bluuebunny/crossref_metadata_2025_split huggingface dataset:
181 FIGHTING BACK AGAINST FRAILTY—THE INTRODUCTION OF A DEDICATED FRAILTY HUB
Authors: Dennehy K , Farrelly A , Gallagher E , Kennedy F , McGlynn J , Donnelly T 
Published: February 2023

Abstract

Background
Quarantine, lockdowns and mandatory isolation have slowed the transmission of Covid-19. However, these public health measures have amplified frailty in our vulnerable older person population by increasing social disconnection, reducing exercise and access to early interventions. In response to this increasingly dependent older population we introduced a ‘frailty hub’ in our hospital. This hub allowed early access to a geriatric review as well as a broader multidisciplinary team intervention.

Methods
We performed a cross sectional review of our new hub which was introduced in our tertiary centre to priortise care of the older person.We analysed attendees from February to June 2021 (20 weeks of data).

Results
There were 121 new patient reviews and 127 follow up consultations.Commonly requested reason for referral was medical assessment (30%), cognitive assessments (30%) and falls(28%). Referral sources were analysed and included consultant referrals (11% n = 13), GP referrals (55% n = 67), multidisciplinary team referrals (6% n = 7) and emergency department referrals (26% n = 32). The average age of those review was 79 years (range 59 years to 99 years). Of all patients 65% were reviewed by physiotherapist, 45% were seen by an occupational therapist, 10% were seen by a speech and language therapist or dietician. 85% had a medication changes. 95% had a follow up review with either a geriatrician or advanced nurse practitioner.

Conclusion
Innovation is required to appropriately target our most vulnerable frail adults.The pandemic has had a detrimental effect on some older adult’s function.Our hub is targeting this group and optimising their care.These are our preliminary findings, we plan on doing further analysis.
182 QUALITY IMPROVEMENT OF THE REFERRAL SYSTEM TO EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE
Authors: Prendergast C , McNamara R 
Published: February 2023

Abstract

Background
Our department has been providing an Emergency Department in the Home (EDITH) service since early 2020. The goal is to bring the emergency services to older people and prevent unnecessary attendances to the ED. With over 3,000 patients seen in its first 14 months, this heavily used service needs a proficient and safe referral system.
The previous referral system predominately involved handwritten referrals and phone calls. Our aim was to streamline this via the introduction of the Siilo Application as a solitary referral source. A referral proforma was also drawn up to ensure all relevant details were included.

Methods
A baseline survey was conducted to establish staff’s opinion on the initial referral system. The questions were.
1. Are you happy with the current system of referring patients to EDITH?
2. Do you think that some referrals are being missed or delayed secondary to the current system?
3. Rank your current satisfaction with the referral system out of ten?
There was also an area for feedback in the survey. The new system was then introduced using the Siilo Application. Staff were trained in its use and a referral proforma was put in place. After three months of use a second survey was conducted with the same questions.

Results
60% were happy with the new referral system, up from 11% on the first survey. Those who believed referrals were being missed had fallen from 88.9% to 70%. The average score out of ten for the current system was 6.9, improved from 5.7.

Conclusion
Having a safe, user friendly and efficient referral system for complex patients is a fundamental part on the service we provide. Staff satisfaction with the referral system, especially in an emergency setting, is paramount to ensure adequate and safe referrals. Satisfaction rates did improve with the introduction of the Siilo Application, but there is room for further improvement.
193 ARE OLDER PATIENTS IN IRELAND BEING ADEQUATELY SCREENED FOR DELIRIUM? RESULTS FROM AN IRISH PERIPHERAL HOSPITAL
Authors: Tan B , Williams R , Cotter P 
Published: February 2023

Abstract

Background
Delirium is associated with increased morbidity and mortality in the older person and still remains poorly detected. The Health Service Executive (HSE) has clear algorithms and guidelines which suggest that any person over the age of 65, especially so for patients with pre-existing dementia, presenting to the Emergency Department (ED) or Acute Medical Assessment Unit (AMAU) should be screened for delirium using the 4AT test. An earlier retrospective audit carried out by the authors in the same hospital showed that only 9% of patients with diagnosed delirium had a 4AT test at any point during inpatient stay and 0% had one on admission. We designed a prospective audit to assess what proportion of patients over 65 coming through the Acute Medical Assessment Unit (AMAU) had a delirium screening test performed on admission.

