bluuebunny/crossref_metadata_2025_split huggingface dataset:
58 EVALUATION OF DIABETES MELLITUS IN A COHORT OF FRAIL OLDER ADULTS
Authors: McGettigan S , Mohamed A S , Pillay I , Brassill M J 
Published: February 2023

Abstract

Background
The aim of this study was to identify the prevalence of diabetes in a cohort of frail older adults who attended a model 3 hospital and explore the relationship between frailty and diabetes in this cohort. Prognosis and treatment of diabetes can vary greatly in the presence of frailty.

Methods
A multidisciplinary team provide liaison geriatric input to frail older adults in this hospital. Comprehensive geriatric assessments (CGAs) are carried out on patients identified using a VIP tool or via inpatient consults. These CGAs were reviewed regarding frailty scores, social/falls history, medications and diabetes complications including hypoglycaemia.

Results
CGAs were reviewed for 213 patients from September to November 2019. Fifty eight patients had a diagnosis of diabetes (27.2%), and all were type 2. The median age was 84. The average Clinical Frailty Scale score was 5.4 indicating mild to moderate frailty. Over two thirds of patients (n = 137) were on more than 5 medications. Seventy-six patients had a history of falls, and 24 (31.5%) of those had diabetes. Twenty-one patients were prescribed either sulphonylureas and/or insulin, and 7 of these were living alone. One patient had a sulphonylurea stopped on admission following CGA. Five patients had a documented history of hypoglycaemia, 2 of these patients were on insulin and 1 was on a sulphonylurea. The median HbA1c was 49 mmol/mol. Fifteen patients had diabetes complications, including 3 with retinopathy and 6 with neuropathy. The median duration of diabetes was 9.5 years. The majority of patients were managed at primary care level (n = 48, 82.75%).

Conclusion
The management of frail older adults with diabetes is complicated by multimorbidity and increased risk of adverse effects of treatment such as hypoglycaemia. Frailty assessment should be a routine component of a diabetes review for all older adults, and then glycaemic targets and medication choices should be adjusted accordingly.
61 AUDIT: MEDICATION REVIEW POST INPATIENT FALLS
Authors: Gibbons C , Gaynor E , Duggan J , Blackstock J , Mullen M , Keena A , Buckley R , Callaly E 
Published: February 2023

Abstract

Background
Falls are the most commonly reported incident in the Health Service Executive (HSE). Inappropriate medications and polypharmacy in the elderly can contribute to increased falls risk.
Our aim was to assess whether a medication review was being completed at the time of the post-fall clinician review.

Methods
We completed a retrospective chart review using an audit tool of consecutive inpatient falls, resulting in serious injury, from March–December 2019.
Standards measured against were: HSE Guideline—Service User Falls: A Practical Guide for Review, Medicines and Falls in Hospital: British Society Guidelines, STOPP & START criteria and NICE Guidelines: Falls in Older People 2013.

Results
We identified 33 charts for review (n = 33)—54.55% (18) female and 45.45% (15) male. Average age was 81 ± 11.2 years. The immediate post-fall review was mainly completed by interns (48.49% (16)) and SHO’s (39.39% (13)). A medication review was carried out 9.09% (3) of the time.
A total of n = 28 (84.85%) had poly pharmacy. When analysed for medications known to increase risk of falling, 51.52% (n = 17) were on anti-hypertensives, 45.45% (n = 15) on laxatives, 24.24% (n = 8) on sedative medications, 18.18% (n = 6) on hypnotics/anxiolytics, 15.15% (n = 5) on opioids and 15.15% (n = 5) on diuretics at the time of fall. The majority of these medications (77.42% (n = 24)) were commenced prior to admission. None of these medications were discontinued or the dose changed on review post fall.

