bluuebunny/crossref_metadata_2025_split huggingface dataset:
148 Urinary incontinence: a hospital inpatient point prevalence study
Authors: Murphy E , Joyce R , Roche A , Osman O , Rasheed M U , O’Connor M 
Published: September 2023

Abstract

Background
Urinary incontinence is a common, although under-reported, problem in hospitalised older adults. One Irish study reported that 26% of hospitalised patients had urinary incontinence. Hospital-acquired urinary incontinence is associated with prolonged hospital stays, infection, poorer functional outcome, and poorer quality of life. We undertook a point prevalence study of all inpatients in a Level 3 hospital, as part of an audit focused on documentation and awareness of urinary incontinence.

Methods
Data were gathered on all inpatient at a single timepoint. The Emergency Department and Intensive Care Unit were excluded. Biographical data, admission diagnoses, diagnosis 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 notes, nursing notes and drug Kardexes.

Results
The dataset compromised 309 patients. 11% were &lt; 50 years old, 8% aged 50–59, 15% aged 60–69, 29% aged 70–79, 29% aged 80–89 and 8% were &gt; 90 years old. 24% had a diagnosis of dementia, and 25% had delirium. Pre-admission continence status was known for 81% of patients; 8% catheterised, 12% incontinent, 12% had occasional accidents and 68% of patients were continent. At the time of data collection, 21% were catheterised. 14% incontinent, 18% had occasional accidents and 48% of patients were continent. 10% of patients were prescribed medications for urinary incontinence and 22% diuretics. 12% of patients with dementia were continent and 18% of patients with delirium. 40% of patients were independently mobile, 32% required assistance of one person, 17% assistance of two and 11% required a hoist. Dependent mobility was associated with increased rates of incontinence.

Conclusion
Our study found a high prevalence of urinary incontinence in hospitalised patients. Risk factors identified included older age, reduced mobility, long duration of admission, presence of dementia and or delirium and use of diuretics. These risk factors could be targeted as quality improvement initiative to promote continence in hospitalised patients,
164 Association between medications and increased fall risk among older adults: implications for medication management and fall prevention interventions
Authors: Wade R , Burke K , Surendrannair U , Devitt A , Dore F , Cooney F , Ciuba D , Connolly W 
Published: September 2023

Abstract

Background
Falls among older adults are a significant public health concern, and certain medications have been identified as potential risk factors. The National integrated care programme for older people is prioritising services to be developed for older people in the areas of frailty, dementia and falls.

Methods
Information on recurrent falls, polypharmacy, and the number of falls experienced by each patient was collected retrospectively via chart review. Logistic regression analysis was performed to assess the association between STOPPfall medication use and the risk of falling, with odds ratios and p-values reported.

Results
Data was available on 48 patients (median age 79, range 65–92) of a total of 73 patients seen. The gender distribution was 62.5% female. Among the patients included, 31 experienced recurrent falls, and polypharmacy was observed in 35 patients. The distribution of falls in the previous year was as follows: 8 patients had three or more falls, 5 patients had two falls, 18 patients had one fall, and 14 patients did not experience any falls. Logistic regression analysis revealed that the use of antihypertensive medications was associated with an increased risk of falling, with an odds ratio of 3.85 (CI =1.08–13.75, p = 0.037). There was no statistically significant association between falls and other STOPPfall medication.

Conclusion
In this study, antihypertensive medications were found to be significantly associated with an increased risk of falling among older adults. These findings emphasise the importance of considering medication-related factors when assessing fall risk in this population. Further research is warranted to determine whether appropriate medication management strategies can mitigate fall risk. Effective fall prevention interventions should incorporate comprehensive medication reviews, particularly for patients on antihypertensive therapy, to optimise patient safety and reduce the burden of falls in older adults.
193 A review of the bed rail use and use of a bed rail risk assessment tool in a rehabilitation unit
Authors: O'Connor A , Elsheikh N , Doyle M , Morris E , Ryan D , McDonagh R 
Published: September 2023

Abstract

Background
Bed rails are used frequently throughout acute, community and home care environments to reduce the risk of bed occupants falling out of bed and causing injury. The use of risk assessment, along with patient preference, has been advised by HSE.