Methods
We reviewed the admission notes of all patients over 65 admitted through the AMAU over a continuous 14 day period from 10/11/20 to 24/11/2020. The admission notes were reviewed within 24 hours of admission. Exclusion criteria included patients presenting delirium tremens and patients presenting with a stroke.

Results
119 patients were identified. The mean age was 78.1 years. 20 (16.8%) had previously diagnosed dementia. 0 patients had a delirium screening test conducted by AMAU/ED staff on admission. 2 (1.7%) had 4AT tests done by members of the Geriatric Emergency Medical Services (GEMS) team within 24 hours. The GEMS team only sees patients who fulfill certain criteria on admission. 10 (8.4%) had ‘delirium’ listed on their differential diagnoses.

Conclusion
Our results show that the older patient being admitted through the AMAU in this hospital in Ireland is not being adequately screened for delirium. Additionally, even when delirium was suspected, delirium screening tools were not being implemented for further assessment. More needs to be done to ensure patients over 65 are assessed as per guidelines.
196 A QUALITY IMPROVEMENT INITIATIVE TO OPTIMISE PHYSIOTHERAPY FALLS ASSESSMENT AND INTERVENTION
Authors: Mealy B , Keohane N 
Published: February 2023

Abstract

Background
Falls are the most commonly reported incident in the Health Service Executive (HSE 2018). Our aim was to implement the standard: every patient referred to physiotherapy over 65 years or at risk of falls received a personalised falls assessment and intervention.

Methods
Falls assessment and intervention standards were captured through documentation audit in November 2020. Representatives from all physiotherapy specialties were invited to join the physiotherapy falls committee. The falls committee met monthly to review tests of change, discuss audit results and plan further initiatives. A ‘Falls Algorithm’ was developed outlining expectations regarding falls, with three components: ‘Ask, Assess, Intervene’. In-service training on falls was organised and added to induction for staff-grade rotations. Falls champions were identified in each area to promote best practice and induct new staff to expected standards. A falls newsletter was added to the department weekly bulletin to keep a focus on falls. Physiotherapy assessment forms on the electronic patient record were updated, embedding falls assessment and intervention into routine practice. A falls prevention and exercise booklet was developed and the falls education talk was transferred to an online format with Occupational Therapy colleagues.
Audits across all areas were completed weekly, then monthly to track results. The most recent audit was carried out in May 2021.

Results
Falls assessment improved from 57% to 99%.
Fear of falling assessment improved from 30% to 88%.
Completion of falls outcome measures improved from 26% to 74%.
Falls intervention increased from 49% to 100%.
Gait/balance deficits were assessed in 94% of cases in the final audit.

Conclusion
The aim that all patients referred to physiotherapy over 65 years or at risk of falls receive a personalised physiotherapy falls assessment and intervention was achieved.
20 FALLING THROUGH THE CRACKS: AN EXPLORATION OF SOCIAL WORKERS’ PERCEPTIONS OF THE NEED FOR ADULT SAFEGUARDING LEGISLATION
Authors: Donnelly S , O'Brien M 
Published: February 2023

Abstract

Background
The investigation of, and interventions on, the alleged abuse of vulnerable adults, including older people,has become an important feature of social work.Policy and practice in adult safeguarding is characterised by competing debates about how regulators define core concepts and reporting systems. It has been argued that the introduction of specialist legislation could enhance responses to adult safeguarding (Montgomery et al.2016). This study sets out to shed light on how social work practitioners are navigating cases in the absence of primary legislation and to explore what benefits or challenges there might be should adult safeguarding legislation be fully enacted in the Irish context.

Methods
Focus Groups (N = 2) and face to face interviews (N = 14) were held with social work practitioners using a critical incident technique.An online survey questionnaire was also administered with N = 116 responses.

Results
Social workers reported that adults at risk were ‘falling through the cracks’ due to the absence of adult safeguarding legislation. In relation to older people, the issue of coercive control by another family member was repeatedly highlighted as a significant issue for which there was no legislative intervention available. Legislative powers such as a duty to cooperate, duty to share information and a duty to involve the adult at risk in the safeguarding process were deemed critically important but absent. In addition, social workers reported that the lack of access to support services for the adult at risk was significantly impacting on their ability to safeguard.

