bluuebunny/crossref_metadata_2025_split huggingface dataset:
224 METABOLIC SYNDROME ASSOCIATED WITH INCREASED LIKELIHOOD OF INCIDENT FRAILTY
Authors: McCarthy K , O'Halloran A , Laird E , Ortuño R R , Kenny R A 
Published: February 2023

Abstract

Background
Frailty and metabolic syndrome (MetS) are both associated with increased mortality. This study aimed to examine the association between MetS and incident frailty in older adults in Ireland over a 4-year follow-up period.

Methods
This study used data from wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Frailty status was operationalised using Fried’s frailty phenotype (FP). FP was determined at both waves. MetS was determined at wave 1, according to the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria. Those who were frail/pre-frail at wave 3 having been classified as non-frail at wave 1 were deemed to have ‘worsening frailty’, while those non-frail at both waves were deemed ‘stable non-frail’. Logistic regression models examined the association between MetS and worsening frailty compared to stable non-frail.

Results
FP was determined for 3,317 participants at both wave 1 and wave 3 of TILDA, of which 970 (29%) and 1,201 (36%) had MetS at wave 1 according to ATPIII and IDF criteria respectively. 664 (20%) had worsening frailty, while 1,624 (49%) were stable non-frail. Adjusted for age, sex and education, MetS was associated with an increased likelihood of worsening frailty, for both ATPIII and IDF criteria, OR 1.70 (p &lt; 0.001) and OR 1.63 (p &lt; 0.001) respectively. This association persisted when further adjusted for smoking history, chronic conditions (excluding diabetes and hypertension), renal function and micronutrients [OR 1.50, p = 0.001 (ATPIII) and OR 1.46, p = 0.001 (IDF)].

Conclusion
MetS increases the likelihood of incident frailty/pre-frailty by approximately 50% over a 4-year period. MetS should be considered a risk factor for frailty and should be considered in any comprehensive geriatric assessment given the dynamic nature of frailty and the potentially modifiable nature of MetS.
260 EXPLORING OLDER PEOPLE’S EXPERIENCES OF SHIELDING DURING THE COVID-19 PANDEMIC
Authors: Phelan A , Daly L , Brian K 
Published: February 2023

Abstract

Background
COVID-19 has resulted in large scale infection rates, significant death rates and an economic crisis for many countries. Older people were identified as being in a high-risk group in terms of morbidity severity and mortality rates. This led to many governments recommending older people shield as a protective, public health measure. This study considers how older people experienced shielding in an urban area of Ireland.

Methods
Twenty participants were recruited through nursing services in one Community Healthcare Organisation. Semi-structured interviews were conducted between 14/1/21 to 8/3/21 and analysed using thematic analysis (Braun & Clarke, 2006).

Results
Two overarching themes were identified: 1) Shielding experienced as a social disruption: Compliance resulted in transformed lives with marked impacts on social roles, identities, ways of living as well as the personal consequences of adhering to restrictions. Older participants spoke of careful strategies of self-protection and acute awareness of the personal and societal effects of the ongoing pandemic. 2) Coping with and countering social disruption: Participants described strategies they engaged in to adapt to, resist, address or avoid the impacts of shielding that challenged pre-COVID-19 social roles, identities, or ways of living.

Conclusion
As global societies slowly emerge from the pandemic, particularly in the context of vaccination roll out, older people’s experiences are important to acknowledge. In this study, there was evidence of both the resilience of older people but also the multi-faceted negative impact on their health and welfare. In addition, the experience of the pandemic has highlighted pre-existing service issues (home care service provision fragmentation), digital divides and the lack of older people’s voices in political decision making. This points to the need to have robust, and accessible rehabilitation services incorporating comprehensive geriatric assessment and to reform health care delivery to enhance capacity to sustain services in pandemic times.
87 PREDICTIVE VALIDITY OF SCREENING TOOLS USED BY A FRAILTY INTERVENTION TEAM IN AN IRISH EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY
Authors: O'Carroll S , Cremin M , Meehan E , O'Leary H , Galvin R , Fitzgerald L , O'Connell P , Mukherjee P 
Published: February 2023

Abstract

Background
Various screening tools exist to identify frail and at-risk older adults in the emergency department (ED). This can facilitate targeted assessment and management, leading to improve outcomes. This study evaluated the predictive validity of four screening tools used by an ED-based team of allied health professionals.

Methods
The Variable Indicative of Placement (VIP) tool, Think Frailty Tool, Clinical Frailty Scale (CFS) and 4AT were administered to adults aged ≥75 years as part of assessment by the Frailty Intervention Therapy Team in an Irish ED. Outcomes were hospital admission; re-attendance within 28 or 90 days; and death within 28 or 365 days. Scores were dichotomised, and for each outcome, relative risks and sensitivity, specificity, positive and negative predictive values were calculated.