Conclusion
Our audit demonstrates that in a cohort of patients who had an inpatient fall medication discontinuation and dose reductions were not performed. Yet, a high burden of polypharmacy and high-risk falls medication were found. This may result in missing a pertinent opportunity to prevent future falls. We advise a structured medication review is carried out for each patient who suffers an in-patient fall to efficiently modify such an easily identifiable risk factor.
77 INCONTINENCE AND DECONDITIONING IN A NONFRAIL SAMPLE OF INPATIENTS AT A UNIVERSITY TEACHING HOSPITAL
Authors: Gorey S , McAteer C , Antonenko A , Abrahams E , Cameron S , Egan A , Ero A , Fraser C , Tey Z H , Boochoon L , Koay W J , Sitram R , Deegan K , Quinn C 
Published: February 2023

Abstract

Background
Incontinence occurs in 26% of hospitalised adults1. Deconditioning in hospitalised adults is common and contributes to increased hospital stay2. The #endpjparalysis movement motivates us to reduce harms of hospitalisation older adults.

Methods
We surveyed inpatients to capture the point prevalence of incontinence. We also collected information regarding functional status, continence status and use of continence wear. Local ethical review-board approval was obtained. All participants provided informed consent.

Results
There were 86 responses. Mean age of participants was 71.5 years. 45.4% were female, &gt;95% were admitted from home and were functionally independent. Mean length of stay for respondents was 7.4 days ±12. The median Clinical Frailty Scale, for respondents aged &gt;65 years, was 3, indicating this cohort is not frail.
17 respondents reported incontinence on the day of survey; 8 of these reported that incontinence was a new experience for them since their admission. 24 respondents wore incontinence wear at home, 31 were wearing incontinence wear on the day of survey.
Of 80 respondents who could toilet independently at home, 23 (26%) reported a new dependency to toilet. Of 83 respondents who mobilised independently at home (with or without an aid), 11 reported needing assistance of one-person to walk, 3 needed the assistance of two-people to walk or stand, five people required a hoist, while 3 were bedbound on the day of survey.

Conclusion
We describe increased dependency in mobility, toileting and increased use of continence wear in non-frail hospitalised older adults. Future work is needed to maintain function during admission to hospital.

References
1. Condon, M., et al. (2019). ‘Urinary and Faecal Incontinence: Point Prevalence and Predictors in a University Hospital.’ Int J Environ Res Public Health 16.
2. Guilcher, S., et al. (2021). ‘A qualitative study exploring the lived experiences of deconditioning in hospital in Ontario, Canada.’ BMC Geriatrics 21.
79 SIMULATION-BASED MEDICAL EDUCATION: A ‘HIP’ WAY TO LEARN ABOUT ORTHO-GERIATRICS!
Authors: Murphy B , Laffan S , Sullivan S O , Ballester G W , Meagher M K , Noone I , Cassidy T , Murphy T , Cooke J , Pope G , Mulcahy R , O'Regan N 
Published: February 2023

Abstract

Background
Simulation-based medical education (SBME) is emerging as a key method of medical education, particularly in the setting of the COVID-19 pandemic. As part of a simulation development competition (SimStars) run by the National Doctors Training and Planning Unit and the South–South West Hospital Group, we brought together an inter-disciplinary team to develop a simulation scenario on hip fracture.

Methods
Our development team consisted of members of the Geriatric Medicine and Orthopaedic Departments. We developed a scenario that can be adapted to suit the needs of learners in orthopaedics, medicine, or nursing. We ran the simulation on a medical ward with one candidate and four facilitators from the Geriatric Medicine Department. The candidate (medical SHO) was presented with a patient (facilitator one), who had sustained a hip fracture following a fall. The candidate was directed to elicit a falls and bone health history, screen for delirium, and suggest further investigations and management. Subsequently, feedback was sought from all participants.

Results
The simulation took twenty minutes, debriefing took fifteen minutes. All considered, the simulation an enjoyable and feasible method for teaching and learning, and a novel way to promote team-building. The candidate felt competent in some areas, reporting that the scenario provided positive reinforcement. She reported feeling supported in identifying areas for further learning. The facilitators also considered this method a useful way to highlight a candidate’s learning needs and direct further teaching. The candidate requested further SBME-based sessions.

