bluuebunny/crossref_metadata_2025_split huggingface dataset:
173 The development and early experience of a multidisciplinary acute in-patient frailty team
Authors: Bambrick P , Doyle M , Prendergast A , Doherty-Walsh A , Byrne E , Simpson S , Murphy G 
Published: September 2023

Abstract

Background
Frail older adults represent a growing proportion of the acute in-patient population. A point-prevalence audit in our hospital revealed 40% of adult in-patients were frail (median age: 74). Following a patient-mapping exercise and review of service-user requirements, a consensus was reached among stakeholders that a multidisciplinary in-patient frailty team would be the most effective approach to supporting this group. The Rapid Assistance with Frailty Team (RAFT) work closely with Emergency Department (ED) and ward-based colleagues to optimise their care.

Methods
Newly admitted patients &gt;75 years are screened daily for mild to moderate frailty (Rockwood Clinical Frailty Scale 5–6) and a Comprehensive Geriatric Assessment (CGA) is completed within 72 hours of admission. Hospital-associated complications e.g. deconditioning, delirium, weight loss, constipation, falls, cognitive and functional decline, are addressed through CGA-led recommendations. Physical and functional status are optimised through supplementary ward-based therapy and Geriatric Medicine support, with a view to facilitating earlier discharge.

Results
609 CGAs were completed over a one-year period. Patients were primarily identified through daily screening (77.51%). Other referral sources included the ED Therapy Team, Primary Teams, therapies and nurses. In 50% of patients reviewed, new onset of confusion, decline in memory, or delirium was noted, with only half of those having a prior history of cognitive impairment. 80% presented with a decline in general function and approximately 35% were admitted with a fall as their main presentation. Polypharmacy was identified in 80% of this patient population.

Conclusion
The initial steps in implementing an inpatient frailty service, i.e. developing a system of patient identification, documentation to support CGA, and an integrated approach to working in a busy clinical environment, have been achieved. The focus is now on prospective data collection, continuous monitoring of key performance indicators, and feedback from service-users and staff, to further streamline this approach.
174 A silver lining: the identification of silver trauma at triage for older persons (&gt;65) presenting to the emergency department
Authors: Connolly K , Keogh S , Kelly L , O'Sullivan L , Geraghty C , Grufferty A , Bennett M 
Published: September 2023

Abstract

Background
Trauma in patients over 65 (silver trauma), can result in serious injury from lower impact mechanisms. The NOCA Major Trauma report highlights that 58% of major trauma is a result of a fall from 2 metres or less and mortality increases with age and comorbidities. Failure to identify, rapidly assess and treat older persons who have suffered silver trauma results in prolonged emergency department stays with an increase in morbidity and mortality. We therefore, performed a completed audit cycle to assess the identification of Silver Trauma in our emergency department.

Methods
A focus group involving key stakeholders was established, including Emergency Physicians, nurses and members of the Gerontological Emergency Department Intervention team. An audit assessed patients triaged as ‘major trauma’ from October to December 2022. We established silver trauma guidelines for triage. Teaching sessions on the recognition of silver trauma were provided, daily briefings were given, and information leaflets were placed in all triage areas. A triage discriminator of ‘Silver Trauma’ was introduced to prompt recognition and review by clinicians. A full audit cycle was completed.

Results
Our initial audit (October to December 2022) revealed 25 patients triaged as ‘Major Trauma’ who were aged over 65. After the completion of the initial audit and implementation of measures, 122 patients were triaged as ‘Silver Trauma’ between January 20th and March 31st. We identified that 59% (N = 72) were due to falls from 2 meters or less. Other mechanisms of injury included unwitnessed fall (21% N = 25), syncope (7% N = 8), fall from height (11% N = 13) and Major Trauma (3% N = 4). Seventy-one (58.19%) were admitted and 51 (41.80%) were discharged home.

Conclusion
This audit demonstrates that departmental education and implementation of a triage discriminator has significantly improved the recognition of silver trauma within the ED setting.
176 The AVERT DOSE international trial: an update on the Irish experience
Authors: McDonnell M W , Kelly N , O'Malley T , Coleman S , Kavanagh H , Prendergast C , Joksaite K , Lynch O , Donohue A , Cassidy T , Mackey C , Dolan E , Lucey F , Hennessy E , O’Connor M , Twomey D , Murphy S , Kelly P , Horgan F , Bernarhdt J 
Published: September 2023

Abstract

Background
Mobility training is a complex intervention and recovery post-stroke is multidimensional. AVERT DOSE aims to define optimal early intervention regimens for people with mild to moderate ischaemic stroke.

Methods
AVERT DOSE (ACTRN:12619000557134) is an international randomised trial that will recruit &gt;2,500 patients. Randomisation is to two groups according to stroke severity. Patients are then randomised to one of four mobility training regimens in each strata and the intervention is delivered for up to 14-days. Primary Outcome: Identification of the intervention regimen that results in higher proportion of favourable outcome at 3-months post-stroke.