Results
Over the six-month period, 429 individuals (median age:82 years) were assessed. Of these, 59% were VIP-positive, 81% screened at-risk of frailty on the Think Frailty Tool, 56% screened positive for frailty on the CFS, and 16% screened positive on the 4AT. Hospital admission, re-attendance at 28 and 90 days, and death within 28 and 365 days were 56%, 12%, 27%, 5%, and 23%, respectively. Positive screens on the VIP, Think Frailty Tool, CFS and 4AT were associated with significantly increased risk of hospital admission and death within 28 or 365 days (p &lt; 0.05). Positive screens on the Think Frailty Tool and CFS were also associated with increased risk of 90-day re-attendance (p &lt; 0.05). Of the four tools, the Think Frailty Tool had the highest sensitivity (86%–100%) for all outcomes. The CFS showed high sensitivity for detecting death within 28 or 365 days (95% and 84%, respectively), but lower sensitivity (68%–75%) for other outcomes. The 4AT demonstrated the lowest sensitivity for all outcomes (20%–46%).

Conclusion
The Think Frailty Tool and CFS were the most useful for predicting adverse outcomes in this group.
118 EVALUATION OF PATIENTS ADMITTED UNDER GERIATRICS FROM SEPTEMBER TO NOVEMBER 2020: GUIDE TO ESTABLISHING A HOSPITAL AT HOME SERVICE
Authors: Cummiskey A G , Nee R 
Published: February 2023

Abstract

Background
Studies have shown that home hospital care is as effective as hospital management and improve patient satisfaction. Up to date guidelines recommends that patients who do not require care uniquely proved in hospitals should be treated at home when possible. We aim to assess the need for a new Hospital At Home (HAH) with Comprehensive Geriatric Assessment (CGA) pathway under Integrated Care Programme for Older People (ICPOP).

Methods
We conducted a retrospective medical chart review of all patients admitted under Geriatrics from September 2020 to November 2020. Demographic data and admission notes were used to assess the patient’s eligibility. Information on dementia and delirium, length of stay, discharge destination, readmission rates, number of previous admissions, length of time at home prior to readmission, use of multidisciplinary team members during admission was also collected.

Results
Over the 3 months 358 patients were admitted and 36 patients met the inclusion criteria. The average age is 84.9 years, 33% were males. 10 patients had a diagnosis of Mild Cognitive Impairment and 5 with Dementia. No patients were delirious on admission, but 7 developed delirium as an inpatient. The average length of stay was 14.8 days, with a total of 534 bed days. Discharge destination was home for 91.7%, 1 patient passed away and 2 were discharged to Long Term Care. 22 patients were readmitted. The average time to readmission was 55 days, with a median of 35 days.

Conclusion
Given the aging population, and continued bed shortage in acute hospitals, the development of a HAH service will aim to alleviate some of this pressure. We aim to provide a holistic service to our patients, focused on medical care, but also improved quality of life, reduction in delirium, continued home living and reduced carer stress.
124 OUTCOME OF SPEECH AND LANGUAGE THERAPY CLINICAL DYSPHAGIA ASSESSMENT FOLLOWING AN INTERDISCIPLINARY SWALLOW SCREEN
Authors: Maher J , Ryan S , King L , Sayers K , Donnellan C , Pillay I 
Published: February 2023

Abstract

Background
A 7 question non-validated swallow screen (Any reported swallowing difficulties? Any coughing with food or fluids? Any choking? Does food get stuck when eating? Any recurrent chest infections? Any pain when swallowing? Any difficulty swallowing tablets?) is used by an integrated care team for older persons to prioritise referrals to the Speech and Language Therapy (SLT) service.
This study identified the proportion of patients screened who appropriately required a clinical dysphagia assessment and intervention.

Methods
This was a retrospective study from September 2020 to June 2021. Patients were assessed by the Clinical Specialist SLT who determined if swallow impairment was present and whether intervention was required. Age, gender and clinical frailty score were documented. Patients who resided out of the catchment area or who had already received an SLT service were excluded.

Results
The average age was 80 years, range 67–103. The male to female ratio was 2:1 and the average clinical frailty score (CFS) was 5. N = 42(32%) screened positive. N = 29(69%) attended for SLT assessment. N = 27(93.1%) had a swallow impairment identified. N = 20 were discharged following a single intervention and 9 required further SLT intervention.