Conclusion
This SBME session in Ortho-Geriatrics was well-received by the candidate and facilitators. All participants enjoyed teaching and learning through this medium. Areas of high competency were reinforced and areas for future learning were identified. Further SBME was requested across more topics and for simulation training to be brought in as part of formal training.
85 ESTABLISHING AN EMERGENCY PERIOPERATIVE FOR OLDER PERSONS SERVICE (POPS) IN A TERTIARY HOSPITAL SETTING: EARLY DATA
Authors: Plant R , Stanley E , Dukelow T , Kayyal Y , Aherne E 
Published: February 2023

Abstract

Background
Evidence supports the role of geriatricians in perioperative settings. The success of orthogeriatrics has encouraged geriatric input into other surgical services. The British Geriatrics Society recommends early geriatric assessment for patients undergoing laparotomy as a means to improve older adult outcomes. We present the initial data of our Perioperative Older Person Service (POPS) that aims to standardise a clinical pathway for older adults admitted under an emergency surgical service using Comprehensive Geriatric Assessment (CGA).

Methods
We obtained an additional a whole-time equivalent geriatric registrar to facilitate establishing the POPS.
Inclusion criteria for assessment included those over 75 either admitted under an emergency surgical consultant, or awaiting a surgical assessment in the emergency department. A geriatrician performed a CGA for these patients.
We collected data including; demographics, diagnosis; premorbid frailty status (Clinical Frailty Scale (CFS) score 2 weeks prior to admission); polypharmacy; 4AT score; admission and discharge destination; procedure performed; 30-day readmission rate; ICU admission; and 90-day mortality. Extra information was gathered using free-text to identify additional geriatric interventions.

Results
At time of submission the service has assessed 15 patients over 21 days. 46% (7/15) were female, 54% (8/15) were male.
53% (8/15) of patients underwent CGA on the day of admission. 100% patients were assessed within 72 hours of their admission.
46% (7/15) had a CFS ≥4.
26% (4/15) were identified as delirious as per 4AT.
18.7% (3/16) had a procedure performed during their admission.
We identified polypharmacy in 73% (11/15).46% (7/15) were discharged with reduced medication burden.
CGA prompted new advanced care planning decisions in 40% (6/15) of patients.

Conclusion
Although the service is in its infancy, the above data is encouraging. Through early identification of frailty and timely CGA, we anticipate this service will ensure the delivery of geriatrically-attuned care to frail older people and improve outcomes.
86 CELEBRATING TEN YEARS OF COMMUNITY LIAISON SPEECH AND LANGUAGE THERAPY SERVICE: BETTER PATHWAYS BETWEEN THE ACUTE HOSPITAL AND NURSING HOMES
Authors: McDonagh S , Duffy F 
Published: February 2023

Abstract

Background
The Community Liaison Speech and Language Therapy (CL SLT) service was established in July 2010. The aim of this new model of care was to provide a fast track home visit service to older persons with communication and swallowing difficulties living in one of the 27 nursing homes in the region. The service facilitates a safer discharge from hospital and admission avoidance with aspiration pneumonia due to rapid SLT follow up in the nursing home.

Methods
This is a retrospective analysis of the CL SLT service over the last ten years. Activity data, key performance indicators (KPIs) and staff and service user feedback were reviewed both quantitatively and qualitatively. How the service operated during the COVID- 19 pandemic was also examined to explore if new creative ways of working emerged.

Results
Analysis of the data showed a total of 5,699 SLT visits over the ten year period. Review of the KPIs showed that priority 1 referrals were seen within the ten working day target which meant that in some incidences residences were not kept on overly modified diets unnecessarily and in other cases the Speech and Language Therapist could respond rapidly to support decision making around quality of life feeding. User feedback showed high satisfaction with the service. Virtual clinics provided an adjunct to the service during COVID-19 and of note, face to face service was only stopped for two 6 week periods in the first and third waves of the pandemic.

Conclusion
The CL SLT model provides a quality, person centred service for older persons living in a nursing home. The care pathways from the acute hospital have allowed for admission avoidance with effective SLT management decisions, including around end of life feeding being made in the nursing home so that residences receive the right service in the right place and time.
92 THE RISE OF SIMULATION BASED TRAINING IN GERIATRIC MEDICINE?
Authors: Buckley E , O'Regan N , Pope G , Mulcahy R , Cooke J 
Published: February 2023

Abstract

Background
Simulation-based training (SBT) offers opportunities for teaching and learning in safe spaces, while learners navigate the acquisition of these complex skills, and work in clinically-realistic teams, supported by faculty. Geriatric medicine is a diverse speciality, requiring trainees to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach. Studies describing SBT in geriatric medicine are limited.

