adults.

Reference
1. Health Service Executive [Internet]. Ireland ‘Anticoagulation Prescribing Tips’ https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/noac-prescribing-tips-for-noacs.pdf.
52 AUDIT CYCLE EXAMINING QUALITY IMPROVEMENT POST EMERGENCY DEPARTMENT MULTI-DISCIPLINARY SIMULATION BASED MEDICAL EDUCATION TRAINING ON HIP FRACTURE CARE
Authors: Clancy C , Mahony R , Meighan V 
Published: February 2023

Abstract

Background
The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1.
We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of COVID-19, the training was available in person and online via Zoom.

Methods
We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway.
Data was collected from the electronic record database (Symphony). We recorded the following data;

Results
2020 n = 31.
Average time to ward—8 hrs 29 mins.
26% patients reached ward &lt;4 hours. (8/31).
2021 n = 25.
Average time to ward—5 hrs 58 mins (32% reduction vs 2020).
72% patients reached ward &lt;4 hours. (18/25) (46% increase vs 2020).

Conclusion
Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.
54 EXWELL: OUTCOMES FROM A SIX-WEEK COMMUNITY EXERCISE REHABILITATION PROGRAM FOR PEOPLE LIVING WITH CHRONIC ILLNESS
Authors: Skelly F , McCaffrey N , Byrne E , Kennelly S 
Published: February 2023

Abstract

Background
Chronic diseases (CD) are long-term conditions, which often require ongoing medical treatment and have the potential to limit the quality of life of the people who live with them. Exercise rehabilitation has been shown to improve physical functioning and health related quality of life (HRQoL) in this cohort.
ExWell is a community-based exercise rehabilitation (CBER) program that offers group exercise rehabilitation classes to individuals with a range of CD. The purpose of this study was to investigate the impact of 6 weeks of participation in the ExWell Medical program on physical functioning and HRQoL in a diverse CD population.

Methods
Participants with a range of CD were referred by healthcare practitioners to the HSE-funded ExWell Medical program based in a community setting. Outcome variables included measurements of body composition, functional capacity and health related quality of life. Assessments were taken at baseline and 6 weeks. Participants were encouraged to attend ExWell Medical classes twice weekly for the duration of the study. Each forty-five minute class included a warm up, aerobic, resistance, core and balance exercises and a cool-down.

Results
Three hundred and ten people (mean age 70.7 ± 7.7 years, 48.3% Female) participated. Statistically and clinically significant improvements were found in cardiorespiratory fitness, lower body strength, balance, co-ordination, body composition and health related quality of life. The greatest improvements were observed in those with the lowest levels of fitness at baseline, and the oldest participants. Improvements in cardiorespiratory fitness and lower body strength matched the recognized clinically meaningful differences in the entire group sample and greatly exceeded them in those in the lowest tertile of fitness at baseline.

Conclusion
The ExWell mixed CD CBER program is an effective approach to rehabilitation delivery in clinical practice. Clinically meaningful improvements can be achieved within 6 weeks of participation, and older and frail participants show greatest improvements overall.
56 EFFICACY OF AN ELECTIVE PERIOD OF IN-PATIENT REHABILITATION FOR PATIENTS LIVING WITH PARKINSON’S DISEASE AND FRAILTY: A PILOT STUDY
Authors: Doyle M , Ryan D , Mello S 
Published: February 2023

Abstract

Background
Frailty and Parkinson’s disease (PD) are more common with increasing age and are associated with syndromes such as falls, immobility, cognitive dysfunction and incontinence. PD may directly cause or co-exist with and compound frailty. A coordinated, multidisciplinary approach to care has been shown to optimize outcomes in both of these conditions. This pilot study aims to examine the short-term effects of an elective two-week in-patient rehabilitation program on frail PD patients’ function, mobility, and self-reported quality of life (QOL).

Methods
This prospective cohort study included all frail PD patients admitted for elective rehabilitation since the program’s conception. Patients included must be able to mobilize independently with or without an aid, or with assistance of one person. They also must be cognitively able to participate in rehabilitation. Patients received consultant-led Comprehensive Geriatric Assessment and attended daily physiotherapy and occupational therapy sessions. Functional outcome and health related QOL measurements were collected on admission and discharge and compared using a paired t-test. Frailty was quantified by the Clinical Frailty Index.

