bluuebunny/crossref_metadata_2025_split huggingface dataset:
141 USING A TEMPLATE TO IMPROVE COMMUNICATION ON DISCHARGE LETTERS REGARDING BONE PROTECTION THERAPY AFTER HIP FRACTURE
Authors: Doyle K , McManus C , O'Brien M , Brewer L 
Published: February 2023

Abstract

Background
Hip fractures are a significant cause of morbidity and mortality amongst older adults. The Irish Hip Fracture Database Standard 5 requires that all patients with hip fracture have a bone health assessment completed; most are commenced on bone protection therapy (BPT) to reduce future fractures. Communication to general practitioners (GPs) regarding long-term BPT is often incomplete and challenging to improve. We aimed to upgrade this communication process at discharge.

Methods
Initial audit was conducted assessing documentation of BPT after hip fracture in discharge letters to GPs. Subsequently we created a detailed BPT template for discharge letters containing clear information for GPs regarding medication initiation and advice for ongoing management. The template was introduced and doctors were educated on its use. We then re-audited discharge letters following this intervention. Patients included were over 60 years old with hip fracture. Patients deemed clinically unsuitable for BPT were excluded.

Results
Ninety discharge letters were reviewed, 45 at initial audit and another 45 after introducing the BPT template. Mean age was 80 years old, 66 (73%) were female. In the first audit cycle, 28/45 discharge letters (62%) briefly specified BPT. On repeating the audit cycle (following introduction of the discharge letter template) all 45/45 discharge letters (100%) clearly specified BPT. Most letters (41/45; 91%) included the detailed BPT template. Following this intervention all doctors reported increased awareness and understanding of BPT, and satisfaction with template use in discharge letters.

Conclusion
Effective implementation of a discharge letter template significantly improved communication to GPs regarding BPT following hip fracture.
146 INTRODUCTION OF A STANDARDISED SCREENING TOOL FOR REFERRAL TO OCCUPATIONAL THERAPY AND PHYSIOTHERAPY ON SPECIALIST GERIATRIC WARDS
Authors: Peppard S , Howard M 
Published: February 2023

Abstract

Background
The Occupational Therapists (OTs) and Physiotherapists (PTs) on the Specialist Geriatric Wards provide assessment, rehabilitation, and discharge planning for frail older adults. All patients are screened on admission by OT or PT to determine the need for therapy input. This rapid response eliminates delay in accessing therapy input and allows for proactive commencement of intervention and discharge planning without the delay of awaiting a referral.
It was identified that the existing process for screening patients lacked structure and clarity, leading to inefficient use of time and resources with the risk of duplication.
The aim of this local Quality Improvement (QI) initiative was to standardise the process for screening using a triage sticker containing set criteria for referral to OT/PT.

Methods
Following team consultation and review of frailty screening tools, a triage sticker was adapted and modified from the ‘Think Frailty’ tool1. QI methodology and PDSA cycles identified 6 blanket triggers for OT/PT assessment on the ward.
F—Functional impairment.
R—Resident in a care home.
A—Acute/chronic confusion.
I—Immobility/Instability.
L—Living at home with support.
S—Specialist seating or skin integrity issues.
Retrospective review of traditional triage vs the new sicker was performed to evaluate accuracy.

Results
Retrospective analysis found 83% accuracy between the new triage sticker and the traditional triage method. Of the patients who did not meet the criteria for referral, to date none have been subsequently referred during their admission, demonstrating its comprehensiveness as a tool.

Conclusion
Pro-active and early intervention from OT and PT is beneficial for ensuring optimum patient care and efficient discharge planning for frail older adults admitted to hospital. This local QI project demonstrated that standardising the screening process for referral to OT/PT could improve clarity and enable more efficient use of time and resources.
153 DIFFERENCES IN POTENTIALLY INAPPROPRIATE PRESCRIBING (PIP) AT DISCHARGE ACCORDING TO FRAILTY STATUS
Authors: Auliffe C M , Hayden D , Kenny J , Byrne S 
Published: February 2023

Abstract

Background
Frailty is a key concept in healthcare service planning development for our ageing population. Guidelines recommend that older patients requiring acute hospital care should be routinely assessed for frailty (NCPOP). Potentially Inappropriate Prescribing (PIP) encompasses both over- and under-prescribing and is associated with adverse health outcomes for older persons. The objective of this study was to investigate differences in PIP at discharge of older patients according to frailty status (robust, pre-frail and frail).
Methods: In this retrospective single-centre cohort study, a random sample of older patients (≥75 years) assessed for frailty on admission, was selected. The discharge prescriptions of 150 patients were reviewed using STOPP and START criteria to identify Potentially Inappropriate Medications (PIMs and Potential Prescribing Omissions (PPOs). Drg Burden Index (DBI) scores, a measure of anticholinergic and sedative burden, were calculated for each patient. Data was analysed using descriptive statistics.

