bluuebunny/crossref_metadata_2025_split huggingface dataset:
317 Analysing the social history aspects of an integrated care comprehensive geriatric assessment incorporating patients views and wishes
Authors: Lynch A , Dennehy K , Reddin C , Costello M , Canavan M , Murphy R 
Published: September 2023

Abstract

Background
An evaluation of social well-being is an important component of a Comprehensive Geriatric Assessment (CGA). There is no clear guidance about how best to structure and examine these factors as part of a CGA. We sought to examine current practice with respect to the collection of information from a social care perspective across different integrated care CGA proformas.

Methods
We completed a cross sectional study of the social care domain of integrated care based CGA proformas. All operational leads for each integrated care hub in the country were contacted and invited to share their local CGA. We completed a thematic analysis of the social care section including social, financial and wellbeing assessments.

Results
We included 16 different CGAs that are in use across different integrated care hubs. All CGAs had a dedicated section for assessing social history with variability in what was included in different CGAs. Patient’s wishes and expectations were commonly included but the manner in which they were collected and emphasis varied. 7 (43%) specifically captured whether the patient has an enduring power of attorney in place, 5 (31%) collected information about formal advanced care directives, and 2 (12%) enquired about nominated assisted decision makers. Ability to manage finances was captured through the Lawton Brody IADL scale in two CGAs. Half of CGAs included a section to capture carer strain and the term ‘next of kin’ was used in 6 of 16 CGAs.

Conclusion
There is significant heterogeneity in the structure of the social care section of a CGAs across different integrated care hubs, particularly with respect to capturing information surrounding advanced care planning. Signposting of patients’ wishes and expectations was useful for focusing on patient-centred care.
324 Statin prescribing in ischaemic stroke patients: quality improvement of an acute stroke ward in a model 4 tertiary teaching hospital
Authors: Ahern E , Dennehy K , Gannon E , Rubel M H , Ryan P , Healy L 
Published: September 2023

Abstract

Background
Stroke remains the leading cause of long-term disability. High cholesterol is associated with increased risk of stroke. Treatment with high intensity statins, as recommended by the SPARCL trial, is effective in reducing recurrence risk. The Medicines Management Programme recommends atorvastatin as the preferred drug, which can be given at any time of the day. With the majority of medications administered in the morning, clustering of medications is associated with higher adherence rates. Low statin adherence is associated with greater risk of death.

Methods
A point prevalence audit was carried out in an dedicated stroke ward in a tertiary model 4 teaching hospital. The data collected included sex, age, number of days since admission, pre-admission statin administration, current statin prescribed, dose, time of administration and change in current vs pre-admission prescription. Results were collected, analysed and compared with the above evidence.

Results
21 inpatients with ischaemic stroke were included. Age ranged from 36 to 89 years, with a mean age of 73. 52% were female. Number of days since admission ranged from 1 to 165, with an average of 48. 13 patients were taking a statin prior to presentation, and 19 at time of data collection. Prescribed statins included atorvastatin and rosuvastatin. 76% had a change in statin type or dose during admission. 95% of patients were prescribed their statin at night time.

Conclusion
Appropriate statin prescribing is an essential part of secondary prevention. Long acting statin should be prescribed at a time that optimises compliance. We hypothesise that long acting statins including atorvastatin/rosuvastatin when given in the morning with other medications will increase compliancy. In line with the PDSA cycle, a planned education session, in conjunction with the pharmacy department, will take place focusing on atorvastatin/rosuvastatin prescribing, with re-audit following this, to ensure sustained change in practice.
325 Demographics of patients presenting to the Rapid Access Frailty Assessment Unit (RAFAU) in a regional hospital in 2023
Authors: Sibthorpe L , Conroy K , Goulden E , Donnelly T , McGlynn J 
Published: September 2023

Abstract

Background
The RAFAU is a five-day rapid-access, multidisciplinary service including Medical, Physiotherapy and Occupational therapy. The aim is to improve biopsychosocial outcomes and ultimately avoid hospital admission. It opened in May 2021 and an expansion of service provision has occurred since then based on ongoing service evaluations.

Methods
Data was manually recorded each day from an existing proforma on Excel, allowing for analysis to be done for the dates including 03/01/2023 to 22/05/2023.