Results
Twelve patients completed the program (58% male). The average age was 79 (range 70–86) and average clinical frailty score was 5.6 indicating mild to moderate frailty. Performance in activities of daily living (Barthel Index: 64 vs 73, p = 0.005), overall mobility (Elderly Mobility Scale: 10.6 vs 12.9, p = 0.004), gait speed (Timed Up and Go: 35 vs 29 seconds, p = 0.05), and balance (Berg Balance Scale: 25 vs 32, p = 0.002) significantly improved from admission to discharge from the program. Health-related QOL also improved (EQ-5D: 44 vs 66, p = 0.004).

Conclusion
Early data suggests that a short elective in-patient rehabilitation program has highly significant benefits for frail PD patients on mobility, performance of activities of daily living, and QOL. Longer term follow-up is required to assess sustainability of these improvements and cost-effectiveness of this intervention.
72 VITAMIN D LEVELS AND SUPPLEMENTATION IN FRAIL OLDER ADULTS PRESENTING TO AN IRISH LEVEL 5 EMERGENCY DEPARTMENT
Authors: Pender C , Dillon L , Byrne C , Magner S , Ryan A , Murphy A , Carribine N , Laguna R , Malomo K 
Published: February 2023

Abstract

Background
The Department of Health published new guidance in November 2020 ‘Vitamin D advice for people aged 65 and older’ which states that all adults &gt;65 years should be supplemented with 15micrograms of Vitamin D daily. TILDA research states that 55.5% of adults &gt;65 years have either insufficient or deficient vitamin D levels in winter (TILDA 2020).
The Frailty Intervention Team (FIT) assess frail adults &gt;65 years in the Emergency Department using medication review and Comprehensive Geriatric Assessment (CGA) to identify vitamin D supplementation.
The audit aim is to determine if the new guideline is being implemented.

Methods
All patients who had a medicine reconciliation completed by the FIT Pharmacist in January 2021 were included in a retrospective audit. Patients were identified from the pharmacists worklist. Data was collected from a Hospital Clinical System using an excel data collection sheet. The data recorded included: Variable Indicative of Placement risk (VIP), Age, Sex, Rockwood Clinical Frailty Score (CFS), serum vitamin D level, date of last serum vitamin D level and vitamin D supplementation.

Results
The FIT Pharmacist completed 60 medicine reconciliations in January 2021.
70% (n = 42) were prescribed vitamin D. Of those 92% (n = 39) were prescribed a supplement containing at least 15micrograms of vitamin D.
85% (n = 51) had a vitamin D level reported in the preceding 6 years. 76% (n = 39) had sufficient vitamin D levels (&gt;50 nmol/L). 21% (n = 11) had insufficient or deficient vitamin D levels (&lt;50 nmol/L).

Conclusion
The new guideline was implemented in 65% (n = 39) of frail patients &gt;65 years. The rate of vitamin D insufficiency in this cohort was lower than TILDA research suggests.
81 LONGER CHAIR-STAND TIME IS ASSOCIATED WITH ORTHOSTATIC INTOLERANCE IN AN OLDER IRISH POPULATION
Authors: Duggan E , Knight S , Rizzo R , David J , Kenny R A , Romero-Ortuño R 
Published: February 2023

Abstract

Background
Hospital admissions for orthostatic hypotension (OH) have risen more than two-fold in the past ten years. OH can lead to orthostatic intolerance (OI), and both OH and OI are common causes of falls and injuries in older persons. Sarcopenia is also common in older persons and associated with adverse health outcomes. The 5-chair stand test (5-CST) can be used as a marker of sarcopenia and a cut-off of 15 s has been proposed. We hypothesized that those with a worse performance on the 5-CST would be at greater risk of OH and sought to investigate this in an older Irish population cohort study.

Methods
5-CST was measured in keeping with a standardised protocol. Beat-to-beat blood pressure was measured with the Finometer device according to the active stand protocol. Multivariable logistic regressions were performed to investigate the associations between OH at 40 seconds after standing (OH40), OI (dizziness after standing), and 5-CST time. Potential confounders were controlled for in the model including age, sex, education, body mass index and medications.

Results
Data from 3,119 participants were available for analysis. Mean age was 63.8 years, 55% were female, 25% took longer than 15s on the 5-CST and mean baseline blood pressure was 141/76 mmHg. Proportion of OH40 was 12.5% and 4.4% reported OI. In the multivariable model, OH40 was not independently associated with 5-CST time after controlling for age (p &gt; 0.05). Worse performance on the chair stands test was however an independent predictor of OI (odds ratio 1.06, p = 0.039).