Methods
A chart review in a rehabilitation ward was undertaken to determine consideration and compliance of a Bed Rail Risk Assessment Tool (BRRAT) by nursing staff during inpatient stay.

Results
44 patients were assessed. 31(70%) used a bed rail, with documented hourly observation noted in 97% of these charts. Of the 31, 30 patients (71%) voiced preference for a bed rail, specifying safety (n = 5) or fear of falling (n = 3) as a reason. Patient preference for no bed rail was documented in the majority (n = 7/9). Where bed rails were used, no patients were deemed at high risk of injury or entrapment. 4 patients at medium risk elected not to use a bed rail with the remaining 3 patients at medium risk choosing to have a bed rail despite the risk, due to fear of falling. All patients at low risk chose to have a bed rail (n = 25). Four patients had no BRRAT documented. 82% of decisions were documented to have been discussed with the patient. 18% were not assessed by the BRRAT as patient preference was taken solely into account.

Conclusion
A high proportion of patients were involved in decision-making, and the majority chose to use bed rails in a rehabilitation setting. Most had documented hourly observation of rails. The use of a BRRAT tool allows one to assess the risk of bed rails also on an individual basis, to ensure a well-rounded decision can be made. A full assessment should be carried out however, to inform the patient of their risk before taking their final decision into account.
229 OPTI-3S (criteria for optimising medicines by stopping, stepping down, or switching to safer alternatives): consensus validation via a Delphi method
Authors: Ali A A H , McMahon N , Ryder S 
Published: September 2023

Abstract

Background
No consensus-based criteria set exists specifically for Potentially Inappropriate Medications (PIMs in hospitalised frail older adults. This study aimed to develop the OPTI-3S core criteria for optimising medicines, using a modified Delphi method.

Methods
The OPTI-3S preliminary list was developed by the research team based on an extensive literature review. A modified Delphi method was conducted to validate a subset (‘core list’) of these preliminary statements. The Clinical Frailty Scale (CFS) was used to differentiate between frailty levels. Eleven practising experts reviewed the core list and full preliminary list in the first round. Participants were asked to rate their agreement with the core list of statements, using a 5-point Likert scale, and suggest additional statements from the full list, or based on their own knowledge. Statements with a median rating of 1 or 2 (i.e. strongly agree or agree) and 75th percentile of 2 or less were included in the final set.

Results
Nine experts completed the three rounds, after which consensus was reached on the inclusion of 45 statements: 17 statements in the first round, 25 in the second round, and three in the third round. These statements suggest optimising and/or deprescribing antidiabetic agents (n = 7), central nervous system (CNS) medications (n = 7), genito-urinary medications (n = 7), antithrombotic agents (n = 5), statins (n = 4), antihypertensives (n = 4), osteoporosis medications (n = 3), heart failure medications (n = 2), perioperative analgesia (n = 2), diuretics (n = 1), proton-pump inhibitors (n = 1), vitamins and supplements (n = 1), and anticholinergic medications (n = 1). 22 statements apply to a specific CFS frailty level, while the remainder apply to all frail older persons (i.e. CFS of 4 or more).
Conclusion: The literature- and consensus- based OPTI-3S core criteria comprise 45 statements relating to PIMsand suggest preferential medications in hospitalised frail older adults. The OPTI-3S criteria may be a useful guide for medication optimisation in frail older people.
240 Reviewing time-to-surgery for acute hip fractures in older adults to develop ‘SipTilSend’ policies
Authors: Mullen M , Koay W J , Duggan J 
Published: September 2023

Abstract

Background
Current international guidelines for pre-operative fluid fasting is 2 hours. Patients presenting with hip fractures often fast indeterminately from the midnight prior to day of surgery. Prolonged oral fluid deprivation is unpleasant for patients and is associated with patient discomfort, malaise, dissatisfaction, nausea and vomiting, dehydration and possibly delirium. Our aim was to review the times-to-surgery with a view of implementing ‘SipTilSend’. ‘SipTilSend’ aims to shorten pre-operative fluid deprivation by allowing patients to sip water or other clear fluids until they are sent to theatre.