Conclusion
Presbyphagia is generally asymptomatic and results from age related anatomical and physiological changes, reduced functional reserve and sarcopenia. Older adults compensate for these difficulties and do not seek assistance. Presbyphagia may progress to dysphagia, resulting in adverse outcomes. The high rate of SLT confirmed swallow impairment and need for SLT intervention highlights a need to prospectively refine and validate this 7 question swallow screen.
147 ‘CHAMPIONING CONTINENCE’—ESTABLISHMENT OF A MULTIDISCIPLINARY CONTINENCE PROMOTION WORKING GROUP IN AN ACUTE TEACHING HOSPITAL
Authors: Howard M , Peppard S , O'Dwyer E , McLoughlin K , McLoughlin L , Carolan N , Walsh N , Chukwureh W , Russell E , Wilson L , Kottackal L M , Kelly M , Sheeran G , Maeri C 
Published: February 2023

Abstract

Background
In line with the National Frailty Programme1, patients over the age of 75 admitted to hospital should have a comprehensive geriatric assessment including the assessment of current continence status and any history of incontinence. Up to 39% of adults are reported to develop new onset urinary incontinence during admission to hospital2,3, however studies show that is it a problem not always identified by staff members,4. In response to these observations within an acute teaching hospital, a continence working party was formed involving members of nursing, physiotherapy and occupational therapy colleagues to explore the current practice and culture relating to continence management.

Methods
The group established key objectives which were broken into four strands;
1. Audit of documentation of baseline continence on admission (therapy and nursing).
2. Obtaining access to additional types of continence wear.
3. Staff education.
4. Pre and post education survey.

Results
1. Audit of documentation demonstrated poor standards of documentation of baseline continence. This led to an amendment to questioning prompts on therapy initial assessment forms and a plan to further evaluate the nursing documentation.
2. A wider array of continence wear has been made available on the wards providing greater options for patients.
3. Staff education session was compiled by a specialist physiotherapist and is widely available for staff to access on the hospitals online training portal.
4. Pre-education surveys have been completed with a view to re-administering following education roll-out.

Conclusion
The aim of this multidisciplinary working group is to equip staff with the correct resources, knowledge, and confidence to ensure best practice promotion of continence on the targeted wards. This project is the first strand of a wider culture changed that is needed around continence promotion for older adults in the acute setting.
163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION
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 geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians.

Methods
Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH.

Results
One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p &lt; 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p &lt; 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p &lt; 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p &lt; 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468).

Conclusion
Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.
186 OPTIMAL MANAGEMENT OF COVID-19 IN NURSING HOME PATIENTS: A QUALITY IMPROVEMENT PROJECT IN AN IRISH UNIVERSITY HOSPITAL EMERGENCY DEPARTMENT
Authors: Foley J , Menzies D , Boyle N , McNamara R 
Published: February 2023

Abstract

Background
The Sars-CoV-2 global pandemic placed an unprecedented demand on acute health services and led to significant morbidity and mortality in older populations. Nearly half of attendances to this ED are over the age of 65 years and there are over 80 nursing homes in the catchment area. A pilot study in January 2021 showed that nursing home attendances increased significantly during the third wave of COVID-19 with many of these attendances potentially avoidable and suitable for optimised care in the nursing home.
The primary objective of this quality improvement project was to enhance the older person’s care and experience when presenting to ED or being reviewed in the community with symptoms and signs of COVID-19. Secondary aims were reduced nursing home attendances to ED and subsequent admissions from these attendances.

Methods
A guideline was constructed based on the RCEM standard for Quality Care for Older People and using the HSE guidelines for managing COVID-19 in nursing home patients. The guideline was introduced to staff and implemented in ED and via the EDITH service.

Results
Two PDSA cycles were undertaken post guideline implementation. There were substantial improvements in the frequency of discussion and documentation of advanced directives with increased numbers of patients being discharged directly back to the nursing home or treated in the nursing home using the guideline. There was a decrease in the number of nursing home attendances throughout the project.

Conclusion
This successful QIP shows the importance of manging older patients appropriately, while considering their wishes. Post-COVID work should centre on managing all older patients with optimised treatment and considering how they will benefit most from their attendance to ED.
188 IMPROVING THE ASSESSMENT AND MANAGEMENT OF FALLS IN OLDER PEOPLE BY THE EMERGENCY DEPARTMENT IN THE HOME
Authors: Sheehan M , Mulcaire J , McNamara R 
Published: February 2023

Abstract

Background
Falls among older adults are the injury pattern that causes the most morbidity and mortality. Assessing and managing these in the patients’ homes is challenging; it requires a comprehensive, systematic approach. This quality Improvement Project used a Comprehensive Geriatric Assessment for older adults who have suffered fall, carried out by an Emergency Department in the Home (EDITH) practitioner in the patient’s home.
Aim: To improve the evaluation and management of older people who have fallen and are attended to by the Emergency Department in the Home.

