bluuebunny/crossref_metadata_2025_split huggingface dataset:
89 Mapping the development of education to implement National Clinical Guideline: appropriate prescribing of psychotropic medication for non-cognitive symptoms of dementia
Authors: Bracken-Scally M , Maloney P , Ward R , Farrell S , O'Dowd S 
Published: September 2023

Abstract

Background
National Clinical Guideline No. 21 (NCG No. 21; ‘Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia’) was published by the Department of Health in 2019. The National Dementia Office secured funding through the Health Service Executive National Service Plan to implement NCG No. 21.

Methods
The implementation programme for NCG No. 21 encompasses three work packages; communication and engagement, education and training, and evaluation. As part of work package two, a multi-component education package (encapsulating Facilitator education, an eLearning module and other resources) has been developed for relevant staff. This is currently being rolled out in a number of settings. An audit tool has been developed and adapted for use across settings. Process mapping of the development process of the education package was completed.

Results
It is hoped that the education package will further increase awareness of the guideline as well as embed the guideline across settings and improve the management of dementia. Audit tools and associated activities to assess compliance with the guideline will contribute to improved quality of care and will enable identification of areas for quality improvement initiatives. Process mapping outlines the various stakeholders and stages involved in the development process. Learning to date from the development of the education package, through process mapping, is presented, highlighting particular facilitators and challenges which were experienced.

Conclusion
Process mapping of the development of the education package to implement NCG No. 21 has provided valuable learning for continued roll-out, as well as for the development and roll-out of other education packages.
90 Combining scoping review and concept analysis methodologies to clarify the meaning of filial coercive control
Authors: Quinlan F , Donnelly S , O’Donnell D 
Published: September 2023

Abstract

Background
Increasingly the phenomena of non-intimate coercive control has been identified as a significant social problem experienced by older adults. This form of elder abuse occurs in relationships where there is an expectation of trust and shares many attributes with psychological elder abuse. Extensive research studies have examined how coercive control is enacted within intimate relationships. However, our understanding of how adult children employ strategies of coercive control in their relationships with their older parents is severely limited.

Methods
Scoping review and concept analysis methodologies were combined in a hybrid model to clarify and analyse the concept of filial coercive control. The framework proposed by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), guided the systematic literature review. Then, using the steps of Rodger’s (1989) evolutionary concept analysis, the antecedents, attributes, and consequences of filial coercive control were described in detail.

Results
This study has extended the theoretical framework of elder abuse by incorporating filial coercive control as a subtype of abuse experienced by older adults. The subject area is complex and heterogenous, encompassing literature generated in the disciplines of law, social science, psychology, and criminology among others. This research has enabled the construction of a theoretical conceptual boundary around the subject by identifying key concepts, theories, surrogate terms and sources of evidence of filial coercive control.

Conclusion
As an emergent topic area, the phenomena of coercive control has been subject to inconsistent terminology. The theoretical framework underpinning the literature has not always been explicitly stated leading to confusion about how the phenomena is constructed. Using scoping review and concept analysis methods, it was possible to gain a better understanding about the evolution of the concept of filial coercive control enabling us to propose a tentative operational definition.
94 Polypharmacy in older adults: the role of the advanced nurse practitioner
Authors: Alookaran S , O'Sullivan F 
Published: September 2023

Abstract

Background
Polypharmacy is the concurrent use of five or more medications and is more prevalent in the care of Older Persons. Polypharmacy is a global issue and is linked to poor health outcomes especially in Older Persons. It is estimated that 20% of people over 65 years of age in Ireland, are prescribed at least 10 drugs repeatedly and 5% are prescribed at least 15 drugs repeatedly. Prescribing and deprescribing medication is a complex process and it can be challenging for people who are over 65 years of age It is estimated that people taking more than 10 medicines are twice as likely to develop frailty; frail cohort were twice as likely to be prescribed a potentially inappropriate medication and three times likely to be admitted to hospital. Over 10% of emergency hospital admissions in this cohort were estimated to be related to adverse drug reactions. Appropriate deprescribing will improve patient outcomes and reduce healthcare costs.

Methods
The Registered Advanced Nurse Practitioner populated a database of all medications that were prescribed and deprescribed within the caseload over the two year period. STOPP/START tool was used for deprescribing.

Results
The study confirmed that Appropriate Prescribing is a person-centred intervention, which required up-to-date knowledge of the patient’s condition, review of medical notes and/or co-ordinating with Pharmacist and/or General Practitioner (GP) to obtain the full list of medication, shared decision-making, monitoring for adverse effects, monitoring laboratory values and routine follow up. Patient engagement and education was vital to achieve positive outcomes. Encouraging the use of unit dose packaging for this cohort was noted to be an effective method of medication adherence.