Results
In Ireland, 4 sites are actively recruiting (1,2,3 and 7), one completing training (4) and two finalising ethical approval and contracts (5,6). Eighteen patients have been recruited to date in Ireland, and over 400 internationally. Trial set-up has proven complex with processes and requirements differing significantly across Irish sites. Time to ethics approval has ranged from 10-months to over 3-years. The novel status of this trial as a non-drug/medical device trial, but rather rehabilitation trial, had led to discussion in relation to the need for a trial EU representative. Staff recruitment and retention challenges have proven to be a significant barrier to recruitment in recent months. The development of an Irish Avert Dose group to collaboratively address challenges and provide peer support has proven very successful in both supporting sites to reach recruitment stage and throughout the stages of screening, recruitment, intervention and blind assessment.

Conclusion
Undertaking rehabilitation research against the backdrop of a global pandemic and increasing staffing challenges requires a determined, problem-solving approach. Irish sites have embraced this opportunity to answer an important stroke research question. Health and social care professionals have displayed innovation and competence in steering clinical research and this should improve future rehabilitation trial readiness. Trial recruitment is expected to gain pace as more Irish and international sites are approved.
202 Development of a be-SPOKE ICPOP clinics in a rural catchment area
Authors: Neachtain M Ni , Okon M , Hanrahan C , Walsh L , Rogan M , Munnelly P , McClean F , Joy S , Geoghegan J , Canavan M , Costello M 
Published: September 2023

Abstract

Background
The hub and spoke model within the healthcare setting is designed around the principle of a main healthcare setting (hub) which offers a full complement of services and investigations and supporting secondary (spoke) clinics, which offer a narrower range of services but may be much more practical and preferable environment for assessment for older adults. This strategic model can meet patient needs fully, allow for appropriate concentration of resources and offers great potential for delivery of high quality patient care.

Methods
Our aim is to describe the development of several SPOKE clinic in a rural catchment area as part of the Integrated care for Older Persons (ICPOP) service.

Results
Our catchment covers a population of 38,000, many of whom are living rurally with few accessible public transport options to attend the nearest city for medical assessments. We identified key locations to develop a spoke clinics to deliver comprehensive geriatric assessments on those with new falls, frailty and decline in cognition. We gathered key stakeholders and identified clinical space, listed equipment and upgrades that would be required and process mapped the patient journey compared to attending a city based hub clinic. Our first spoke clinic began January 2023, with two further locations added in April 2023 with positive feedback from patients and caregivers to date. Practical aspects have been praised by patients including parking, distance to clinic room and accessible facilities.

Conclusion
This model is in its early phase but has been satisfactory to date. An additional benefit has been improved interaction with local services and primary care teams co-located at spoke clinic sites. This model would be suitable to implement in any community catchment area with a large urban and rural population mix.
204 A prospective study using the Irish Hip Fracture Database developed Frailty Index to predict delirium and prolonged length of stay
Authors: Fitzpatrick D , Bradley E , Lannon R , McCarroll K , Romero-Ortuno R 
Published: September 2023

Abstract

Background
Hip fracture in older adults is associated with life changing disability and mortality and those with frailty are at greatest risk. The National Office of Clinical Audit, in collaboration with the Irish Hip Fracture Database (IHFD) has developed a Frailty Index specific to this population. A retrospective review of Hospital Inpatient Enquiry (HIPE) and IHFD data demonstrated an association between frailty index and adverse outcomes. In this study, we evaluate the use of this tool prospectively to predict delirium and prolonged Length of Stay (LoS) in older hip fracture patients.

Methods
Data was collected prospectively on an acute inpatient orthopaedic ward from October 2022 to May 2023. We excluded patients aged &lt;60 years and those with periprosthetic or atypical femoral fractures. The Frailty index (a 21-item scale based on comorbidities and premorbid functional status) was calculated and delirium identified by a 4AT score ≥ 4 or a documented clinical diagnosis. Logistic regression was used to evaluate the potential relationship between frailty index and outcomes of delirium and delirium prolonged LoS (≥30 days).

Results
There were 92 patients, of whom 68.5% were female with a mean age of 79.5 ± 9.1 years. Delirium developed in 29.3% of patients and 19.5% had a length of stay of ≥30 days. A 4AT score was calculated in 45.7% of patients. Patients with versus without delirium had a lower frailty index (0.13 vs 0.21). Frailty index was also associated with delirium (p = 0.04) and prolonged LoS (p = 0.04) independent of age and gender.