Methods
Data of patients over the age of 65 admitted with a hip fracture collected as part of the Irish Hip Fracture Database over a five month period from December 2022 to April 2023 was analysed. This included age, time-to-surgery, reasons for delay in surgery as well as 4AT scores on day1 and day3.

Results
Of the 55 patients presenting with hip fracture, the average age was 79, with a mean time-to-surgery of 34.8 hrs. 83.6% of patients (n = 46) achieved time-to-surgery of &lt;48 hours, with a mean of 25.2 hrs. The shortest time-to-surgery was 8.3 hrs, longest 46.9 hrs. 9 patients underwent surgery after 48 hours from time of presentation, five were delayed due to being on anticoagulants, two due to theatre overrun, one required a pacemaker check and one had experienced polytrauma. The incidence of delirium (4AT score &gt; 4) was 14.5% (n = 8), the mean time-to-surgery for these patients was 32.9 hours.

Conclusion
Time to surgery for patients over the age of 65 presenting with acute hip fractures can be varied and extended. Despite efforts of proactive trauma list planning to improve fasting times, this effect in practice was small. Our plan is to implement ‘SipTilSend’ and perform a re-audit on the overall risk for aspiration and patient comfort.
265 Polypharmacy and potentially inappropriate medication prescriptions in older Nursing Home Residents presenting to the Emergency Department
Authors: Fallon A , Noonan C , Kennelly S P 
Published: September 2023

Abstract

Background
Nursing Home Residents (NHR) have high rates of polypharmacy and Potentially Inappropriate Medication (PIM) prescriptions. Emergency Departments (ED) are an access point to acute hospitals for unwell NHRs. Attendance is associated with adverse outcomes. This project aims to identify polypharmacy and PIMsin older NHRs presenting to ED and associations with adverse outcomes.

Methods
A prospective cohort study including all NHR aged≥50 years presenting to ED over one year (01/10/2019–30/09/2020). Data collected included demographics, medications at attendance, Charlson Comorbidity Index (CCI), Clinical Frailty Score (CFS), modified Barthel Index (BI), continence, falls history, ED presentation details, ED Length of Stay (LoS), hospital LoS and 6-and 12-month mortality. Polypharmacy was defined as ≥5medications. The Screening Tool of Older Persons’ Prescriptions version2 (STOPP), STOPPFrail and Beers’ Criteria were used to identify PIMs

Results
There were 516 attendances by 343 individual NHRs. Mean age was 78.6 years (50–103; ±10.9). Prescriptions were available for 93.0% (480/516). A mean of 12.4 (0–31,±5.24) medications were prescribed per patient, with polypharmacy present in 96.0% (461/480). Mean age of the polypharmacy group was lower (76.2 vs 83.7; p &lt; 0.001). There were no significant differences in CCI, CFS or modified BI scores. STOPP identified 99% (n = 475) as having ≥1 PIM(mean 7.47[0–19; ± 3.67] per patient). All had ≥1PIM according to STOPPFrail(mean 8.59[0–26; ±3.90] per patient). Beers’ classified 97.5% (n = 468) as having ≥1PIM (mean 4.32[0–13,±2.41] per patient). STOPPFrail identified continence (71.9% vs 65.8%) and intellectual disability (76.7% vs 67.5%) as significantly associated with a higher proportion of PIMsp &lt; 0.001). Beers’ identified delirium and hospital admission as associated with a lower proportion of PIMs31.7% vs 36.8%, 33.2% vs 38.1% respectively; p &lt; 0.001). All tools showed NHRs who died at 6-and 12-months had a lower proportion of PIMs