Conclusion
The study recommends regular medications reviews for patients on Polypharmacy. Future changes in the healthcare should include electronic prescribing, improved access to medical records for Primary and Secondary care to improve prescribing in Older Persons.
98 Bone health: managed correctly? A clinical audit
Authors: Rust G S 
Published: September 2023

Abstract

Background
Bone health is as important in the geriatric population as any other clinical system. The International Osteoporosis Foundation states that approximately 75 million people have osteoporosis across Europe, the United States and Asia. Osteoporosis and Fragility Fractures have become a common finding in presentations to general practices and emergency departments. Clinical guidelines exist with key elements to best identify, investigate, treat, and follow up these patients—but are guidelines being followed?

Methods
A clinical audit and service evaluation of patients attending a geriatric assessment and treatment clinic was compared to the new 2021 United Kingdom National Osteoporosis Guideline Group publication. The comparison between strong recommendations in these guidelines and clinical practice in patients with known osteoporosis and fragility fractures was undertaken using a self-designed matrix. 28 patient files were identified, and findings recorded.

Results
This study suggests that bone health in geriatric patients is undertreated. Only 25% of identified patients were investigated, treated, and prescribed bone health medication as per the 2021 United Kingdom National Osteoporosis Guideline Group publication. History taking regarding comorbidities, level of mobility and frailty scoring were judiciously completed across the 28-patient sample. Referrals to allied health practitioners was lacking though patient follow up was well documented.

Conclusion
The key is to identify poor bone health early, act swiftly with relevant investigations and commencing medications and preventing fragility fractures and hospital admissions. Future reviews of bone health management in the geriatric populations are still required to allow full understanding on the topic.
100 Prevalence of probable sarcopenia and associated factors in older adults undergoing Comprehensive Geriatric Assessment
Authors: Sayers K , King L , Ryan S , Harty E , Donnellan C 
Published: September 2023

Abstract

Background
Sarcopenia is a skeletal muscle disorder, underpinned by adverse muscle changes that accrue across the lifespan. It is associated with increased likelihood of falls, fractures, physical disability and mortality. Low muscle strength is a principal parameter of sarcopenia. Sarcopenia is probable when low muscle strength (grip strength) is detected. The aim of this study was to evaluate the prevalence of low grip strength in older adults referred for Comprehensive Geriatric Assessment (CGA). The relationship between grip strength and sarcopenia- related factors was evaluated.

Methods
A period prevalence study was undertaken between September 2022 and March 2023. All patients ≥65 years who underwent CGA by a Community Specialist Team were included. Grip strength was measured using the Southampton Protocol. Associated factors measured were age, gender, frailty (CFS: Clinical Frailty Scale score), risk of malnutrition (MST: Malnutrition Screening Tool), co-morbidity, cognitive change on Dementia Screening Interview (AD8), falls history and mobility impairment. Probable sarcopenia was based on EWGSOP2 definition. Descriptive statistics, odds ratio (OR) with 95% confidence intervals (CI) and cross tabulation using Persons Chi squared test were used to determine if there was correlation between probable sarcopenia and associated factors.

Results
In total, 173 people attended for CGA (69 male, 104 female), mean age was 80 years (SD =7) and the median CFS score was 5 (mildly frail). The percentage of people who had their grip measured was 84% (n = 145). The prevalence of probable sarcopenia was 52% (n = 75). A positive correlation was identified between probable sarcopenia and age (p = 0.039), Clinical Frailty Scale score (p = 0.025), mobility impairment (p = 0.033) and those reporting cognitive change (p = 0.008). A positive association was identified between those with probable sarcopenia and ≥ 6 co-morbidities (OR 2.13; 95%CI 1.1–4.2).

Conclusion
Probable sarcopenia is associated with frailty, multi-morbidity, impaired mobility and cognitive change. Grip strength can identify older people who require CGA and targeted multimodal intervention.
123 Setting up a new pathfinder service—peaks and pitfalls
Authors: O'Donoghue B , Griffin A , Meagher B , Burke D , Cox T , O'Shea T , Allen T 
Published: September 2023

Abstract

Background
Pathfinder is a team of advanced paramedics, physiotherapists and occupational therapists which responds to low-acuity 999 calls to provide alternative care pathways to hospital emergency departments. Pathfinder originated as a joint initiative between Beaumont Hospital and the National Ambulance Service (NAS). Since then, Pathfinder has been rolled out nationally with the aim of expanding the service further in the future. The geographical landscape and available acute and community services vary in each organisational context, requiring each new service to identify its needs individually. This research highlights the peaks and pitfalls of rolling out a nationwide initiative within a local context.

