bluuebunny/crossref_metadata_2025_split huggingface dataset:
286 Gait speed—a useful addition to dementia risk prediction in midlife? Results from ENBIND
Authors: Morrison L , Dyer A , Kennelly S 
Published: September 2023

Abstract

Background
Midlife Type 2 Diabetes (T2DM) is associated with a two-fold increased risk of dementia in later life. The utility of spatiotemporal gait characteristics to identify those with midlife T2DM at greatest risk of later cognitive decline has not been assessed. This may aid in selecting-out those at greatest risk for preventative brain-health interventions.

Methods
ENBIND is a longitudinal study of cognitively-healthy individuals with midlife T2DM (free from microvascular/macrovascular complications) and healthy controls. At baseline, gait speed was measured across three tasks (usual gait speed, maximal gait speed and cognitive dual-task—whilst reciting alternate letters of the alphabet). Domain-specific neuropsychological performance was assessed using the Montreal Cognitive Assessment (MoCA) and a custom CANTAB battery with identical assessments repeated at a 4-year interval. Linear regression was used to analyse results with adjustment for important clinical confounders.

Results
30 individuals (aged 55.5 ± 9 years; 50% female) were followed up, of whom three-quarters (n = 23, 76.7%) had midlife T2DM. Individuals with midlife T2DM did not experience greater cognitive decline over 4 years. Slower ‘usual’ gait speed (but not dual-task or maximal speed) at baseline was associated with greater likelihood of incident errors on the MoCA at 4 years, which persisted on controlling for T2DM status, age, sex and baseline cognition (B: -0.22 [95% Confidence Interval: −0.41, −0.03, p = 0.03]). Slower maximal (B: −3.07, −6.06, −0.08, p = 0.04) and cognitive dual-task (B:-1.98, −3.61, −0.17, p = 0.03) speed were both associated with significantly poorer delayed memory performance after 4 years.

Conclusion
In middle-aged individuals with known dementia risk factors, gait speed may be a useful adjunct to identify those at greatest risk of longitudinal cognitive decline. Whilst usual gait speed was associated with a decline in global cognition, fast and dual task gait speed were associated with longitudinal decline in delayed memory performance.
322 Implantable Loop Recorders in unexplained falls
Authors: Bourke R , Perez S , Leenders M , Maree A , Melis M , Foran T , Kenny R A 
Published: September 2023

Abstract

Background
Falls are the most common cause of injury in older adults leading to hospitalisation, functional decline, and increased morbidity and mortality. Cardiac arrhythmia is a known risk factor for falls with arrhythmias implicated as causative in up to 20% of unexplained falls in older adults. The aim was to examine arrhythmia and activity data in older fallers using an Implantable Loop Recorder (ILR) with an embedded accelerometer (Medtronic reveal LINQ).

Methods
Thirty participants with at least two falls in the previous two years were prospectively recruited. All met criteria for ILR insertion following a comprehensive cardiovascular assessment, where no abnormalities were detected. Cardiac and accelerometer data were collected for 1 year. Falls details were collected using falls diaries.

Results
The mean age of participants was 68.0 years (±9.3). 19/30 (63.3%) were female. 22/30 (73.3%) had at least one cardiovascular condition documented in their medical history. Sixteen participants (53%) had a significant arrhythmia during follow up with mean time to arrhythmia 101.6 days. Arrhythmias included tachyarrhythmias, bradyarrhythmia (with asystole) and atrial fibrillation. Five (17%) required pacemaker insertion. Combining nocturnal and diurnal cardiac parameters with accelerometer data were not predictive of falls.

Conclusion
ILRs are useful tools to help identify the cause of unexplained falls. The paroxysmal nature of arrhythmia make diagnosis without prolonged monitoring difficult, given that all participants had thorough cardiovascular investigations prior to implantation. This research supports European Society of Cardiology and World Falls guidelines for implantation of ILR in older people with unexplained falls. The addition of a triaxial accelerometer did not demonstrate added value in falls prediction.
326 Pre-morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study
Authors: Carthy C Mc , Yusuf S , Judge C , Ferguson J , O’Donnell M 
Published: September 2023

Abstract

Background
We have previously shown that disturbances in sleep to be associated with acute stroke, but their association with stroke severity is less certain. In the INTERSTROKE study, we evaluated the association of pre-morbid sleep disturbance with stroke severity and functional outcome in acute stroke patients.