Results
There was a significant difference in the mean number of medications between the groups (F = 12.335,p &lt; 0.001), with frailer patients prescribed more medications. Significantly more hyperpolypharmacy (≥10 regular medications) was identified in the frail group (χ2 = 17.378,p &lt; 0.001).
A high prevalence of both PIMs(72%) and PPOs (63.3%) was found, as was a significant difference in the proportion of patients with PPOs according to frailty status (χ2 = 6.507,p = 0.039). The median number of PPOs increased significantly from the robust to pre-frail and frail groups (χ2 = 8.194,p = 0.017).
DBI scores increased significantly from the robust to pre-frail and frail groups (χ2 = 7.389, p = 0.025) and there was a significant difference in the proportion of patients with high DBI exposure (scores≥1) across the groups (χ2 = 6.497,p = 0.039).

Conclusion
Frail patients were on more medications, had more instances of PPOs and a higher anticholinergic and sedative burden than their non-frail counterparts. The results of this study support the use of frailty assessments in identifying patients for targeted medication reviews aimed at reducing PIP.
154 SAFEGUARDING ADULTS AT RISK OF ABUSE—IDENTIFYING KNOWLEDGE GAPS AMONGST HOSPITAL STAFF TO GUIDE POLICY IMPLEMENTATION AND TRAINING
Authors: Killeen E , Higgins M , Keogh C , Russell S , Curran C 
Published: February 2023

Abstract

Background
Safeguarding is the protection of health, wellbeing and life free from abuse. Abuse is a a violation of a person’s human and civil rights; forms include psychological, financial, physical, sexual, neglect and self-neglect. Health Service Executive (HSE) drafted the 2019 ‘Adult Safeguarding Policy’ for adults at risk of abuse to replace the 2014 version. In preparation for implementation a tertiary hospital founded a Safeguarding Committee in 2021. A core objective was establishing staff understanding, experience of safeguarding and education needs to guide future training.

Methods
10-question survey of 223 staff; included doctors, nurses, allied health professionals, medical social workers, healthcare assistants, porters, psychologists.

Results
91% response rate.
184 (91%) staff were familiar with the term ‘safeguarding’; only 44% were aware of the HSE 2019 policy. 129 (64%) had experience with a case of suspected abuse. Most common forms were financial, psychological and self-neglect (n = 60, 47, 39 respectively). Sexual abuse was least common (n = 10).
47% felt ‘somewhat’ confident recognising possible abuse compared to 42% who felt ‘extremely’ or ‘very’ confident.
61% were ‘somewhat’ or ‘not so’ confident about the next steps for suspected abuse; only 11% were ‘extremely’ confident.
49% felt ‘extremely’ or ‘very’ confident in reporting a suspected abuse case; 50% felt ‘somewhat’ or ‘not so’ confident.
Most common reasons for lack of confidence were lack of training, unclear reporting process and lack of experience with cases of abuse. Medical social workers were most confident; doctors were the least.
170 (84%) wanted more safeguarding training—the most popular options were online or in-person training.

Conclusion
Gaps in knowledge and confidence were identified amongst staff for cases of suspected abuse. This will guide future training in the hospital in line with the HSE Adult Safeguarding policy.
156 POTENTIAL ELIGIBILITY FOR ADUCANUMAB THERAPY IN A REGIONAL SPECIALIST MEMORY SERVICE UTILISING AD PHENOTYPE, CSF BIOMARKERS AND APPROPRIATE USE CRITERIA
Authors: Dolphin H , O'Dowd S , Kennelly S P 
Published: February 2023

Abstract

Background
Aducanumab, the first monoclonal antibody directed against amyloid beta peptide has recently been licensed for use by the FDA for treatment of patients with mild cognitive impairment (MCI) due to Alzheimer’s Disease (ad) or mild ad dementia. Appropriate use criteria (AUC) for Aducanumab have recently been released. In light of these AUC, the aim of this study was to review patients in our specialist memory service with positive CSF biomarkers for ad [low amyloid- beta-42 (AB-42), high phosphorylated tau (p-tau)] to assess their hypothetical eligibility for Aducanumab therapy.