Conclusion
Whilst the current policy measures in place offer some protection, it is evident that social work practitioners believe that safeguarding procedures should be placed on a statutory basis to ensure the safeguarding process is applied in a consistent and effective way.

Reference
Montgomery, L., Anand, J., McKay, K., Taylor, B., Pearson, K. C., & Harper, C. M. (2016). Implications of divergences in Adult Protection legislation. Journal of Adult Protection, 18(3).
200 AN EXAMINATION OF THE FACTORS ASSOCIATED WITH PNEUMOCOCCAL VACCINATION UPTAKE IN THE OVER 50’S IN IRELAND
Authors: Organ K , Kenny R A 
Published: February 2023

Abstract

Background
Community acquired pneumonia presents a significant risk for morbidity and mortality in older adults. We aimed to look at the prevalence of pneumococcal vaccination in the over 50’s as well as which factors may influence it’s uptake by this group by using a nationally representative sample of adults from The Irish Longitudinal Study on Ageing (TILDA), a population-based study of community dwelling adults aged ≥50 years.

Methods
Cross-sectional data from the fifth wave of TILDA data collection (n = 5,020) was analysed. Several self-reported measures of pneumococcal vaccination uptake were examined that covered questions such as whether they had received a pneumococcal vaccination and whether any healthcare professionals had discussed vaccination with them. Logistic regression was performed to examine whether differing levels of healthcare entitlement was associated with higher pneumococcal vaccination uptake when adjusting for factors such as age, sex, education and self-reported health.

Results
Of the 5,206 participants over 50 who took part in Wave 5 data collection, 22.97% had reported receiving a pneumococcal vaccination. Of the 4,020 individuals who have not received a pneumococcal vaccination, only 5.79% had their GP discuss pneumococcal vaccination with them, 6.18% had discussed it with other providers such as nurses & pharmacists and 88.03% reported that they had never been spoken to about pneumococcal vaccination by any of their healthcare providers. Medical card coverage, OR = 2.48 (CI = 1.64:3.74, p = &lt;.000) and dual coverage, OR = 3.71 (CI = 2.45:5.61, p = &lt;.000) were associated with higher rates of pneumococcal vaccination but this association was not present with insurance coverage only, OR = 1.18 (CI = 0.778:1.79, p = &lt;.431).

Conclusion
These findings suggest that differences in levels of healthcare entitlement can affect access to preventative measures such as routine vaccinations, with those with both insurance coverage and a medical card being most likely to be vaccinated. It has also highlighted a need for more healthcare professionals to discuss routine pneumococcal vaccination with their patients.
206 EXPLORING THE RELATIONSHIP BETWEEN LONELINESS, FRAILTY, AND HEALTHCARE UTILISATION IN IRELAND’S OLDER ADULTS DURING THE COVID-19 PANDEMIC
Authors: Gyenes M , Jones C , Madigan R , Grunner M , Sheehan O C 
Published: February 2023

Abstract

Background
The COVID-19 pandemic has disproportionately affected older adults, both in morbidity and mortality1. The effects of the pandemic go beyond contracting the SARS-CoV-2 virus, leading to devastating consequences, particularly for individuals over the age of 60. In Ireland, isolation in older adults was exacerbated by cocooning measures and geographical limitations. The purpose of this study was to explore the relationship between loneliness, frailty, and the utilisation of health services in a sample of sexagenarians in Ireland.

Methods
Adults aged 60–70 attending COVID-19 vaccine appointments at a Level 3 Hospital in Ireland (n = 75) were invited to participate in a 36-item questionnaire. Participants reported demographic information and questions regarding physical well-being, healthcare utilisation, lifestyle and behaviours, and impact of vaccination. The survey also included three validated questionnaires: PRISMA-7 for frailty, SARC-F for sarcopenia, and the UCLA 3-Item Loneliness Scale (UCLA-3ILS).

Results
Of the 75 survey respondents, the mean age was 63.2. 72% (n = 54) identified as female. 28% (n = 21) reported that they had been cocooning during the past year. While 84% (n = 63) of respondents reported that they cancelled routine medical appointments during the pandemic, none reported avoiding attending hospital. Five respondents met the criteria for frailty and four were identified as probable sarcopenic. There was no significant difference (p = 0.64) in mean scores on the UCLA 3-ILS between frail and non-frail individuals. Persons identified as sarcopenic were more likely to have higher scores on the UCLA-3ILS (p = 0.0005).