Methods
INTERSTROKE was an international case–control study of first acute stroke. This analysis comprised cases who completed a standardised questionnaire concerning nine symptoms of sleep disturbance (sleep onset latency, duration and quality, nocturnal awakening, napping, snoring, snorting and breathing cessation) in the prior month (n = 2,361). Two indices were derived representing sleep disturbance (range 0–9) and Obstructive Sleep Apnoea (OSA; range 0–3) symptoms. The modified-Rankin score (m-RS) was used to measure stroke severity at initial assessment and functional outcome at 1-month follow-up. Severe stroke was defined as an m-RS of &gt;3, and functional deterioration was defined as an increase in m-RS at 1-month. Logistic regression was used to estimate the magnitude of association between symptoms and stroke severity.

Results
The mean age of participants was 62.9 years, with 42% female, 80% diagnosed with ischaemic stroke and 17% reporting &gt;5 sleep symptoms. On multivariable analysis, there was a graded association between increasing number of sleep disturbance symptoms and initially severe stroke (2–3: Odds Ratio [OR]:1.44; 95% CI [Confidence Interval]:1.07–1.94, 4–5: OR:1.66; CI:1.23–2.25, &gt;5: OR:2.58; CI:1.83–3.66). Having &gt;5 sleep disturbance symptoms was associated with a significant increased odds of functional deterioration at 1-month (OR:1.54; CI:1.01–2.34). A higher OSA score (2–3 vs 0–1) was also associated with a significant increased odds of initially severe stroke (OR:1.48; CI:1.20–1.83) but not functional deterioration at 1-month (OR:1.19; CI:0.93–1.52).

Conclusion
Symptoms of sleep disturbance were common and associated with an increased odds of severe stroke and functional deterioration at 1-month. Interventions to modify sleep disturbance may help prevent disabling stroke/improve functional outcome after stroke, and should be the subject of future research.
329 The impact of a novel tele-education programme on phases score and palliative care symptom severity markers in nursing home residents
Authors: Dowling M , Molloy U , Murphy C , McLean S , Ryan D 
Published: September 2023

Abstract

Background
Education delivery to nursing homes may improve the palliative care residents receive, improving symptom burden and potentially avoiding unnecessary hospital admissions. Phases Score is an internationally utilised palliative care outcome-based tool to describe a patient’s condition. Patients are categorised as stable, unstable, deteriorating, or dying; the patient can move from one Phase to another based on response to their treatment plan. The aim of this study was to explore the impact of a novel teleconference-facilitated education programme (Project ECHO) by monitoring the change in residents’ Phases scores and other palliative care markers in participating and non-participating nursing homes.

Methods
A ten-session education programme was delivered to 20 nursing homes in Dublin. Palliative care severity markers (Phases Score, pain, etc.) were collected from residents that had been referred to community palliative care. Data collection took place for six months prior to and six months after the education programme in nursing homes that participated (cases). For further analysis, data was also collected in non-participating nursing homes (controls).

Results
Data was collected on 94 palliative care episodes for 34 patients from participating nursing homes. After the ECHO education programme there was a trend towards a higher proportion of residents in the ‘Stable Phase’ (1/18 (6%) pre-ECHO vs 18/76 (24%) post-ECHO, p = 0.09). There was also a trend towards a lower proportion of residents in the ‘Unstable Phase’ (4/18 (22%) pre-ECHO vs 7/76 (9%) post-ECHO, p = 0.12). Post-ECHO, there was a significant reduction in the proportion of residents reporting pain (12/18 (67%) vs 30/76 (39%), p = 0.03). A 1:1 age-matched case–control analysis with non-participating nursing homes did not show the benefits seen in the ‘Pre/Post-ECHO’ analysis of cases.

Conclusion
This study attempted to validate an educational approach using a ubiquitously utilised palliative care tool and may indicate a trend towards improved symptom control associated with the education programme.
3 Defining loneliness for older adults: a multi-study synthesis
Authors: Power J M 
Published: September 2023

Abstract

Background
Loneliness is an unpleasant experience linked to multiple adverse health outcomes, but we lack effective interventions to reduce or prevent it. Most interventions are based on a social psychological definition of loneliness (“a perceived discrepancy between actual and desired social relationships, but such interventions are typically unsuccessful. A recent umbrella review of loneliness interventions suggests that they should target specific population subgroups to be effective. This means that we may need more specific definitions of loneliness. In this presentation, I will integrate data from across studies to present an integrated definition of loneliness for older adults.

Methods
Across two qualitative grounded theory studies, we interviewed two samples of adults aged 60 and over: one living rurally and identifying as socially isolated; the other spousal dementia caregivers whose spouse recently moved to long term care. Data from these studies were integrated and framed in the context of a theoretical synthesis of loneliness we published and recently updated.

Results
Loneliness was defined in multiple ways, arising from boredom or inactivity, vulnerability, passivity, giving way to predictable behavioural patterns such as distracting tasks, and affective responses such as self-pity. We integrated this with our theoretical synthesis, which frames loneliness as arising from factors on proximate levels (loss of intimate partners, parental relationships, life transitions), as well as more distal influences such as the social network, and culture).