Methods
Retrospective database analysis was undertaken of patients with positive (high p-tau, low AB-42) ad-biomarker CSF analysis. Demographic, neuropsychological performance, neuro-radiological, laboratory, and clinical phenotype diagnosis data were reviewed at time of CSF analysis to determine hypothetical eligibility for Aducanumab. Data was extracted and analysed using SPSS v.25.

Results
Forty-nine patients had positive ad-CSF biomarkers, 41/49 (84%) of whom presented with common ad phenotypes. 28/49 (57%) were male. Mean patient age was 71.2 (±5.9) RBANS delayed memory index score mean was 80.2 (±14.5) and mean EXIT-25 scores were 13.2 (±6.7). 63.2% (31/49) patients met eligibility criteria for Aducanumab therapy by AUC guidelines. 12.2% (6/49) wouldn’t have qualified due to abnormal laboratory findings and 14.2% (7/49) due to MMSE &lt;21 or MoCA &lt;17. Two patients would not have qualified due to underlying medical conditions and two were prescribed therapeutic anticoagulation. However by FDA guidelines, a further 30.6% (15/49) of patients may have been unsuitable due to global Clinical Dementia Rating Scale ≥0.5.

Conclusion
AUC for Aducanumab address some of the controversial aspects in its licencing. This report highlights the presence of patients eligible for Aducanumab therapy should a European licence be granted, and the need to develop a system readiness and capacity to deliver this and other emerging disease-modifying ad therapies.
161 THE ROLE OF THE GERIATRIC DAY HOSPITAL DURING THE COVID 19 PANDEMIC
Authors: Lynch A , Quinn L , Briggs R , Tan T , Thorpe O , Romero-Ortuno R , Byrne T , Cunningham C , Lavin A 
Published: February 2023

Abstract

Background
The geriatric day hospital (GDH) provides outpatient medical, nursing and rehabilitation care to older adults. Historically the main focus has been on rehabilitation. This project’s objective was to evaluate how the GDH adapted during the COVID-pandemic to provide acute medical care to older adults.

Methods
This is a pre and post COVID-19 comparative study. Referral source, multidisciplinary-team input and admission rates were evaluated for all new patient referrals from April 1st to May 31st 2019 (pre-pandemic) and compared to April 1st to May 31st 2020 (during-pandemic). This service evaluation project was approved by the local Research and Innovation Office.

Results
There was a 37.7% reduction in the number of new patient referrals for 2020 compared to 2019, p &lt; 0.00; Geriatric medicine referrals reduced by 46.5%, emergency department referrals reduced by 61.5%; community referrals increased 15-fold[AL1]. There were no differences in patients referred in terms of gender (p = 0.069), mean age (80.9(SD7.6) vs 79.1(SD6.6), p = 0.092), median conditions (5(IQR3.75–7) vs 6(IQ4–8), p = 0.329) and median medications (8(IQR5–11) vs 8 (IQR5.25–9), p = 0.600). Those referred pre-pandemic were frailer according to the clinical frailty score; median 5(IQR5–6) vs 5(IQR4–6), p = 0.013. In 2020, there was a significant reduction in referrals for physiotherapy (72.9% vs 37.3%, p &lt; 0.001), occupational therapy (58.5% vs 37.8%, p = 0.005) and social work (47.5% vs 26.7%, p = 0.004). Clinical nutrition and speech and language remained the same, 16.1% vs 12%, p = 0.430 and 9.3% vs 12%, p = 0.552, respectively. In 2020, patients referred had significantly fewer attendances; median 4(IQR2–7) vs 3(IQR1–5), p = 0.002. There was no difference in admission rates between 2019 and 2020 (3.3% vs 7.9%, p = 0.149).

Conclusion
During the COVID-Pandemic, the GDH evolved to provide more acute ambulatory medical care to avoid admissions. The GDH continues to adapt as the pandemic evolves and older adults needs change. Further comparative analysis will be required.
165 WHAT FACTORS ARE ASSOCIATED WITH ADVANCED CARE PLANNING IN COMMUNITY-DWELLING OLDER PEOPLE?
Authors: Breslin L , Connolly E , Lavan A , Kenny R A , Briggs R 
Published: February 2023

Abstract

Background
Advance Care Planning (ACP) involves expressing wishes regarding your future medical care and/or preferences about your end-of-life in the event of serious illness.
The aim of this study was to clarify the proportion of community-dwelling older people who engage in ACP and what factors are independently associated with ACP.