Results
202 attendances were recorded. Similar numbers were seen in the age groups 70–75 (20.3%), 76–80 (22.8%), 81–85 (19.3%) and 86–90 (21.8%) with smaller numbers in those &lt;70 (9.9) and over the age of 91 (5%). 1 person’s age was undocumented. Approximately 40% of attendees were male and 60% were female. 38.6% of patients had a CFS of ≤3. 55.9% had a CFS of 4–6. 4% had a CFS of ≥7. The reasons for referral included medical review (38.6%), mobility and falls (36.1%) and cognition and memory (23.3%). GP’s referrals totalled 66.8% with other sources of referrals including the Emergency Department (ED) and Rapid Access Frailty Team based in the ED (21.8%), Hospital Consultants (7.4%) and allied health practitioners (4%).

Conclusion
The RAFAU provides an important and timely service to the catchment area of the regional hospital, particularly in assistance to primary care and community services. Only a small number were below the age of 70 or above the age of 90. Approximately 60% were of moderate to severe frailty. As the number of attendances increase, the service provision in RAFAU as well as community services may require further expansion.
333 Integrated care and impact on length of Time-At-Home, a retrospective cohort study
Authors: Loughlin E , Murphy R , Canavan M 
Published: September 2023

Abstract

Background
The Integrated Care Programme for Older People (ICPOP) shifts care from unscheduled hospital attendance to planned ambulatory community care. The impact of these services should be measured to inform service delivery in the provision of sustainable healthcare for older adults. We aimed to measure the average Time-At-Home for patients attending an ICPOP service. Time-At-Home was defined as the time from review to next unscheduled attendance.

Methods
A retrospective cohort study was carried out on consecutive attendances at the ICPOP service, between January–March 2023 inclusive. Electronic health records of the Comprehensive Geriatric Assessment were reviewed and any subsequent unscheduled hospital attendance at our institution were recorded to measure the length of Time-At-Home for each patient (days). Predictors of longer Time-At-Home were calculated by regression analysis.

Results
191 patients were analysed, 56% female (n = 107), mean age 81.9 years (SD 6.5), 82.7% GP referrals (n = 158). Reasons for referral included memory assessment (n = 90), falls (n = 43), frailty (n = 28), decreased mobility (n = 12), Parkinson’s disease (n = 6), home supports (n = 4) and miscellaneous (n = 8). Mean Clinical Frailty Score (CFS) was 4.72 (SD 1.6), median number of medications was 9 (IQR 5). Median duration of follow-up was 109 days (IQR 61 days). 25.7% (n = 49) of patients were admitted during period of follow-up. Reasons for attendance included delirium/memory-related issues (n = 4), falls/pre-syncope/syncope (n = 13), infection (n = 12), mobility (n = 4) and miscellaneous (n = 17). Those admitted were more likely have been referred from an acute hospital service (p = 0.03), had higher Clinical Frailty Scores (CFS) (p = 0.02) and higher degrees of polypharmacy (p = 0.01). Median length of Time-At-Home was 61 days (IQR 91). There was no difference in length of Time-At-Home by age, CFS or number of medications.

Conclusion
Reasons for and predictors of acute hospital attendance following ICPOP review are important to measure. This will inform the delivery of services going forward and areas to address to further reduce acute hospital attendance rates.
346 The Bons effect—evaluation of the Frailty Service provision in Bons Secours, Galway
Authors: Okpaje B , Carty J , Raftery A , Scanlon K , Gill E , Hegarty V , Mullane D 
Published: September 2023

Abstract

Background
The Frailty Service in the Bons Secours Galway was created following the Covid pandemic. It is a 15-bed unit led by 2 consultant geriatricians and their team. NICE published guidelines in September 2016 for Clinical Assessment and management of multi-morbidity, where they advised on approaches to care of the older person. This included individualised management plan that incorporate non-pharmacological treatments. We aimed to evaluate the non-pharmacological intervention of the multi-disciplinary team input during the inpatient stay and assessed the result of same, using the outcome of discharge destination.