Conclusion
We argue for cohort-specific definitions of loneliness since these are likeliest to lead to effective interventions. We offer some possible definitions and aspects of loneliness to focus upon in interventions for older adults.
11 Audit of the effectiveness of the MBI as a functional outcome measure & the correlation between admission scores and discharge destination
Authors: Kennedy S , Somers J 
Published: September 2023

Abstract

Background
Current health and social care policies are changing. The importance of rehabilitation has been highlighted, therefore gathering evidence and having measurable outcomes are essential. Stroke is currently the largest cause of community disability in Ireland. The current widespread lack of community services is having a significant impact on people living with stroke in the community. Therefore emphasis has been put on quality of rehabilitation and treatment to reduce the disability post stroke and promote independence of stroke survivors. As Occupational Therapists we focus on outcome measures to evaluate real changes that occur for clients. Outcome measures provide evidence of effectiveness of treatment and whether an intervention impactful.

Methods
MBI was completed pre and post intervention with a total score identified. All clients in the stroke rehabilitation unit between June—August 2021 were included. SHAH’s prediction table was used to forecast discharge destination based on MBI scores.

Results
MBI performance scores increased from 41–63/100 with an average increase of 22%, ranging up to 49%. 56% were predicted as ‘unlikely to return home’ compared to 38%. 25% were predicated to need community services compared to 50%. 13% were predicted to move from dependency to assisted independence compared to 6%. 6% were predicted to be discharged independent compared to 0%.

Conclusion
The outcome demonstrated the effectiveness of the MBI as an outcome measure. The improvement of scores clearly show how OT intervention can maximise independence and decrease dependency. No significant correlation was identified between BMI and SHAH’s predicted outcomes. Further research into this area is warranted with a larger population size. Measuring post stroke functional outcomes, quality of rehab and dependency level of stroke survivors returning to the community is essential. The burden of disease is estimated to double worldwide by 2030 therefore restoration to living from an acute/rehabilitation setting is essential.
20 Clinical competencies of the clinical nurse specialist in Care of the Older Person in a geriatric assessment unit
Authors: Artiles C E , Toner C , Álvarez L P , Thomas S 
Published: September 2023

Abstract

Background
Access to geriatric assessment, coordination between healthcare providers and integration of care across the health system are critical to meet the care needs of older adults living in the community with complex care needs. Clinical Nurse Specialists (CNS) with knowledge and clinical skills in gerontological nursing are key for the provision of care in this cohort. Our aim was to conduct an audit of CNS activity in the Geriatric Assessment Unit (GAU) in relation to specialist nursing clinical competencies.

Methods
We conducted a retrospective audit of CNS activity during the first quarter of 2023 with a focus on the CNS clinical core competencies as defined in the Framework for the Establishment of Clinical Nurse\Midwife Specialist Posts in two GAU in Louth.

Results
In total, n = 301 patients attended the two GAU in the first quarter of 2023, 58% female, with mean age 79.90 (95% CI 79.18–80.62), n = 78 of whom were new to the service. Within an interdisciplinary approach, a Comprehensive Geriatric Assessment (CGA) is conducted by the CNS, which includes obtention of a detailed medical history, nutritional assessment, falls risk, skin integrity, frailty and dependency level, assessment of continence, cognitive screening and swallow screening. These assessments led to n = 273 referrals to community-based services, including Public Health Nurse (n = 51), Occupational Therapist (n = 38) and Memory Rehab (n = 18). Mean waiting time to attend the clinic for the first time was 104.13 days (95% CI 89.79–118.47).

Conclusion
The CNS in Care of the Older Person conducts a CGA, identifies unmet care needs and plans, coordinates and initiates person-centred care for older adults living in the community with complex care needs. CNS input is key to achieve adequate management of complex care needs while avoiding negative outcomes and promoting quality of life.
24 Benefit of therapeutic oral trials in dysphagia rehabilitation
Authors: Loughnane H , Seoighe C D , Sheridan M 
Published: September 2023

Abstract

Background
Therapeutic oral trials (also known as ‘swallow trials’) are one therapeutic approach offered by Speech and Language Therapists (SLTs) as part of dysphagia rehabilitation. It involves offering prescribed amounts of a specified consistency of food and/or fluids to patients whom it is felt would not safely take full portions of oral intake due to risk of aspiration. These patients typically receive the majority of their nutrition and hydration artificially with the purpose of therapeutic oral trials being comfort, enjoyment and an opportunity to swallow in a functional manner (incorporating principles of neuroplasticity such as specificity, intensity and grading).

