bluuebunny/crossref_metadata_2025_split huggingface dataset:
213 A Frailty Intervention Therapy Team (FITT) trialling extended hour’s service within a level 3 Emergency Department
Authors: Bell A , Murphy K 
Published: September 2023

Abstract

Background
Older adults with frailty in the Emergency Department (ED) often present with complex needs requiring a holistic approach to their care. Research has shown the effectiveness of Frailty Intervention Therapy Teams (FITT) in the ED to help reduce hospital admissions as well as improve patient and staff satisfaction. Majority of these teams are working standard working hours with many complex patients presenting outside of these times. The aim of this trial was to assess the benefit of providing this service to older adults that present later in the day.

Methods
Over a one month period an extended hour trial was completed by the 2 Physiotherapists on the FITT which included cover until 6 pm Monday- Friday. The FITT takes a blanket referral system for those ≥75 who present to the ED and all patients reviewed received a routine interdisciplinary assessment.

Results
Over the month 244 patients were screened by FITT with 18%(n = 44) of the patients screened in the extended hour period. This was an increase in patients assessed compared to the previous month (n = 191). Of these patients 80% were deemed frail (Clinical Frailty Score 4–7). We assessed 55%(n = 135) of patients within 2 hours of presenting to ED compared to 50%(n = 95) in the previous month. Of the patients seen in the extended time frame 32% (14) were discharged directly home & 40% (n = 6) were discharged with a new community referral. The admitted patients had an average length of stay(LOS) of 6.5 days compared to the hospital average length of stay of an admitted patient (10 days).

Conclusion
Providing an extended hours service enables a larger proportion of frail older adults to be assessed by the FITT. This facilitates an earlier supported discharge and if admitted improve their outcomes while in hospital.
224 Profiling the first service users of a Community Specialist Team for older persons: a retrospective chart audit
Authors: Wade R , Burke K , Connolly W , Devitt A , Dore F , Ciuba D , Cooney F 
Published: September 2023

Abstract

Background
Community Specialist Teams (CST) are a promising approach to reduce reliance on acute care and improve healthcare delivery for older people. This study aimed to profile the initial cohort of service users to a CST as part of the National Integrated Care Programme for Older Persons (NICPOP), focusing on those who sought assessment through a newly established ambulatory hub or home visits.

Methods
Using a comprehensive retrospective chart audit, data from 70 service users assessed and discharged during the team’s first year were analysed using Microsoft Excel.

Results
The median age of clients was 80, with a range of 66 to 92, and 51% were female. The Clinical Frailty Scale (CFS) scores ranged from 1 to 7, with a median of 5. Notably, 80% of service users were classified as frail, as indicated by a CFS score of 5 or higher (36% CFS 5, 33% CFS 6, and 11% CFS 7). Additionally, 23% of the service users lived alone. The most common reasons for referral included functional decline (77%), post-stroke rehabilitation (9%), non-injurious falls (7%), and injurious falls (7%). Geographically, the two Community Healthcare Networks (CHNs) showed a distribution of 56% and 44% respectively. The average length of stay (LOS) of 10 weeks service exceeded the target duration of six weeks.

Conclusion
Overall, our findings confirm that the CST effectively targets the appropriate cohort in accordance with the NICPOP framework. However, the study highlights an extended LOS, surpassing the intended duration. It is crucial to identify potential contributing factors to this increase, such as challenges in accessing equipment, increased frailty, and the impact of remote addresses. To optimise service delivery, further research should prioritise investigating these factors, enabling the development of targeted interventions. The insights gained from this study lay the groundwork for future initiatives aimed at enhancing the quality of care for older people.
261 Perceptions of and attitudes towards problematic polypharmacy and prescribing cascades in older adults: a stakeholder analysis
Authors: Jennings A , Doherty A , Clyne B , Boland F , Moriarty F , Fahey T , Kennelly S , Wallace E 
Published: September 2023