Methods
This new Pathfinder service implementation was structured using a Plan, Do, Study, Act Cycle. This included the development of structured organisational processes between the NAS and the hospital. The creation of terms of reference documents, relevant policies and a risk register to guide service implementation. The promotion and education of the service and appropriate referrals. The establishment of integration between the service and existing acute and community resources.

Results
A group of local stakeholders were identified and monthly operational meetings with an agreed terms of reference were set up. Relevant policies and risk registers were developed. Eleven information sessions were completed to increase awareness and to aid in discussions regarding the integration of services. Referral sources were identified, and education of the service took place through information leaflets, emails, presentations, communication and informal feedback to staff. Local referrals to Pathfinder service increased post local education by 83%. Ongoing challenges include the separate Information Technology systems and communication channels within acute and community settings.

Conclusion
Setting up national services within different organisational contexts requires further thought and consideration. Close working relationships and good communication with key stakeholders are essential in setting up services. Education and networking lead to increased awareness of the service and appropriate referrals.
138 Falls management simulation
Authors: Pierpoint R , McElwaine P , Mullen C , Varghese S , Smith A 
Published: September 2023

Abstract

Background
Simulation is a clinical education opportunity that creates an experience without having to go through a real event. Simulation facilitates a debriefing for the participants of the ‘event’. Simulations support healthcare professionals in developing knowledge and skills. Falls are common in hospital and are potentially serious events. Prompt patient post-fall assessment is important in identifying injuries, ensuring safe observations levels and taking action to prevent the next fall. Our aim was to improve post fall patient care through a Falls Management Simulation.

Methods
Falls management simulations, with a standardised patient event, took place on two Specialist Geriatric wards between February and April 2023 with 31 learners taking part consisting of CNM’s, staff nurses, healthcare assistants, and physiotherapists. Post simulation participants completed a Kirkpatrick’s level 1 and 2 evaluation.

Results
Kirkpatrick’s level 1 evaluation (feedback questionnaire) asks participants to rate eight general statements about the programme. The median outcome for each of these statements indicated participants found the simulation to be a positive learning experience. Kirkpatrick’s level 2 evaluation (self-assessment pre and post training) showed an improvement in knowledge post simulation. Participants were asked to evaluate their level of knowledge pre and post simulation from very high to very low. In the assessment of injuries post fall and, the care of the patient after an unwitnessed fall participants’ knowledge improved post simulation from a median of unsure (pre simulation) to very high (post simulation).

Conclusion
The feedback on the simulation reflected an increase in participant’s knowledge and confidence on the management of a patient post-fall. This education programme is in its early development. We aim to continually monitor and adapt the simulation to meet the learners’ needs, provide variation for repeat learners and ensure it is a positive educational experience for all.
142 Identifying common housing conditions affecting older people relevant to integrated Care for Older Persons in Ireland
Authors: Grey T , O'Donoghue J , Xidous D , Nicol S , Kennelly S , Coveney E , O’Neill D 
Published: September 2023

Abstract

Background
The health and well-being of older people is significantly affected by housing, representing an essential aspect of preventative healthcare in the community. Good quality housing is an important factor in a person’s ability to maintain mental and physical health, as well as sustain optimal quality of life. This is particularly true for older people who may spend more time at home than other demographic groups. This study explores the linkages between housing conditions and the health and wellbeing of older people with the aim to inform housing designers, providers, and policy makers about the key aspects of healthy homes and common housing hazards, affecting older people.

Methods
The qualitative research programme involved an in-depth stakeholder engagement strategy, with activities including focus groups, diaries, and interviews to place the perspectives of older people at the centre of the work. The research also included a series of case study visits to the homes of patients of an Integrated Care Programme for Older People, where the research team conducted a series of qualitative semi-structured interviews with the patient, as well as a technical and quantitative survey of the home.

Results
Key themes identified throughout the research programme include overarching themes such as healthy ageing and housing and ageing in place; themes related to the hospital and integrated care, and the local authority; housing conditions and hazards; and built environment issues across the key spatial scales.

Conclusion
There is a need for better, more accessible data on the housing issues, conditions, and hazards for older people throughout Ireland. Additionally, it is essential to consider the needs of patients with additional care requirements, such as those living with dementia, as the built environment greatly impacts them.
145 Audit of yearly prevalence of atrial fibrillation in ischemic stroke patients admitted to a level III acute Irish hospital
Authors: Sohail A A , Mergani M , Gaffney C , Varghese B , Ziya N 
Published: September 2023

Abstract

Background
Global AF burden in acute ischemic stroke patients is studied in some evidence at 30%, with similar results in Ireland. We therefore sought to perform an audit of prevalence of atrial fibrillation in acute ischemic stroke patients in a level III hospital in republic of Ireland, to study its comparability with available evidence nationally and internationally.