Conclusion
The IHFD Frailty Index is effective in predicting delirium and prolonged length of stay in older hip fracture patients. Using a frailty index may help identify frail patients who are at greater risk of adverse outcomes and may benefit from early targeted interventions and orthogeriatric review.
220 Kildare West Wicklow OPT: a pilot study to provide early supported discharge for older adults (&gt;65) in Naas General Hospital
Authors: Dunne E , Fingleton C , Kenny B , Hayes S , Dempsey G 
Published: September 2023

Abstract

Background
In the absence of clinical governance from a Consultant Physician in Geriatric Medicine, KWWICPOP team developed an altered pathway in collaboration with Naas General Hospital (NGH). The Kildare West Wicklow Older Persons Team (KWWOPT) early supported discharge pilot commenced in October 2022. KWWOPT is an interdisciplinary team whose aims, in line with Slaintecare, are to: (1) Provide timely planned coordinated care via a therapy at home model, (2) Minimise acute hospital admissions, (3) Facilitate early supported discharge, (4) Augment the link between acute and community services and (5) Provide early supported discharge for older adults (&gt;65 years) in NGH who would benefit from receiving multidisciplinary coordinated rehabilitation, (&gt;2 disciplines currently employed on OPT) in the home.

Methods
Referrals are received from NGH. A keyworker is appointed and Comprehensive Geriatric Assessment is completed. The keyworker presents the results at MDT meeting and generate internal referrals to other team members. If referrals are required to other services not currently in post, referrals are generated to Primary Care Services. Clients may also be referred to external services. Each discipline carries out their own individual assessment and treatment and clients are discussed at MDTs at regular intervals to ensure care is coordinated. A discharge summary is prepared by each discipline involved in the clients care. The discharge summary is sent to the clients GP and local Primary Care Centre. All clients and their families are given a feedback form to complete at the end of their episode of care.

Results
Referrals in the first 5 months of this pilot: (1) 69% from inpatient wards (early supported discharge and reduced hospital bed days), (2) 25% from Naas General Hospital Frailty Intervention Team (Admission avoidance) and (3) 6% other sources.

Conclusion
The KWW OPT continues to grow and provide interdisciplinary integrated care as part of the National Care Programme for the Older Person.
228 The impact of lack of fulfilled home support service allocation on informal caregivers
Authors: Shiel E , Whelan A , Mannion K , Donuhue M , Cleary A , Cosgrove J , Gavin C , Sestak K , McDonnell C , Geoghegan James , Hanrahan C , O'Malley K , Okan M , Murphy R , Costello M , Canavan M 
Published: September 2023

Abstract

Background
With an ageing population, there is a growing demand for home support services to enable older people live independently. Despite investment, there remains an acute labour shortage in this sector. Here we report the profile of patients impacted by the consequences of disparity in allocated support and care hours fulfilled.

Methods
Retrospective analysis of 155 patients presenting to community based clinics across a period of 2.5 years in whom data on home help hours were available was conducted. Participants included were new patients referred for comprehensive geriatric assessment.

Results
Participants had a mean age of 82 years (Standard Deviation: 7). 63% (n = 97) participants were female. 23.9% (n = 37) of participants had a mismatch in home support hours filled compared to hours allocation. Those with a mismatch in home support hours were more likely to be female, with higher CFS. While 85% were independently mobile, 85% were frail, 80% were dependent for IADLs, and median MOCA was 18. Patients who had an informal caregiver were more likely to have a mismatch in hours (Odds Ratio [OR]: 5.97; 95% Confidence Interval [CI]: 1.67–38.11). A mismatch in home support hours was associated with a significant increase risk of caregiver burnout/strain (OR: 3.58; 95% CI: 1.68–7.85). Patients assessed in 2023 had a higher proportion of mismatched hours (30% Vs 23.9%), and were noted to be predominantly rural dwelling (85% Vs 69%) and living alone (55% Vs 46%).

Conclusion
We identified that there was a sizable mismatch in support hours allocated and hours received among a predominantly rural dwelling, frail cohort with cognitive decline and this was significantly associated with caregiver strain. Further dedicated research is required to explore barriers to successful home support integration including needs and expectations of the older person, their informal carers and the people delivering home care services such as role development, training and incentives.
230 Inter-rater reliability assessment of OPTI-3S (criteria for optimising medicines by stopping, stepping down, or switching to safer alternatives)
Authors: Ali A A H , McMahon N , Ryder S 
Published: September 2023

Abstract

Background
The OPTI-3S criteria comprise newly developed consensus-based statements identifying potentially inappropriate medications for hospitalised frail older adults. This study assessed the inter-rater reliability of the OPTI-3S core list.

Methods
Data were collated from ten patient cases in the publicly archived ‘The Irish Longitudinal Study on Ageing’ (TILDA) dataset (Wave 3). Five healthcare professionals assessed medication appropriateness across the cases according to the OPTI-3S statements, indicating the applicable statement(s). Their assessments were compared against a ‘Gold Standard (GS) assessment’ consisting of a combined assessment of a research team member and a clinically experienced academic researcher, who independently assessed the medications’ appropriateness. Concordance between the GS rating and other raters was assessed by kappa statistics. Major discrepancies were identified when a rater applied a statement &gt;2 times more or less frequently than GS [1].