Abstract

Background
Research to date on appropriate prescribing in older adults has focused on characterising inappropriate prescribing using explicit prescribing indicator tools. Less is known about other causes of problematic polypharmacy such as prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat or to prevent the symptoms of an adverse drug reaction and may be characterised as intentional or unintentional, as well as appropriate or inappropriate. Prescribing cascades, therefore, represent an important and under-researched area of problematic polypharmacy. The aim of this study was to conduct a stakeholder analysis (patients with polypharmacy; carers; General Practitioners [GPs]; hospital doctors; community pharmacists; professional organisation representatives and policymakers) to elicit perceptions of and attitudes towards problematic polypharmacy, with a focus on prescribing cascades.

Methods
Qualitative one-to-one semi-structured interviews were conducted. Participants were recruited via a gatekeeper approach. Interview duration ranged from 58 to 80 minutes. Interviews were analysed thematically.

Results
Thirty-one participants (six patients, two carers, seven GPs, eight community pharmacists, four hospital doctors, two professional organisation representatives, and two policy makers) were interviewed. The challenges of communication at the interface of primary and secondary care were outlined, including the lack of clear ownership of drug monitoring. The community pharmacist and, at times, the patient were relied upon to fill in these gaps in communication. Patients discussed the burden of taking multiple medications. GPs described the importance of ‘mindful prescribing’ to avoid, where possible, unintentional prescribing cascades. The need for further education for health care professionals and patients on prescribing cascades was highlighted, as was the importance of improved collaboration between health care professionals.

Conclusion
Understanding the perceptions of different stakeholders towards problematic polypharmacy and prescribing cascades is key to the development of effective tools or resources to improve patient care.
278 Avoiding acute hospital admission through rapid access rehabilitation pathways for frail older patients through cross site integrated working
Authors: Magner S , Glynn M , Whelan M , Daly C , Callaly L , Purcell R , Byrne C 
Published: September 2023

Abstract

Background
Ireland’s population is ageing. Patients over 65 use over half of inpatient hospital beds. Prolonged Length of Stays (LoS) in ED and hospital increase risk of adverse outcomes. Barriers like complicated referral systems, ineffective communication across sites and reduced awareness of services contribute to delays in accessing timely rehabilitation. Aims include: (1) Establish alternative care pathways between ED, rehabilitation and community settings for frail older people; (2) To use a comprehensive geriatric assessment (CGA) as a single referral form.

Methods
Patients were identified in ED as suitable for direct transfer to rehabilitation, or discharge home with Community Specialist Team—Older People (CST-OP). The CGA was accepted as the handover document to all services. Patients in the community deemed to have increased rehabilitation needs could be admitted directly into inpatient rehabilitation. We analysed data from July to December 2022 for the ED, two rehabilitation sites, and the CST-OP.

Results
Patient were aged 66–101. The ED team saw 1,691 patients, 3.5% (n = 56) were transferred to offsite rehabilitation, and 3.7% (n = 63) discharged to the CST-OP. 69 patients were admitted across two rehabilitation units. 33% of patients seen in ED had evidence of a cognitive impairment, compared to 70% in rehabilitation. Approximately 80% of patients in rehabilitation had a Clinical Frailty Scale (CFS) of ≥5, compared to 60% ED patients. 16 patients represented to ED within seven days. On discharge from rehabilitation, 42% of patients required increased formal supports, compared to 3% from ED. Five patients discharged to the CST-OP required admission to inpatient rehabilitation. Average LOS for the rehabilitation units were 46 and 39 days. 9% of patients transitioned into nursing home care.