Methods
We reviewed the electronic records of all patients admitted to the Bons Secours Frailty service within November 2020 and January 2023, evaluating the input of the Occupational Therapist (OT) in their management plans. We assessed the core OT assessments (which included functional, cognitive, environmental/social assessments, and liaison with community services) and rehabilitation delivered in the frailty unit. Considering that the OT also covered the discharge planning of the patients, we therefore assessed the discharge destinations of the patients as a secondary outcome.

Results
Of the 434 total admissions, of which the average age was 84 years with 37% males and 63% females, OT reviews were performed in 100% of patients. The waiting time was &lt;24 hours from admission. An average of 2.5 interventions were performed per patient, with Core OT assessments carried out in all cases. 82% required cognitive assessments. 10% required home visits. 61% of patients required equipment on discharge. Of the 434 patients, 78.1% returned home (of which 92% required a home care package), 5.06% transitioned to Respite, 9% required Long-Term Care placement and 1.6% were re-admitted to hospital.

Conclusion
Our findings of the Frailty service provision in Bons Secours reflect the importance of a specialist geriatric service and multi-disciplinary team in producing favourable outcomes for the older person who often have multi-morbidities and are vulnerable.
106 Older adults’ perspectives on participation in a community arts-based programme (Music and Movement for Health): a qualitative study
Authors: O'Reilly S , Fitzell C , Bhriain O Ni , O'Malley N , Cheung P-S , Byrne S , Moss H , Thabane L , O’Neill D , Glynn L , Gowran R J , Woods C B , Maher C , Louw Q , Clifford A M 
Published: September 2023

Abstract

Background
Ireland, like most counties worldwide, has an ageing population. It is estimated that there will be greater than one million older adults by 2031, demonstrating an increase from 13% (2015) to 20% of the overall population. Physical inactivity, which increases with age, is associated with greater multimorbidity, mortality and economic burden. Arts-based exercise programmes are an emerging area of preventative healthcare. The aim of this study was to explore the opinions and experiences of older adults on Music and Movement for Health (MMH), a tailored arts-based exercise programme.

Methods
An embedded qualitative study was conducted among older adults who participated in MMH. Data were collected through four focus groups (n = 33) and telephone interviews (n = 5). Data were analysed inductively using thematic analysis.

Results
Three overarching themes were developed; ‘Encouraging Exercise Through the Arts’, ‘Socialising in the Community: Experiences and Influences’, and ‘Coming to Terms with Retirement’, with a total of six subthemes. Participants recognised that MMH was a novel and unique programme and were attracted to MMH due to an interest in music and dance. The behaviour change techniques facilitated exercise habit formation. Through MMH, participants were able to interact with others in the community and, for some, this led to new connections within the group. Finally, the findings highlight the experiences of participants who stated they faced significant changes to their lives following retirement; however, participating in MMH provided structure to their lives.

Conclusion
The inclusion of music and dance into an exercise class was desirable to many older adults and promoted exercise habit formation. Overall, MMH appears to be an enjoyable programme which had positive perceived effects on mental and physical health. MMH is a unique evidence-based programme designed with input from key stakeholders, and community-dwelling older adults can potentially benefit from this intervention across the country.
200 Higher bone mineral density in prediabetes, diabetes and with increasing HbA1c in older Irish adults: results from the TUDA study
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
Patients with type II diabetes have higher Bone Mineral Density (BMD) but paradoxically have an increased fracture risk. However, less is known about the relationship between prediabetes and BMD or fracture risk. We aimed to evaluate the relationship between pre-diabetes, diabetes, HbA1c and BMD in older Irish adults.

Methods
Study participants were from a large cross-sectional study of adults aged &gt;60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Patients on treatment for osteoporosis, current or previous long-term glucocorticoids, aromatase inhibitors or androgen deprivation therapy were excluded. Diabetes was defined by self-report, use of diabetic medications or HBA1c ≥6.5% and after excluding same, prediabetes was defined as a HbA1c of 5.7–6.4%[1]. BMD was measured by DXA at the total hip and lumbar spine. The relationship between prediabetes, diabetes, HbA1c and BMD was explored in regression models.