Conclusion
This research highlights the multifaceted relationship between frailty, loneliness, and healthcare utilisation among Irish adults ages 60–70 during the COVID-19 pandemic. Future research in program, policy, and intervention development for at-risk older adults, particularly those who are frail, sarcopenic, and/or lonely, can work to reduce associated negative outcomes.

Reference
1. Kang S-J and Jung, SI. (2020). Age-Related Morbidity and Mortality among Patients with COVID-19. Infect Chemother., 52(2): 154–164.
216 IMPROVING INPATIENT INFLUENZA VACCINATION RATES—THE VALUE OF AN ELECTRONIC PATIENT RECORD REMINDER SYSTEM
Authors: Chapman L , Piggott R S , Kelly M , O'Connell B , Bannon C , Cunningham C , Briggs R 
Published: February 2023

Abstract

Background
Influenza vaccination, particularly for vulnerable, older adults, will have added importance this winter given the possibility of further waves of COVID-19 pandemic. Previous interventions at the study site noted poor awareness on the need for inpatient Influenza vaccination1. This study examines a vaccination reminder process using an electronic patient record (EPR) to identify high-priority eligible inpatients.

Methods
The study site is a 900-bed university teaching hospital with all clinical notes accessed via an EPR.
We included a convenience sample of 750 adults aged≥50 years (mean age 75.9 +/− 0.4 years, 48% female) and high-priority for influenza vaccination (Age &gt; 65 years and/or length of stay (LOS) &gt;30 days) from October 1st 2020 to January 12th 2021.
A live electronic dashboard identified eligible inpatients for vaccination, prompting vaccination reminders to the clinical teams via the antimicrobial pharmacist.
Data was collected retrospectively. Logistic regression models reporting odds ratios were used to assess the association of these reminders with vaccine uptake.

Results
Over one third (35%, 264/750) of high-priority patients received the Influenza vaccine while inpatients, including 40% aged ≥80 years.
The reminder was sent on 41% (305/750) of patients and was associated with an almost 50% higher likelihood of vaccination after adjusting for other covariates (Odds Ratio 1.48 (95% CI 1.00–2.20); p = 0.048).
Other factors independently associated with vaccination were advancing age (Odds Ratio 2.69 (95% CI 1.12–6.47) for age ≥ 80 years); LOS (4% higher likelihood of vaccination for every additional day in hospital) and admission under geriatric medicine (Odds Ratio 3.71 (95% CI 2.45–5.62) when compared to other specialities).

Conclusion
Our study shows relatively low uptake of inpatient Influenza vaccination and strategies to improve uptake are required. Reminders sent to clinical teams using the EPR appear to be an effective means of increasing Influenza vaccination and should be considered as part of this year’s inpatient vaccination drive.
220 WEEKEND WARRIORS—GETTING OLDER REHABILITATION PATIENTS MORE ACTIVE OVER THE WEEKEND
Authors: McDonnell I , McDaid E 
Published: February 2023

Abstract

Background
Reduced physical activity levels in hospital can increase an older person’s risk of deconditioning, frailty, sarcopenia (Guy et al., 2012). Older people can spend only 60 minutes upright per day in an in-patient rehabilitation setting (Smith et al., 2008). This can be further reduced at weekends when therapy services are often unavailable. The Weekend Warriors was introduced to older persons’ services in a post-acute rehabilitation hospital to combat this.
The aims were:
1. Examine patient perception of physical activity at weekends
2. Examine the feasibility of a weekend activity self-management programme
3. Evaluate patient satisfaction with a self-directed weekend activity programme
4. Evaluate whether a self-directed activity programme lead to increased patient-reported weekend activity levels

Methods
A pre-intervention anonymous survey was distributed to rehabilitation patients in the older persons’ services examining weekend activity levels and the patients’ perception of same. The Weekend Warriors packs consisted of 4 levels of difficulty and were distributed based on the patient’s ability. A post intervention anonymous survey was distributed. Data was analysed using Microsoft Excel.

Results
At completion, 19 patients participated in the pre-intervention survey. 10 patients participated in the post-intervention survey.
Pre-intervention survey findings show that 74% of patients carried out 30+ minutes of exercise on weekdays, compared to only 21% on weekend days. Post-intervention, this increased to 70% on weekend days.
Pre-intervention, 74% of patients felt good about their weekday exercise, while only 36% felt good about exercise on the weekend. Post- intervention, 90% of patients felt good about their weekend exercise.