Results
The ten patients’ median age was 74 (Interquartile Range: 70–80) years, and 40% were female. The median (IQR) number of medications was 10 (9–12). Cohen’s kappa coefficient ranged from 0.65 to 0.86, indicating substantial to perfect interrater reliability when agreement was measured between the GS rating and any other rater. The overall mean (95% CI) Fleiss kappa coefficient between all raters was 0.67 (0.65,0.69), indicating substantial interrater reliability. The mean Fleiss kappa coefficient (95% CI) between the GS rating and geriatricians was 0.63 (0.60, 0.67). A good Fleiss kappa coefficient of 0.81 (0.75, 0.86) was found between the GS rating and pharmacists. Major discrepancies in applying seven statements were noted between the GS rating and three raters. Three of these statements were misinterpreted, indicating revised wording is needed.

Conclusion
The OPTI-3S core list shows substantial inter-rater reliability between experts with no previous experience using it. However, further testing with a larger number of clinical cases and raters is required.
234 Staffs’ understanding of human rights based care in Long-Term Care facilities in Ireland- a qualitative study
Authors: Savolainen K , Phelan A 
Published: September 2023

Abstract

Background
In 2019, Health and Information Quality Authority (HIQA) in Ireland produced a human rights-based care guidance document for long-term care (LTC) facilities. Despite the guidance launch in 2019, little is known of the staff’s understanding of human rights-based care in Ireland. Also, internationally various bodies have acknowledged a deficit in knowledge of human rights in healthcare. The aim was to establish the staff’s understanding and knowledge of the human rights-based care framework in LTC facilities in Ireland.

Methods
Semi-structured interviews with 15 staff members in three LTC facilities were conducted between January and April 2022 as part of a more extensive study into the human rights of older people in LTC facilities in Ireland. Trinity College Dublin granted ethical approval. Staff were asked if they had heard of a human rights-based care framework. Transcribed interviews were analysed to establish knowledge of human rights-based care.

Results
Interviews with seven staff nurses and six healthcare assistants were conducted. Their professional experience varied, but the average length of employment in the LTC sector was 7.76 years. Only one staff member, a staff nurse with over 20 years of experience, had heard of the human rights-based care framework. There was no significance in understanding between staff nurses and healthcare assistants. Very little was known when asked for more detailed knowledge of human rights and how to apply it to care delivery for older people.

Conclusion
Although the guidance document being in place since 2019 and regulating bodies raising awareness of human rights-based care in LTC facilities, staff’s awareness about human rights-based care was limited. Similar to previous international studies, this study highlights the enormous gap in knowledge of human rights-based care for older people in LTC facilities and robust systematic awareness programmes are needed.
235 A clinical audit of detection and management of sarcopenia in a mixed stroke ward in an academic teaching hospital
Authors: O'Connor A , Harte G , Ryan D , Collins R 
Published: September 2023

Abstract

Background
Sarcopenia is the loss of skeletal muscle mass and function and correlates with physical disability, poor quality of life, and mortality. Screening guidelines have been set as per the International and European Clinical Practice Guidelines, and treatment recommends progressive resistive training and a protein-rich diet.

Methods
A retrospective chart review was conducted on a mixed stroke/geriatric ward, using a custom-designed audit tool.

Results
22 patients were included. 82% of patients were over the age of 65. No patients had sarcopenia documented on admission as a diagnosis, or were screened for it on admission. The majority of patients were under the care of a geriatric team (68%, n = 15), and were more likely to have their muscle strength assessed during their stay, than by other inpatient teams (53% vs 38%). 71% of inpatients under another team were over 65 (n = 5). Stroke patients were more likely to have muscle strength assessment vs non-stroke admissions (61.58%, n = 8 vs 33%, n = 3). 10 patients had difficulty following commands, and a third of these had muscle strength assessments undertaken. 96% of inpatients displayed evidence of, or possibility of sarcopenia. The most common muscle strength assessment tool used was isometric lower limb testing (n = 6), followed by oxford scale (n = 3), and grip-strength (n = 1). No patient had analysis of muscle quality. 87% (n = 13) of patients under geriatric care were assessed by clinical nutrition, whereas only 60%(n = 3) of the patients over 65, under the care of another team had such assessment.

Conclusion
Sarcopenia is not well screened for on our mixed geriatric/stroke ward. An all age cohort and multiple primary physicians may be factors. We plan to examine effects of an education tool on risk recognition, assessment (SARC-F) on screening and detection. Improvement in awareness may lead to more appropriate multidisciplinary referrals for intervention and analysis of muscle quality, which should help improve patient outcomes.