Results
There were 2,127 participants and mean age was 70.0 ± 6.5 with 57.9% female. 17.7% had diabetes and 26% prediabetes. Compared to normoglycaemic participants, diabetics had higher BMD at the hip (p &lt; 0.001) and spine (p = 0.007) and prediabetics higher BMD at the hip (p &lt; 0.001) after adjusting for age, sex, body mass index, serum vitamin D, eGFR, smoking, alcohol intake and timed up and go. In multivariate analysis, increasing HbA1c in non-diabetics was also associated with greater BMD at the hip (p = 0.001) but not the spine.

Conclusion
This study demonstrates that BMD is increased in older adults with both diabetes and prediabetes and with increasing HbA1c in non-diabetics. Despite this, BMD is known to underestimate fracture risk in diabetics where a lower treatment threshold for starting osteoporosis medications is recommended. This might also hold true in prediabetes where altered BMD could affect material bone quality and fracture risk though studies are conflicting and more research is required.
214 A single-site retrospective review of In-Hospital Stroke
Authors: Chapman L , Kennnedy O , Bradley D , Harbison J 
Published: September 2023

Abstract

Background
In-Hospital Stroke (IHS) is defined as a stroke occurring while in hospital for another diagnosis. IHS represent a distinct cohort with greater deficits, higher mortality rates, and are less likely to be discharged home compared to Community-Onset Stroke (COS).

Methods
A retrospective cohort study was performed in an acute teaching hospital from January 1st 2020 to December 31st 2021 to compare quality of care and outcome measures of IHS cases with COS counterparts. Stroke cases were identified from the hospital database submitted to the Irish National Audit of Stroke (INAS) during the 2-year period. Descriptive statistics were calculated. Categorical variables were compared using Chi Square.

Results
Of the 563 stroke cases during the 2-year period, 15% (n = 88) reflected an IHS event. The median age observed in IHS and COS cohorts was 73 and 72 years respectively. COS patients were more likely to have no disability pre-stroke when compared with IHS patients (47% versus 30%, p = 0.006). Over half (52%; n = 46) of IHS patients were admitted to the intensive care unit (ICU) during their hospital admission (p = &lt;.0001).Co-diagnosis with COVID-19 was more common among IHS than COS (9% versus 1%; p = 0.0003). The proportion of patients receiving thrombolysis was greater in the COS cohort compared to IHS cohort (12% versus 7%; p = 0.06). Fifteen percent (n = 13) of IHS cases died compared with 12% (n = 56) of COS. IHS cases were more likely to be discharged to long term care (LTC) (8% versus 3%; p = 0.04), have moderate/severe disability (38% versus 24%; p = 0.001) and have longer length of stay (LOS) (43% versus 4%; p &lt; 0.0001) when compared with COS counterparts. COS cases were more likely than IHS cases to be admitted to the stroke unit (SU) (79% versus 43%; p &lt; 0.0001). Swallow screening was performed more frequently on the COS cohort (76% versus 50%; p &lt; 0.0001).

Conclusion
IHS represent a distinct stroke subgroup in terms of outcomes and performance on stroke quality of care measures.
314 Cross-sectional analysis of patient cohort transferred to a transitional care unit under a new service model
Authors: Dennehy K , O’Donovan C , Fitzgerald R , Plant R , Rynne R , Faez I , Horgan A , Ahern E , Jennings E 
Published: September 2023

Abstract

Background
Currently in Ireland a proportion of hospital inpatients avail of ‘transitional care funding’ which has been in place in the HSE since 2015.The funding supports patients who are awaiting long term care placement or who require a convalescent period up to six weeks prior to discharge home. The aim of this project was to analyse the patient cohort transferred to the Transitional Care Unit (TCU) during a newly trialled model of care where a consultant geriatrician co-ordinated patient care. This new model aims for best practice by synchronising patient care through assessment, care planning, treatment, discharge planning and education.

Methods
We did a cross sectional analysis of the patient population who transferred from our model 4 tertiary hospital to the TCU under the new model of care over a 6 month period assessing their inpatient stay and discharge destination.

Results
78 patients were transferred under the new model of care to this TCU unit. Patients were transferred from the emergency department (N = 1), medical (N = 55) and surgical teams (N = 22). 27% (N = 21) of patients had a documented cognitive impairment on admission to TCU, further testing was completed during inpatient period in TCU and a further 20% (N = 14) of patients had cognitive impairment identified. Bartel scores increased from admission to discharge with 54% of patients (N = 42). 62% went directly home or home with a home care package (N = 48), other discharge destinations from TCU included rehab or long term care.