Methods
We hosted an in-situ competition designed to encourage participation in simulation and to develop a simulation faculty network across a hospital group. All healthcare professionals in the hospital group were eligible to enter. Contestants designed a simulation case scenario within a speciality of their choice. Entrants participated in five virtual workshops on core elements of SBT. Six cases were selected to participate in the virtual final. The finalists submitted a video summarising the performance of and evaluation of the learners’ experience of the scenario.

Results
Thirty-four teams submitted initial SBT proposals and participated in the five virtual SBT workshops over a three-week period. Of these,17.6% (n = 6) were geriatric medicine teams, comprising seven geriatric medicine consultants, four advanced nurse practitioners and 13 non-consultant hospital doctors (five registrars, six senior house officers and two interns). Case scenarios submitted by geriatric medicine teams included acute stroke care, diagnosis and management of delirium, management of perioperative delirium post hip fracture and capacity assessment.

Conclusion
The level of interest in SBT generated amongst geriatric medicine faculty and trainees suggests this may be a useful tool to enhance the training experience. SBT offers geriatric medicine trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging patient scenarios, in a protected environment. In this innovation, we identified a range of geriatric medicine-related topics for which SBT was deemed to be valuable by both faculty and trainees and could be facilitated through in-situ simulation settings.
97 AGEING POPULATION: THE IMPACT ON ADMISSIONS TO LONG-TERM CARE
Authors: McCormack R , McNally S , O'Shea D 
Published: February 2023

Abstract

Background
The aging population of Ireland continues to increase rapidly. As the age continues to increase, so too does the need for long-term care (LTC). In 2006 LTC utilisation was estimated between 4.4%–4.8% of the over 65s population. It was proposed that this would increase to between 4.8%–5.3% by 2021 (Wren et al., 2012). This study intended to explore if this projection was evident in discharges from an acute Care of the Older Person’s setting between 2016 and 2021.

Methods
A random selection approach was used to retrospectively review 45 patients seen by occupational therapy in an Irish acute Care of the Older Person’s service in 2016. Discharge destinations were recorded. These were then compared to the discharge destinations of 45 randomly selected patients open to occupational therapy in the same service during the first half of 2021.

Results
The review of 2016 found that 15.56% (n = 7) of those seen by occupational therapy discharged to a LTC facility, and 4.45% (n = 2) discharged home with a back-up LTC plan. Additionally, 33.33% (n = 15) transferred to a rehabilitation facility and 42.22% (n = 19) went home with community supports, 4.44% (n = 2) passed away.
Contrastingly, in 2021, 28.89% (n = 13) patients discharge to LTC with an additional 6.66% (n = 3) going home with 24/7 private care in place, and 4.45% (n = 2) went home with a LTC back-up plan. Just 22.22% (n = 10) went for rehabilitation and 26.67% (n = 12) went home with community supports. In 2021, 11.11% (n = 5) of those randomly selected passed away during their admission.

Conclusion
A significant increase of the number of inpatients discharging to LTC between 2016 and 2021 was found. These findings are greater than that previously proposed and may suggest that COVID-19 has caused a further increase in individuals requiring LTC. However, this sample size was small and other factors such as age, physical ability and cognition were not explored. Further studies are recommended.
98 SCHEDULED MEDICATION REVIEWS AND EDUCATION ON SEDATIVE PRESCRIBING FOR RESPONSIVE BEHAVIOURS IN NURSING HOME RESIDENTS, A 3 YEAR FOLLOW-UP STUDY
Authors: Killeen E , Horan S , Pollock A , Lee A , Martin A 
Published: February 2023

Abstract

Background
Sedative medications including neuroleptics, benzodiazepines, opioids, ‘z’ drugs and trazadone are commonly prescribed for older adults. Nursing home residents are three times more likely to be prescribed benzodiazepines. Sedative medications are associated with significant risks including falls and delirium in older adults. Neuroleptics also increase risk of cerebrovascular disease and functional decline. Regular medication review and education have been shown to reduce rates of sedative use in nursing homes. Scheduled medication reviews were introduced in an Irish nursing home with a specific focus on reduction or discontinuation of these target medications in combination with education of management of Behavioural and Psychological symptoms (BPSD). We demonstrated previously a significant reduction in prescribing following these interventions. This audit examines the prescribing patterns 3 years on from the initial audit.