Methods
This OD project was carried out using the HSE People’s Needs Defining Change model. A new, streamlined version of the Comprehensive Geriatric Assessment tool was developed and introduced, and this was implemented and altered over two PDSA cycles.

Results
Documentation of falls improved dramatically, from a median of three out of 12 domains included to a median of 11 domains included. Users’ feedback helped the CGA evolve and was incredibly positive about the change.

Conclusion
This project shows that a CGA can be used successfully in patients’ own homes to assess risk factors for falling. The HSE’s People’s Needs Defining Change can be used to implement community-based projects. The community CGA tool could be explored by other areas and organisations in the future.
202 THE SILVER TRAUMA CLINIC—A MULTIDISCIPLINARY CLINIC FOR FRAIL OLDER PATIENTS FOLLOWING TRAUMATIC INJURY
Authors: Ramiah V , Byrne C , Ramakrishnan J , Morgan P 
Published: February 2023

Abstract

Background
Increasing numbers of older individuals are presenting to Irish emergency departments following trauma. Advances in the care of chronic diseases have increased the number of older people with active lifestyles, predisposing them to injury. ‘Silver trauma’ has been a relatively neglected despite deficits of traditional trauma care for this vulnerable cohort.
The Silver trauma clinic was developed in conjunction with the Frailty Intervention Team, Geriatric services and HSCP service in May 2021. The goal of the clinic is to provide a comprehensive multidisciplinary management for frail older patients following non operative injuries.

Methods
Frail older patients discharged from the ED can be referred for short interval multidisciplinary trauma review.
A trauma tertiary survey is carried out by an emergency physician with specialist interest in geriatric trauma. Rapid access to imaging ensures timely definitive diagnosis. The service integrates virtually with specialist services, such as spinal orthopaedic services and musculoskeletal interventional radiology.
Physiotherapists initiate a tailored early rehabilitation plan. Consultant geriatrician and frailty ANP screen for complications of injury as well as bone health, falls risk and cognitive screening. The clinic integrates with existing outpatient and community services for older persons.

Results
The clinic has seen 30 patients since commencement in May 2021. Median patient age: 85. Injuries: 25% vertebral fractures, 30% limb fracture, 20% thoracic trauma, 30% pelvic trauma. Mean number assessments: 2. Disposition outcomes: Primary care 50%, Geriatric clinic 30%, Integrated Care Team 10%, specialist clinic 10%.

Conclusion
The Silver trauma clinic is a new approach of patient focused multidisciplinary trauma care for frail older patients following non operative trauma in the Irish health system.
218 INCREASING PREVALENCE OF METABOLIC SYNDROME IN OLDER ADULTS IN IRELAND
Authors: McCarthy K , O'Halloran A , Laird E , Ortuño R R , Kenny R A 
Published: February 2023

Abstract

Background
Metabolic syndrome (MetS) is a cluster of inter-related risk factors of metabolic origin, occurring together more often than by chance alone. MetS is a recognised risk factor for cardiovascular disease, several other chronic medical conditions and mortality. This study aimed to describe the prevalence of MetS in older adults in Ireland and to examine if this changed over a 4-year follow-up period.

Methods
This study used data collected as part of wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Using objective measurements of triglycerides, high-density lipoprotein cholesterol, blood pressure, height, weight, waist circumference and glycated haemoglobin (HbA1c), in addition to medication usage, the prevalence of MetS using both the National Cholesterol Education Program Third Adult Treatment Panel criteria (ATPIII) and the International Diabetes Foundation criteria (IDF) were determined. Weights were used to allow the sample to be representative of the population. Weights for wave 3 included an adjustment for attrition between wave 1 and wave 3. Weighted logistic regression models were undertaken to examine the odds ratios for age, sex and educational attainment.

Results
32.5% of the community-dwelling population aged ≥50 years at wave 1 had MetS according to the ATPIII criteria, with 39.3% according to the IDF criteria. Males were 36% (ATPIII) or 53% (IDF) more likely than females to have MetS at wave 1. MetS was increasingly prevalent with age, and lower educational attainment at both waves. Prevalence had increased by wave 3 with 35.1% and 41.3% meeting the ATPIII and IDF criteria respectively.

Conclusion
The prevalence of MetS, a modifiable disorder, is very high and increasing in older adults in Ireland, with nearly 400,000 of the community-dwelling population ≥ 54 years at wave 3 meeting either the ATPIII or IDF criteria. More public health interventions are warranted.