Conclusion
Polypharmacy and PIMsare common in NHRs attending ED and should be considered at presentation. NH liaison services may facilitate medication review and deprescribing.
287 Profile of patients receiving physiotherapy within an Integrated Care Programme for Older Persons (ICPOP) service covering a large geographical area
Authors: Gavin C , Walsh L , Fitzmaurice C , Rogan M , Sestak K , Canavan M , Costello M 
Published: September 2023

Abstract

Background
The Physiotherapist is a key member of the ICPOP team and the need for intervention is identified through Comprehensive Geriatric Assessment (CGA) and interdisciplinary collaboration which includes effective communication with Primary Care to avoid duplication. Our aim was to: (1) Examine the profile of those who received Physiotherapy within ICPOP and (2) Identify those known to Primary Care (PC) Physiotherapy.

Methods
We conducted an audit of 85 patients who received ICPOP Physiotherapy from January 2023—April 2023. Key demographics were obtained along with Clinical Frailty Scale (CFS) score, reason for referral to ICPOP and rationale for Physiotherapy intervention.

Results
Of this cohort 59% were Female (n = 50) with Median age of 83 years. One third were referred to ICPOP for evaluation of Falls, one third for Frailty, 21% for evaluation of cognition and the remainder were a combination of two or more of the above. Of those requiring Physiotherapy, 28% had a recent decline in mobility, 28% had overall deconditioning, 26% had falls, and the remainder had balance and pain issues. Median CFS score was 5. Timed Up and Go (TUG): median 19.85 s, median grip strength: 14 kg. Initial mobility assessment showed 65% requiring gait assistance. 76% of initial assessments took place in a domiciliary setting. 58% of people were previously known to PC Physiotherapy.

Conclusion
CGA can identify a need for Physiotherapy intervention for older adults not outlined as a concern at initial referral. We identified, an unmet need for patients with reversible frailty and the importance of a close working relationship with PC Physiotherapists to ensure timely and appropriate service provision to this cohort. This audit identified two main challenges-the large geographical area currently covered and the lack of dedicated ICPOP hubs for assessment and optimal intervention.
297 Assessing continence care in a rehabilitation unit: insights from an audit
Authors: Davey N , Merron G , El Eraky N , Pereppadan B , Fallon A , McDonough A 
Published: September 2023

Abstract

Background
Urinary incontinence, a prevalent condition and one of the original geriatric giants, remains a taboo topic and is frequently underreported. Urinary incontinence significantly impacts patients and often times their discharge destination. However, urinary incontinence is neither inevitable nor always irreversible. This audit aimed to assess continence and incontinence wear in a rehabilitation facility.

Methods
The continence care quality in a medical gerontology ward was assessed using the Royal College of Physicians (RCP) National Audit of Continence Care (NACC) standard. A prospective audit was conducted over a five-day period, documenting incontinence wear and urinary continence on a medical gerontology ward. Two interventions were implemented prior to re-auditing. Firstly, continence was incorporated as a teaching topic on the Non-Consultant Hospital Doctor (NCHD) teaching schedule. Secondly, the Multi-Disciplinary Team (MDT) proforma was adjusted to include a patient-specific continence record. A snapshot re-audit was conducted to evaluate any changes resulting from these interventions.

Results
In the initial audit, 31 patients were included. Among them, 26 (83.9%) wore incontinence wear, with 21 (80.8%) voluntarily opting for it. Urinary incontinence was documented in 13 patients (41.9%). In the re-audit, 40 patients were included. Among them, 27 (67.5%) wore incontinence wear, with 19 (70%) choosing it. Urinary incontinence was documented in 18 patients (45.7%).