Conclusion
Longer time taken on the 5-CST, a marker of sarcopenia, was an independent predictor of OI in a large population study. The relationship between sarcopenia and orthostatic blood pressure response is not well elucidated. We plan to further investigate this area in a future clinical cohort.
82 INVESTIGATING LEARNING NEEDS, OUTCOMES, AND CURRICULA IN HEALTHY AND ACTIVE AGEING: A SCOPING REVIEW AND MULTINATIONAL SURVEY
Authors: Wiggin D , Penic B , Sulopuisto O , Setti A , Strockl D E , Timmons S , Consortium E M M A 
Published: February 2023

Abstract

Background
Older people are projected to make up almost one third of the European population by 2060. Healthy and active ageing (HAA) and age-friendly society frameworks offer a method to capitalise on this increasingly older demographic. To inform a new online EU-based taught masters programme, a scoping review and subsequent multinational survey were conducted to identify potential students’ learning needs related to these frameworks.

Methods
The scoping review included a systematic search of four databases. Data were extracted from 32 studies, guiding the development of an anonymous online survey targeting senior undergraduates and recent graduates; future employers; relevant academics; and other key stakeholders (e.g. advocacy groups, policy-makers, and ‘expert’ older people). Participants ranked the importance of 14 broad topics and linked subtopics on a Likert scale, and suggested other key topics. Descriptive data from the first survey wave are presented.

Results
The scoping review revealed a literature focus on intergenerational learning, age-related design, health, attitudes towards ageing, and collaborative learning. Few studies (16%) surveyed students to determine their learning needs. While 72% of studies reported programme evaluations, most were informal/unstructured. From the 473 responses across the initial five survey participation countries (Ireland, Portugal, Greece, Austria, Slovenia), over 90% of potential students, academics, and ‘other’ stakeholders scored psychological aspects of ageing, health promotion, and social inclusion as important topics. In descending order, the workplace/retirement, human rights, physiological and social aspects of ageing, physical environment, technology, and older people in education, were next-ranked. Participants’ suggested other topics included sexual health, oral health, blue zones (regions with marked longevity), and the rights of vulnerable older people.

Conclusion
This study highlights the limited prior investigation into learning needs around HAA and age-friendly society, and demonstrates key stakeholder priorities for education content. The resulting European Masters in Active Ageing will commence student intake in 2023.
90 IMPACT OF AN INTEGRATED CARE MODEL FOR OLDER PERSONS: EVALUATING A PILOT PROGRAMME
Authors: Geoghegan J , Conry M , Mannion E , Shiel E , Flanagan L , McCleane F , Nolan M , Corry M , Chawke M , Coffey K , Costello M , McCarty C E , O'Donnell M , Robinson S , Waters R , Canavan M 
Published: February 2023

Abstract

Background
In September 2019 Sláintecare helped establish an Integrated Care team for Older People. The aim of this service was to provide a Comprehensive Geriatric Assessment (CGA) to older people within a community network. Service user experience/feedback are critically important for development of a team and a service. To give service users a platform to evaluate the service a patient experience survey was conducted.

Methods
The survey was designed by the multidisciplinary team, consisting of 13 closed/3 open questions. A Likert scale was utilised for closed questions and thematic analysis for open questions. A question on impact of COVID-19 was also included.
150 of the 950 service users who received a CGA from June 2020 to June 2021 were selected randomly and invited to participate in the postal survey. All participants received a covering letter, questionnaire and a stamped address envelope to return their completed surveys.

Results
47% response rate (71/150). 77% were aged ≥75. 52% completed the survey themselves, 48% required assistance. 61% attended more than twice and most would prefer to attend a local spoke clinic. 96% agreed/strongly agreed that they were satisfied with the service. 99% felt they were treated with dignity/respect and had confidence in the service. 93% agreed that they were involved in care decisions. 82% reported their carers had the opportunity to discuss concerns. Themes emerging included importance of care close to home, avoiding acute hospital, difficulty parking at tertiary centres. 42% highlighted isolation and loneliness due to COVID-19 as a major issue.

Conclusion
Service users had an overwhelmingly positive experience especially when care was delivered in clinics close to their homes. Development of the hub and spoke model is acceptable and feasible to older people and their carers’ in this region and will be the focus for expansion of this service.