Methods
The study was retrospective observational audit study of all patients admitted with a diagnosis of acute ischemic stroke to the concerned hospital from January, 2022 to December, 2022. Patients were identified via their diagnosis recorded in HIPE coding and in-hospital stroke registry. All patients with the diagnosis of acute ischemic stroke were screened for presence of atrial fibrillation via 72 hours R-testing. Data was collected via charts review and R test result review, compiled via flow charts, graphs and excel sheets, and studied.

Results
156 patients were admitted to the hospital’s stroke service with ischemic stroke in the set time frame. 41% (N = 65) had Atrial Fibrillation (AF) which was deemed to be the cause of their stroke. 18% (N = 29) had newly diagnosed Atrial fibrillation. 23% (N = 36) had known AF. In those with known AF (N = 36), 13.8% (N = 5) were not on anticoagulation, 58.3% (N = 21) were on the adjusted dose, and 27.7% (N = 10) were not fully compliant. All new and existing AF patients not anticoagulated, were commenced on anticoagulation.

Conclusion
The audit shows that total atrial fibrillation burden and rate of pick-up of new atrial fibrillation in the acute ischemic stroke patients in the concerned hospital, were comparable to international evidence. Under dosage and poor compliance were major causes of anticoagulation failure in patients who were anticoagulated with known AF.
150 Strengthening community bonds to support older people: a dynamic partnership between ALONE and the GAA
Authors: Rooney P , Clarke R , Moloney S , Regan C , O'Reilly A 
Published: September 2023

Abstract

Background
The GAA and ALONE were both members of a multi-sectoral COVID-19 Community Response Team that worked to ensure all vulnerable members of communities affected by the pandemic were appropriately supported. Subsequently, ALONE and the GAA entered a formal partnership with the aim of improving understanding of older people’s needs, building local capacity to support older people, and raising awareness of ALONE services. As part of this collaboration, ALONE delivered a series of information and awareness events via the GAA Heathy Club initiative in nine locations across Ireland. The GAA also ran a pilot exercise programme in their Connacht GAA Centre of Excellence for older persons to improve their cardiovascular health and wellbeing.

Methods
Attendees at information and awareness sessions were asked to fill in a short survey about their satisfaction with the event, awareness of ALONE services, and whether the event had enhanced their intentions to support older people. Club coordinators were also invited to complete a short survey to provide feedback on organising the event and willingness to host similar events in the future.

Results
Overall, over 200 people attended the nine events, held in a mix of urban/rural locations: 81 attendees and six club coordinators responded to the survey. Feedback from attendees was very positive; all indicated they were more likely to support older people in their community while club coordinators indicated they were likely to host a similar event in the future. A small increase in referrals to ALONE services was observed after the event.

Conclusion
This project demonstrated there is substantial demand within local communities for support services for older adults, and a real willingness among communities to support this group. Services need to ensure they respond to this need but should also focus efforts on building capacity in local communities to support older people.
161 Mapping and analysing outpatient clinics for a quality improvement
Authors: Marion I , Power D 
Published: September 2023

Abstract

Background
Due to the increasing prevalence of chronic non-communicable illnesses for a growing, ageing population, the outpatient clinic has to be efficient to cope with the demand. It creates a logistical challenge on top of a complex operation.

Methods
Quality improvement project management was designed and executed in an outpatient Clinic in North Dublin with a capacity of 400–450 patients per month between October 2022–May 2022. Key concepts of operation management were utilised, including process mapping and run charts. Problem areas were identified using TIMWOODS (Transportation, Inventory, Motion, Waiting, Overproduction, Overprocessing and Defects) framework. A few main problems were addressed, including lost clinicians’ time to session start late and finish early, high variability of patient waiting time, and carrying out additional investigations that are not needed. Key stakeholders were identified and approached, including frontline staff, managers and patients. The QI team focused on one problem, specifically on the cohort of patients who missed the appointment or came to the appointment outside the allocated time using the DMAIC (Define, Measure, Analyse, Improve and Control) Six Sigma tool. An appointment reminder system was established, including a short messaging system and a quick phone call 24 hours before the clinic. A month of baseline data was collected, presented, followed by three months of intervention. A pre and post-descriptive analysis Fischer Exact test was applied.

Results
There was a significant improvement in patients attendance from 69% to 82% (p &lt; 0.05).

Conclusion
A QI team identified a few problem areas utilising lean six sigma tools. A simple, cost-effective intervention of appointment reminder systems was carried out. Continuous, incremental quality improvement is an ongoing process to ensure sustainability. There is a need to engage with the main stakeholders, exploring their valuable opinion and increasing their engagement (Gemba walk).