Methods
Point prevalence study of sedative prescriptions and BPSD on 6/5/21 of all 95 nursing home residents. Data compared with two preceding audits in 2018 in the same unit. All data anonymised. Data analysed with SPSS statistical software.

Results
Significant reduction in quetiapine use sustained from 30% of residents pre-intervention to 14% post-intervention in 2018 and 2021 (p = 0.06).
Neuroleptic prescription reduced from 39% to 25% (p = 0.06).
‘Z’ drug prescribing increased from 8% to 17% (p = 0.03).
33% of residents had BPSD reported compared to 49% pre-intervention.

Conclusion
3 year follow-up showed regularly scheduled medication reviews and education in a nursing home can effectively rationalise sedative prescription rates. Sustained reduction in neuroleptics and increased ‘z’ drug prescriptions may represent appropriate replacement. Reduced BPSD may be due to changing nursing home resident cohort or reporting bias of staff since the introduction of regular education.
Potential therapeutic targets for sarcopenia identified by Mendelian randomisation
Authors: Jiang Wei , Zhan Wenli , Zhou Luoqi , Dong Minghao , Liu Liang , Xu Xiangshang , Cao Zhixin 
Published: February 2023

Abstract

Background
Identifying sarcopenia’s causally associated plasma proteins would provide potential therapeutic targets.

Methods
We screened out sarcopenia-related proteins with genome-wide association studies (GWAS) summary data and cis-protein loci genetic instruments. Summary data of sarcopenia were obtained from a GWAS of 256,523 Europeans aged 60 years and over. The causal effects of the proteins were investigated by cis-Mendelian Randomisation (MR) and multiverse sensitivity analysis. We also explored the robust proteins’ causal associations with appendicular lean mass (ALM) and surveyed their druggability and clinical development activities.

Results
In sum, 60 proteins from plasma proteome analysis studies and 12 from other studies were enrolled for MR analysis. In the whole population, four proteins (HPT, AT1B2, ISLR2 and TNF12) showed causal associations with the risk of sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) criterion. In the female population, AT1B2 and TNFSF12 revealed causal associations with sarcopenia risk according to the EWGSOP criterion; HGF revealed a negative association according to the National Institutes of Health criterion. All of them were druggable, and the inhibitors of TNF12 and HGF were evaluated in clinical trials for other diseases. TNF12 also revealed a negative causal association with ALM, whereas HGF was positively causally associated with ALM.

Conclusions
Five druggable plasma proteins revealed causal associations with sarcopenia in the whole or female populations. TNF12 and HGF were the targets of therapeutic agents evaluated in clinical trials, and they were also causally associated with ALM. Our study suggested the potential mechanisms and therapeutic targets for sarcopenia.
A Mixed-Methods Study of Clinicians’ Attitudes Toward Pathology Explanation Clinics
Authors: Bergholtz Sarah E , Kurnot Sophia R , DeJonckheere Melissa , Hawley Sarah T , Owens Scott R , Lapedis Cathryn J 
Published: February 2023

Abstract

Objectives
To characterize the attitudes of treating clinicians toward pathology explanation clinics (PECs).

Methods
Clinicians from a tertiary care academic medical center were asked, “How interested would you be in having your patient meet with a pathologist to discuss their pathology report and see their tissue under the microscope?” Clinicians ranked their interest, then expanded on concerns and benefits in a semistructured interview. Audio recordings of interviews were transcribed and analyzed using a qualitative thematic approach.

Results
A total of 35 clinicians were interviewed, with 83% reporting some level of interest in PECs. Clinicians felt that highly educated and motivated patients were most likely to benefit from a PEC. Clinicians recognized that PECs could improve understanding and emotional processing but that the patient’s information needs must be balanced with the potential for cognitive overload and emotional distress. When integrating the pathologist into the care team, clinicians worried about the pathologist’s communication skills, care fragmentation, and increased clinician workload. If performed well, clinicians felt PECs had the potential to increase clinician efficacy and improve quality of care.

Conclusions
Overall, clinicians are interested in PECs when they fulfill a patient’s information needs and are optimally performed.