Conclusion
The re-audit revealed a slight decrease in incontinence wear usage (67.5% compared to 83.9% initially). Many patients wearing incontinence wear expressed a preference for it in both audit cycles. The prevalence of urinary incontinence remained similar between audits (41.9% and 45.7% respectively). The persisting prevalence of urinary incontinence calls for effective strategies to address this issue. Additionally, the patients’ preference for incontinence wear emphasises the importance of engaging not only the MDT but also the patients themselves in future interventions. Future projects should focus on gaining a deeper understanding of patients’ perspectives on continence care and evaluating the impact of incontinence on patient outcomes.
32 An evaluation of a 6 week physiotherapy strength and balance intervention for the older person in primary care
Authors: Kennedy N , Daniels M , Sayers K 
Published: September 2023

Abstract

Background
Ageing is associated with a decline in skeletal muscle mass, strength and function, resulting in sarcopenia and frailty. Guidelines for physical activity in older adults recommend multimodal exercise. The aim of this study was to evaluate a group exercise intervention for older adults attending Primary Care Physiotherapy.

Methods
Participants were over 65 years, independently mobile with or without an aid, and deemed suitable by the referring Physiotherapist. The 6 week intervention based on the Otago programme, with additional upper limb strength training. It was delivered once weekly with additional independent home sessions advised. Outcome measures included SARC-F (Sarcopenia Screening Tool), grip strength, 5 Times Sit to Stand (5XSTS), and Timed Up and Go (TUG). Data was analysed using descriptive statistics.

Results
31 participants completed the intervention (22 women and 9 men). Mean age 80 years (SD = 5.6). 52% of participants (n = 16) had a score of ≥4 greater using the SARC-F Tool indicating a need for further evaluation. The mean grip strength for women was 15.70 kg (SD 4.4) suggestive of probable sarcopenia based on EWGSOP2 definition. Mean grip for men of 29 kg (SD = 8) was within normal range. Mean TUG was 13.8 seconds, indicating falls risk. Mean 5XSTS in all age categories was lower than aged matched norms suggesting functional impairment (60–69 years = 11.14 sec, 70–79 years = 18.58 sec, 80–89 years = 17.2 sec). Following intervention, mean grip strength for men improved (33.5 kg, SD = 8.8). Mean grip strength for women improved to within normal range (18.4 kg, SD = 4.3). Mean TUG score improved to 12.6 sec. Mean 5XSTS improved but remained lower than age matched norms (60–69 years 9.84 sec, 70–79 years 16.72 sec, 80–89 years 15.52 sec).

Conclusion
The study demonstrated the accessibility, feasibility and benefits of a Physiotherapy group strength and balance intervention in Primary Care.
209 The experiences of native Irish speaking older adults in navigating healthcare services in Ireland: a generic qualitative inquiry
Authors: Breathnach C , Hynes S 
Published: September 2023

Abstract

Background
Research on the impact of language barriers in healthcare is well-developed. However, limited evidence includes the patient perspective. Furthermore, there is an absence of qualitative literature on the healthcare experiences of native Irish speaking older adults, despite the population’s recent and predicted growth. This study aims to provide insight into the healthcare experiences of native Irish speaking older adults, who dwell in Gaeltacht areas, and to explore their perspectives on what promotes or hinders their access to healthcare services in Ireland.

Methods
Participants were recruited through poster and radio advertisement. Convenience sampling was used. The researcher conducted semi-structured interviews in the Irish language with seven participants. Interviews were conducted in a health unit, audio recorded and transcribed. Data was coded using Nvivo software and analysed thematically through the Irish language. Quotations were presented in both Irish and English to illustrate findings.

Results
Participants reported their experiences of Irish healthcare services, and preferences for healthcare interactions. Shared communications preferences included using pidgin Irish, English, or interpreters. Participants preferred if healthcare providers were proficient in both Irish and English, and valued a long-standing therapeutic relationship with healthcare providers. In addition, participants commented that communicative difficulties they experienced must be exacerbated for monoglot Irish speakers.

Conclusion
Native Irish speaking older adults’ healthcare experiences aren’t ‘black and white’. Each participant had individual preferences for communication during healthcare interactions, speaking from both negative and positive experiences. To cater for the native Irish speaking older adult population in Gaeltacht areas, a consensus among participants was that healthcare providers working in these areas should be fluent in Irish and English, and have a long-term contract. This study highlights the need for language concordant care to be available for native Irish speaking older adults living in rural Gaeltacht areas, and further emphasises the importance of language concordant care for minority language speaking populations.