Conclusion
Shared clinical governance among geriatricians in different services facilitated integrated working of MDTs across sites. The teams have implemented end to end care pathways integrating front door frailty services, CST-OP and existing rehabilitation services.
281 Side-effects associated with IV Zoledronic Acid infusion in patients with osteoporosis
Authors: Maher N , Fallon N , Caraher J , Steen G , O’Carroll C , Fitzgerald D , McCarroll K , Lannon R 
Published: September 2023

Abstract

Background
Osteoporosis is a common condition affecting bone, leading to fragility and fractures. Oral bisphosphonates are the first line treatment for osteoporosis reducing vertebral, hip and non-vertebral fractures. However poor compliance and Gastro-Intestinal (GI) intolerance result in poor persistence. Intravenous Zoledronic Acid (IV ZA) is an effective alternative therapy, improving compliance and tolerability. Side effects have been reported such as fever, flu-like symptoms, myalgia, arthralgia, headache, uveitis, iritis and hypocalcaemia.

Methods
This prospective observational study was carried out in a dedicated Bone Health Service. Patients diagnosed with osteoporosis were assessed by the Bone Health team regarding suitability for IV ZA. Infusions were administered in a nurse-led IV ZA clinic. Pre and 1-week post infusion bloods including Renal, Liver and Bone profile, Parathyroid hormone, Vitamin D and bone markers- Osteocalcin, CTX, PINP were taken. Side effects post infusion were recorded.

Results
N = 189. 161:28 female to male ratio. Age range 32-90 years, median 61 years. All diagnosed with osteoporosis in hip and/or spine. Forty-three percent were bisphosphonate naïve. 51 (27%) attended GP for post infusion bloods while 7 patients received infusion while inpatients. 29% of those returning to clinic for post infusion bloods reported side effects. Treatment naïve and treatment experienced reported similar rate of side effect 21%/20% respectively. Most common side effects include flu-like symptoms (31%) with fatigue/tiredness/generalised aches and pains/GI upset 16% respectively. 10% reported headaches while 5% experienced sore/swollen eyes. Rash, swollen joints and pre-syncope experienced by 3% respectively. Symptoms resolved after 24-48 hrs.

Conclusion
IV ZA is a well-established treatment for osteoporosis particularly for patients intolerant or poorly compliant with oral bisphosphonate therapy and an accepted treatment to close-off Denosumab. According to our study IV ZA is well tolerated with self-limiting side effects. However, pre infusion screening is essential to deem suitability.
330 Evaluating anticoagulant prescribing errors in older adults in a rehabilitation setting
Authors: Merron G , Killeen E , Davey N , Pereppadan B , Fallon A , McDonough A 
Published: September 2023

Abstract

Background
Anticoagulant use is common in older adults for the prevention or treatment of a number of conditions, most commonly Venous Thrombo-Embolism (VTE) or to prevent stroke in atrial fibrillation. Our audit aimed to review anticoagulation prescribing practices, identify errors and areas for improvement.

Methods
The initial retrospective audit of all inpatients in a medical gerontology ward took place from 15/11/2022–30/12/22. Data collected included age, sex, weight, renal profile, anticoagulation type, dose and indication. Information was collected from medication records, clinical notes and online laboratory system. After initial audit, multiple education sessions were conducted with the medical team. Re-audit of all inpatients occurred from 05/04/2023–25/04/2023. The guidelines used were the HSE Prescribing Tips for Anticoagulation and local Hospital Guidelines on VTE prophylaxis.

Results
The initial audit of 73 patients showed 15% (11) rate of prescribing error with 7 subtherapeutic and 4 supratherapeutic doses. Of these 11 errors, 4 doses were corrected recently prior to audit. Average age was 82.6 (64–100) and 55% (40) were female. The re-audit of 51 patients showed the rate of error improved to 7.84%(4) with 4 supratherapeutic doses. 1 dose was corrected on admission and 5.88%(3) required dose adjustment due to fluctuations in weight and renal function throughout admission. Average age was 83.1(66–103) and 69%(35) were female.