Conclusion
This cross sectional analysis identifies the baseline characteristics of patients transferring into transitional care. This patient population remains vulnerable with significant number having cognitive deficits. Transitional care placement influence outcomes for older persons including returning home. Our study highlights that oversight and advocacy for patients entering transitional care is essential to optimise care.
320 AKI-ng for better adherence: a quality improvement initiative on the medication ‘sick day rule’ in patients over 65 with acute kidney injury (AKI)
Authors: McManus C , Neves R , Rajan M , Rme R 
Published: September 2023

Abstract

Background
The successful mitigation of Acute Kidney Injury (AKI) among older patients is contingent on meticulous medication management, specifically adherence to the medication ‘sick day rule’. These rules, recommended by the National Institute for Health and Care Excellence (NICE) in their guidelines ‘Acute kidney injury: prevention, detection and management’, involves the temporary cessation of certain medications during episodes of acute illness. However, suboptimal adherence to this rule presents a considerable challenge in clinical practice. This quality improvement project aimed to address this issue, seeking to enhance adherence to the sick day rule among patients over the age of 65 admitted with AKI.

Methods
Initially we performed a medication reconciliation on all patients admitted to the medical take over a five-day period. Our intervention involved the distribution of information cards that clearly detailed the NICE guidelines. The cards were displayed prominently in key medical admission areas and could attach to doctors’ identification badges. We also provided education to Non-Consultant Hospital Doctors at Grand Rounds.

Results
Data collected revealed that of the 92 patients over 65 admitted, 27 met the AKI criteria. 23 of these 27 AKI patients were on medications that could exacerbate their AKI, while only 6 had all appropriate medications held. This trend extended to specific medication categories: only 8/19 patients on ACE inhibitors/ARBs, 1/5 on SGLT2 inhibitors, and 4/9 on metformin had their medication held. However, both patients on NSAIDs had their medication held, indicating a better adherence rate.

Conclusion
The goal of this quality improvement initiative is to bolster adherence to the medication sick day rule, thereby potentially reducing the incidence and severity of AKI in our older patient population. We plan to reaudit in the coming weeks to assess the impact of our intervention, affirming our ongoing commitment to improving patient outcomes through evidence-based quality improvement strategies.
Effects of defoliant exposure and medication use on the development of Parkinson’s disease in veterans
Authors: Song Seulki , Kim Jun Y , Lee Young , Jeong Hyokeun , Kim Seungyeon , Lee Eunkyung E 
Published: September 2023

Abstract

Background
Vietnam-era veterans were exposed to Agent Orange (AO), which is associated with a high prevalence of Parkinson’s disease (PD). However, little is known about the development of PD-like symptoms caused by drug-induced parkinsonism (DIP) in such populations. This study aimed to investigate PD incidence and PD risk following exposure to AO or DIP-risk drugs in veterans.

Methods
A retrospective cohort study was conducted using 12 years (2009–2020) of electronic medical records of the Veterans Health Service Medical Center, the largest Veterans Affairs hospital in South Korea (n = 37,246; 100% male; age, 65.57 ± 8.12 years). Exposure to AO or DIP-risk drugs, including antipsychotic, prokinetic, anti-epileptic, dopamine-depleting and anti-anginal agents, was assessed in veterans with PD, operationally defined as having a PD diagnosis and one or more prescriptions for PD treatment. The PD risk was calculated using multiple logistic regression analysis adjusted for age and comorbidities.

Results
The rates of DIP-risk drug use and AO exposure were 37.92% and 62.62%, respectively. The PD incidence from 2010 to 2020 was 3.08%; 1.30% with neither exposure, 1.63% with AO exposure, 4.38% with DIP-risk drug use, and 6.33% with both. Combined exposure to AO and DIP-risk drugs increased the PD risk (adjusted odds ratio = 1.68, 95% confidence interval, 1.36–2.08, P &lt; 0.001).

Conclusions
The PD incidence was 1.31 times higher with AO exposure alone and 1.68 times higher with AO exposure and DIP-risk drug use. The results suggest the necessity for careful monitoring and DIP-risk drug prescription in patients with AO exposure.