Methods
Participants aged ≥60 years (n = 4,831, mean age 71 years) at Wave 4 of the Irish Longitudinal Study on Ageing were asked: Have you made your wishes/preferences known about the kind of care that you would like to receive in the event of serious illness? If yes, they were asked if this had been documented informally (family/carers or medical professionals) or formally (by written advanced care plan).
Logistic regression models assessed the association of covariates of interest with ACP.

Results
One quarter of the study sample (1,153/4,831) had an ACP. Only 10% (119/1,153) had ACP documented in writing, while only 2% (27/1,153) had discussed ACP with a healthcare professional.
Age ≥ 80 years (OR 1.63 (1.31–2.02)), female sex (OR 1.58 (1.37–1.83)), higher educational attainment (OR 1.42 (1.18–1.71), poorer self-rated health (OR 1.58 (1.04–2.39) and lower levels of religiosity (OR 1.50 (1.03–2.19) were independently associated with ACP.

Conclusion
While ACP may have benefits in extending autonomy and facilitating decision-making, only 1 in 4 of this population-representative sample of older people had engaged in ACP, with only 1 in 50 having their ACP documented in writing.
Further work is therefore required to educate the public and healthcare professionals regarding the benefits of ACP.
166 HEALTH TRAJECTORIES OF FRAIL, OLDER PEOPLE WHILE COCOONING DURING THE COVID-19 PANDEMIC
Authors: Bailey L , Ward M , DiCosimo A , Lavan A , Briggs R 
Published: February 2023

Abstract

Background
Cocooning, i.e. staying at home and reducing interaction with others, was a key part of the strategy to protect older people during the COVID-19 pandemic.
Unfortunately, there are concerns this has had a negative impact on the physical and mental wellbeing of those who have been isolated.

Methods
We completed a survey of 150 patients (55% female, mean age 79.8 years, average Clinical Frailty Scale 4.8) attending ambulatory medical services in a large university hospital.
Questions were focused on: access to healthcare services, mental health, physical health, and attitudes to COVID-19 restrictions.

Results
Almost 40% reported that their mental health was ‘worse’ or ‘much worse’ while cocooning, while over 40% reported a decline in their physical health.
Over 57% had a scheduled healthcare-related visit cancelled while cocooning, most frequently hospital outpatient appointments.
Worryingly, almost 1/6 reported not seeking medical attention for an illness that they would usually. Of these, half did not as they were worried about catching COVID and 46% did not as this service was not currently available to them.

Conclusion
The COVID-19 pandemic and lack of access to essential services, both medical and social, has had a devastating impact on older people.
This is evident in both the acute presentations to hospital and the longer-term impact it has had on health and function.
It is important that in the future clear policies are in place to enable older people to access care when they need it.
168 ANXIETY SYMPTOMS AMONG OLDER PEOPLE DURING THE COVID-19 PANDEMIC: PREVALENCE AND ASSOCIATED FACTORS
Authors: Robinson A , Ward M , Kenny R A , Briggs R 
Published: February 2023

Abstract

Background
There are concerns that the COVID-19 pandemic could lead to a rise in mental health problems including anxiety amongst older people, especially those shielding alone during the pandemic.
The aim of this study therefore is to examine the prevalence of anxiety symptoms during the COVID-19 pandemic amongst older people and clarify factors associated with higher burden of symptoms.

Methods
We analysed data from the COVID-19 study of The Irish Longitudinal Study on Ageing, conducted on over 3,100 community dwelling people aged ≥60 years from July–November 2020.
Anxiety symptoms were measured with the Generalised Anxiety Disorder-7 Questionnaire with a score ≥ 10 indicating moderate–severe anxiety.
Linear regression models were used to assess the association of variables of interest with anxiety symptoms.

Results
Almost 9% of participants (n = 3,128; mean age 71 years) had moderate–severe symptoms of anxiety.
Factors independently associated with a higher burden of anxiety symptoms included female sex (β = 0.60 (0.33–0.87)); living alone (β = 0.72 (0.41–1.02)); ≥2 chronic diseases (β = 0.85 (0.41–1.30); heart disease (β = 0.95 (0.45–1.46)) and reporting frequent loneliness (β = 6.59 (6.03–7.16)). Age ≥ 80 years (β = −0.77 (−1.16—0.37)) and tertiary level education (β = −0.48 (−0.86—-0.10)) were associated with lower anxiety symptom burden.