Conclusion
The re-audit demonstrated ongoing education sessions reduces prescribing error with a 48% reduction. However ongoing monitoring throughout admission is required to account for fluctuations in weight and renal function. Suggestions for further improvements include ongoing regular education sessions with the medical team. Further sessions are planned with the wider multidisciplinary team members to highlight importance of regularly monitoring weight and renal function and medication dosages. This audit also reinforces the importance of the role of pharmacist in the multidisciplinary team in Rehabilitation Units and would support regular pharmacist input on an regular basis.
348 Capturing the impact of an occupational therapy led falls education group with a client-centred and peer-learning approach on older inpatients
Authors: Ward K 
Published: September 2023

Abstract

Background
Falls and fall-related injuries have negative impacts on functional independence and quality-of-life. The risk of falling increases with age with a third of older people falling yearly. Falls can often be prevented. Research from the most up-to-date World Falls Guidelines, emphasises the significance of adopting a client-centred approach on falls efficacy. It highlights engaging with client’s attitudes and priorities about falls, along with utilising standardised outcome measures. A weekly Cccupational Therapy (OT) led evidence-informed falls education group is run weekly with older adult inpatients in a Dublin hospital. The group is informed by the World Falls Guidelines and adopts a client-centred and peer-learning approach to address falls education needs. In order to gather information on the effectiveness of the group on participants, this project saw an opportunity to introduce a standardised outcome-measure.

Methods
The Modified Falls Efficacy Scale (MFES) is recommended by the World Falls Guidelines and was trialled as an outcome measure pre and post-group to measure the success of the intervention. After a period of trialling the MFES, feedback was obtained from OT colleagues and patients and there was increased compliance. Comparison of pre and post scores identified an increase in self-efficacy and qualitatively participants advised greater insight and awareness into the impact of self-efficacy on preventing falls.

Results
Introducing the MFES successfully evaluated the efficacy of the group quantitatively while also providing clients with insights into their individual risk-factors, including self-efficacy. Further benefits were seen with the peer-support element of the group where clients had the opportunity to share their lived-experience to enable patient-empowerment.

Conclusion
Occupational therapists can play a pivotal role in supporting clients to recognise the importance of self-efficacy and education as an element of falls management. Furthermore, utilising standardised outcomes-measures which incorporate participant subjective perspectives can support greater patient insight.
351 Snapshot of Transient Ischaemic Attack inpatient management at a model three Irish hospital
Authors: Beirne E , Hickey P , O'Malley G 
Published: September 2023

Abstract

Background
Transient Ischaemic Attack (TIA) is a common presentation to hospitals and portends a high risk for eventual stroke. The EXPRESS study suggested the benefit of urgent outpatient assessment of TIA, which was associated with a 80% risk reduction of early recurrent stroke when compared to usual care. The HSE model of care for stroke endorses that rapid access TIA clinics could reduce costs of hospital admissions. Average length of admission for TIA is 6.7 days in Ireland. This study aimed to examine TIA admission lengths and identify possible targets for improvement in a model three Irish hospital.

Methods
All patients with a HIPE coded diagnosis of ‘Transient Ischaemic Attack’ from 17/12/21 to 20/8/22 were included. All coded diagnoses of ‘Transient Ischaemic Attack’ had a normal MRI brain DWI—abnormal MRI DWI imaging is coded as stroke. Therefore the true number of TIAs was not captured. Hospital electronic databases were used to identify baseline demographics, date of inpatient investigation request and date of inpatient investigation completion.

Results
64 cases were identified. The median age was 79 years (interquartile range 67 to 86 years). 45% were female. 52% were admitted under a stroke/geriatric team. Median length of admission was 4 days (IQR 3 to 7 days). CT was requested on median day 0. MRI, carotid doppler US and echocardiogram were requested on a median day 1. 94% underwent CT brain imaging on median day 1. 34 (53%) underwent MRI brain DWI, on median day 3. 13 (20%) underwent carotid doppler US, on median day 3. 20 (31%) underwent echocardiogram, on median day 4.