Conclusion
Overall, the Weekend Warriors intervention improved time spent exercising at the weekend and patient satisfaction. Further studies could be carried out on the efficacy of creating exercise videos that could be shown to patients on the weekends, or the inclusion of an objective measure.
228 GENDER DISPARITIES IN DIAGNOSING OSTEOPOROSIS
Authors: Morrison L , Fernandes L , Lyons D 
Published: February 2023

Abstract

Background
It is estimated that up to 300,000 people in Ireland have osteoporosis, however it is a disease most commonly associated with women. Women aged over 50 years have a four times greater rate of osteoporosis and are twice as likely to have osteopenia as men.1 However the recognition and treatment of osteoporosis in men cannot be forgotten. The Irish Hip Fracture Database National Report 2019 showed that 31% of 3,701 hip fractures that year were in males. Hip fractures have been shown to result in higher overall mortality in men than in women.2

Methods
A retrospective observational study was carried out by analysing the reports of all dual-energy X-ray absorptiometry (DEXA) scans performed in a large university teaching hospital from January 1998 to August 2021, collecting data on gender, age, bone mineral density and osteoporosis risk factors.

Results
A total of 39,611 patients having their first DEXA scan in our hospital were included. 85.2% were female and 14.8% male. In all patients over 75 years, only 12.9% of all patients getting a first DEXA scan were male. Of all women who had DEXA scans, 29.1% were diagnosed with osteoporosis and 38.4% with osteopenia and in men 16.6% osteoporosis and 40.7% osteopenia.

Conclusion
Our results highlight that men have DEXA scans performed much less frequently than women. This is seen in all age groups, especially in patients over 75 years old. As in women, the prevalence of osteoporosis in men increases with age. This study demonstrates the importance of evaluating for and treating osteoporosis in men as well as women, as fragility fractures can cause significant mortality and morbidity in both genders.

References
1. Alswat KA. Gender Disparities in Osteoporosis. J Clin Med Res.2017;9(5):382–387. doi: 10.14740/jocmr2970w.
2. Kanis JA et al. The components of excess mortality after hip fracture. Bone.2003;32(5):468–473.
244 ORAL ANTICOAGULANT PRESCRIBING IN OLDER PERSONS: AN AUDIT OF A COMMUNITY HOSPITAL REHABILITATION UNIT
Authors: Ahern E , Condon J , Okpaje B , Mohamed A , Saleh A , Ali B , Mannion M , Walsh A , Gabr A , Shanahan E , Peters C , O'Connor M 
Published: February 2023

Abstract

Background
Prescribing in older persons is complex and involves greater risk of drug-related harm. Prescribing appropriate anticoagulation balancing thromboembolic versus bleeding risk is essential with consideration to multiple comorbidities and polypharmacy. 27% of adults were prescribed inappropriate anticoagulation dosing in the GARFIELD-AF study. The Health Service Executive provides guidelines under the medicines management programme on prescribing anticoagulation treatment. The European Heart Rhythm Association (EHRA) published an updated practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in 2021.

Methods
A point prevalence audit was carried out in a community hospital rehabilitation unit, including all inpatients receiving oral anticoagulants (OAC). The data collected included: age, OAC prescribed, dose, documentation of indication, length of treatment, if a reduced dose was prescribed and reason why, creatinine clearance and reason for co-prescribing of an antiplatelet agent. Results were collected, analysed, and compared with the above guidelines.

Results
25 inpatients were included. 9 were on an OAC (36%). All patients were 70 years or over. DOACs were prescribed in 7 patients and warfarin in 2. All patients had a prescribing indication documented. All patients had an appropriate treatment duration documented. 3 OAC users were on a reduced dose, all of whom had an indication for a reduced dose documented. 1 patient was on medications with a documented drug–drug interaction. Only 3 patients had their creatinine clearance documented. No inpatients were co-prescribed an antiplatelet agent.

Conclusion
Creatinine clearance is an important factor in prescribing of OAC and must be documented. Interventions to improve documentation of creatinine clearance will be explored and implemented. Consideration to drug–drug interactions in older patients with polypharmacy requires a multidisciplinary approach including pharmacy input.