Conclusion
Almost 1 in 10 of this population-representative sample of older people had moderate to severe anxiety symptoms during the COVID-19 pandemic.
Strategies to address loneliness, which was particularly strongly associated with anxiety symptoms during the pandemic, should be a priority.
169 RECOGNITION OF POLYPHARMACY IN OLDER ADULTS: AN AUDIT OF POLYPHARMACY DOCUMENTATION AT TIME OF ADMISSION IN AN ACUTE HOSPITAL
Authors: Tangney N , McMahon I , McCarthy K 
Published: February 2023

Abstract

Background
The World Health Organisation has highlighted the international importance of recognising polypharmacy by including it as part of Medication Without Harm, the third Global Patient Safety Challenge. Older adults are at the greatest risk of polypharmacy and the adverse outcomes or events that can occur secondary to polypharmacy. For example, an increased risk of drug interactions, incorrect administration of medications, unacceptable pill burden, increased medication side effects potentially leading to a prescribing cascade and a decrease in medication adherence. This audit aimed to identify if polypharmacy is being recognised as a diagnosis for older adults on admission to an acute hospital.

Methods
An audit was performed of medical wards, over a single day, in an acute hospital to identify those patients, who were seventy years of age or more, with polypharmacy and whether polypharmacy was included as a diagnosis in their admission note. Polypharmacy was defined as five or greater medications listed on admission.

Results
Thirty two patients were identified that fit the inclusion criteria. None of these patients had polypharmacy included in the admission diagnoses list.

Conclusion
The above results highlight a lack of recognition of polypharmacy as a significant issue for many older patients that are admitted acutely. Of note the most common admission diagnoses recorded were hyponatraemia, acute kidney injury, and confusion which are frequent adverse effects of commonly prescribed medications in older adults. Several screening tools have been developed for identifying inappropriate prescribing and for applying a systematic approach to potential deprescribing.As such, the application of a screening tool in the emergency department may aid the process of timely appropriate deprescribing.
177 REDUCTION OF RESTRICTIVE PRACTICES IN AN OLDER PERSON RESIDENTIAL CARE FACILITY; THE IMPACT ON HUMAN RIGHTS AND RESIDENT SAFETY
Authors: Hogan F H , Ahern A , Faherty L , Lordan R , O'Toole M 
Published: February 2023

Abstract

Background
We are a 140 bed long term care residential care facility for older people. We strive to achieve a ‘Restraint Free Environment’ in accordance with Article 40.4 of the Irish Constitution and Articles 14 (liberty and security) and 15 (freedom from torture or cruel, inhuman or degrading treatment) of the UN Convention on Rights of Persons with Disabilities(1). Health Act 2007, Regulations 2013 defines restrictive practice as ‘the intentional restriction of a person’s voluntary movement or behaviour’. Use of restrictive practices is warranted when there is a real and substantial risk to a person and this risk cannot be addressed by non-restrictive means’ (HIQA, 2019) (2).

Methods
An extensive review of non pharmacological restrictive practices in the Organisation was undertaken. This included One to One supervision, use of bedrails, Exit Alarm mats and Electronic Monitoring bracelets. Bedrails were replaced for some residents with Safety Wedges and Ultra Low beds.

Results
Review of restraint interventions showed no clear link to prevention of falls or injuries as a result of restraint. Contrary there was evidence of breach of dignity and privacy for the residents. Based on the review, bedrail use was reduced radically between 2016 and 2021 by 79% (42–9). Falls rate remained consistent approximately 3.6–3.2 per 1,000 Occupied Bed Days.
Exit Alarm mats, Electronic Monitoring bracelets and One to One supervision was discontinued. These were replaced with direct observation and two hourly anticipation of needs. Cost saving on One to One estimated to have been €25,000 in 2016 alone. Clear care planning of the resident’s needs are core.

Conclusion
We have demonstrated that we could successfully reduce restrictive practices, thus respecting Human Rights, with no compromise to resident safety.

References
1. United Nations Convention on Rights for Persons with Disabilities (2007)
2. H.I.Q.A 2019 Guidance on promoting a Care Environment that is Free of Restrictive Practice.