Conclusion
Length of hospital stay has improved compared to prior studies. Limited access to investigations may prolong hospital stay. Streamlining services with development of urgent outpatient TIA clinics, could improve outcomes, save clinician time, free up hospital beds and save hospital funding.
160 Frailty at the front door: a two-way street
Authors: Madden R , Connolly K , Harding N , McLoughlin R , Dunleavy N , McKenna K , Kelly L , Kelly A J , Kearin C , Ryan M , Whelan C , Hayden D , McElwaine P 
Published: September 2023

Abstract

Background
The National Clinical Programme for Older Adults (NCPOP) advocates for timely access to integrated care that is attuned to the complex needs of older adults. Frailty Intervention teams have been introduced in Emergency Departments (ED) around the country, and have proven effectiveness in reducing wait times and hospital length of stay in older patients. The introduction of the Pathfinder service—a collaboration between acute hospitals and the National Ambulance Service—is also proving effective in reducing ED attendances for low-acuity problems in older adults.

Methods
We aimed to develop pathways between a Gerontological Emergency Department Intervention (GEDI) team, and a new Pathfinder team within our hospital catchment area, in order to support older adults to remain at home where safe and feasible. A mapping exercise of potential pathways between these services was conducted. Suitability criteria were developed and a communication strategy for case discussion was formulated. A collaborative approach was taken to ensure continuous two-way communication, and a patient-focussed ethos maintained throughout.

Results
A total of four open-ended pathways were identified between the two services: (1) Pathfinder convey patient to ED via GEDI team, and patient discharged from ED back to Pathfinder for follow up; (2) GEDI identify patient suitable for ED discharge, supported by Pathfinder team; (3) Patients discharged outside of GEDI operational hours (08:00–18:30) supported by Pathfinder team (where already assessed by GEDI); (4) Patients conveyed by Pathfinder, identified as suitable for Age-Related ANP-led Assessment Unit.

Conclusion
Close collaboration between two frailty-focussed older persons’ teams has helped to avoid unnecessary hospital admissions among frail older adults, and provide more gerontologically-attuned care on the acute floor. Through this close collaboration, we are reflecting the NCPOP aims of using integration and Comprehensive Geriatric Assessment to support older people to live well in their own homes.
189 Incidence of hospital admission among Long-Term Care Facility residents versus Community Dwelling older adults: a population based observational study
Authors: Power L , Rana W , Coen N , Bambrick P , Mello S 
Published: September 2023

Abstract

Background
Long-Term Care Facility (LTCF) residents are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. This study aims to determine the incidence of hospital admission among LTCF residents in comparison to their Community Dwelling (CD) counterparts, and to describe reasons for hospitalisation, and admission-related adverse outcomes.

Methods
Hospital In-Patient Enquiry (HIPE) data was obtained for all LTCF residents and CD adults over the age of 75 residing in Waterford County, Ireland, who were acutely admitted in 2022. This included demographic data, International Classification of Diseases (ICD-10) diagnosis, Length of Stay (LoS), and discharge outcome. Incidence was calculated by dividing the number of persons admitted to hospital by the total population at risk over a one-year period. Chi-squared test was used to determine significant difference between the two groups.

Results
Admission incidence was 0.40 for LTCF residents and 0.28 for CD (p &lt; 0.001). Average age was 83 years, and median LOS was seven days in both groups. The most common causes for admission among LTCF residents were infection (56%, n = 147) and falls (12%, n = 31). CD were mostly admitted with infection (31%, n = 805), cardiac issues (16%, n = 414), and falls (12%, n = 303). LTCF residents were more likely than CD to be admitted with Covid-19 infection (9% vs 4%, p = 0.003). There was no difference in mortality rates (8% LTCF vs 6% CD, p = 0.33). LTCF residents were more likely to have a diagnosis of dementia (43% vs 11%, p &lt; 0.001) and develop delirium during admission (30% vs 16%, p &lt; 0.0001).

Conclusion
LTCF residents are significantly more likely to be hospitalised than CD, and to experience delirium during admission. Proper advanced care planning and provision for treatment with intravenous antibiotics in the LTCF may reduce admissions to hospital, but more importantly will provide person-centred care and potentially improve clinical outcomes.