Methods
Three patients &gt;60 years age from a variety of patient cohorts (stroke, cardiothoracic surgery, critical care) presented with moderate–severe dysphagia (confirmed on instrumental assessment). All received full nutrition and hydration via nasogastric tube. All received baseline clinical bedside assessment and Fibreoptic Endoscopic Evaluation of Swallowing (FEES). Based on the results of same, programme of dysphagia rehabilitation exercises were provided. All patients also received daily swallow rehab consisting of therapeutic oral trials (ice chips, fluids, diet) along with traditional exercises. Repeat FEES was completed after three weeks to assess progress and guide recommendations for oral intake and rehab.

Results
After three weeks, all patients showed two point improvements on dysphagia outcome severity scale. After six weeks, all patients were on full oral intake, no longer receiving artificial nutrition. Anecdotally, all patients reported that therapeutic oral trials provided significant enjoyment and added to quality of life. SLTs subjectively noted improved engagement and improved oral hygiene versus swallow rehab alone.

Conclusion
The concept of therapeutic oral trials builds on principles of neuroplasticity and are a useful adjunct in the dysphagia rehab toolbox of the SLT. They can have clinical benefit and support traditional rehabilitation. Importantly, patients report significant enjoyment and improved swallow-related quality of life when receiving them.
30 An Irish multi-hospital longitudinal study of discharged patients with a diagnosis of dementia
Authors: Kilgannon A M 
Published: September 2023

Abstract

Background
Approximately 64,000 people in Ireland are living with dementia. The care of people living with dementia poses increasing challenges in acute inpatient settings, yet a lack of data exists in Ireland and Europe on the distribution and prevalence of dementia across acute hospitals. To date studies indicate a dementia prevalence in adult inpatient admissions of 29% in 6 Cork hospitals and 42.4% in a single London teaching hospital.

Methods
Retrospective longitudinal analysis of discharge data extracted from NQAIS Clinical from January 2018 to December 2022.

Results
According to data retrieved from NQAIS Clinical for those over 65 years, only 1% of patients discharged from ten acute hospitals had a dementia diagnosis in 2018. This figure remained relatively unchanged between 2018 and 2022. A decrease of 0.04% was noted during the COVID-19 pandemic in Ireland from March 2019 to early 2021. Data recorded for patients under 65 years indicates a gradual upward trend from 2018 to 2022.

Conclusion
Ireland has no systematic approach to the collection and analysis of dementia data. This data only includes diagnosed dementia cases, entirely relying on hospital record documentation. These results reinforce the lack of accurate dementia diagnosis recording and coding within the acute setting and highlights the need for improvement of dementia services given the rising number of dementia diagnoses.
34 Dysphagia at the front door: profiling dysphagia in a frail population presenting to the emergency department
Authors: Leonard A 
Published: September 2023

Abstract

Background
The prevalence of both frailty and dysphagia advances with age. Worsening dysphagia increases the degree of frailty and reduces quality of life. The aim of this study was to describe the characteristics and mortality risk of a population of patients identified for Speech and language therapy (SLT) review in a Frailty at the Front Door (FFD) team.

Methods
A FFD team performs comprehensive geriatric assessment (CGA) for older frail patients presenting to the emergency department. To assist service planning, all patients were screened for the possible presence of dysphagia using the 4QT and those with a response to 1 or more screening questions underwent SLT review. Data were collected from consecutive SLT patient records and a hospital based patient database of CGAs over a 3-month period. Age, gender, 4AT, MST malnutrition risk screen, clinical frailty score (CFS), nursing home (NH) residence, dysphagia outcome severity scale, need for acute hospital admission and mortality rate at 1000 days was collected. Data were entered onto Excel and analysed using descriptive statistics.

Results
69 swallow assessments were carried out. The mean age was 83 (+/−9) years. 71% (n = 49) were female. The 4AT was ≥4 in 36% (n = 25). 42% (n = 29) were at risk of malnutrition. The CFS was ≥6 in 62% (n = 43). 23% (n = 16) resided in a nursing home, 72% (n = 50) had dysphagia, 92% (n = 63) required hospital admission and 36% (n = 25) were experiencing their ‘last 1,000 days’ at follow-up.

Conclusion
Older patients presenting to the ED with a coexisting dysphagia are at high risk of malnutrition and delirium, moderately frail, present with moderate dysphagia, and are more likely to require acute hospital admission. This cohort need early screening, identification, assessment and intervention, in order to reduce dysphagia related risks and improve patient outcomes, particularly given the high proportion that are in their last 1,000 days.
38 Operational teams leads-stuck in the middle?
Authors: Shé É Ní , Hartnett P J , Burke P , O'Shea M , O’Donnell D 
Published: September 2023

Abstract

Background
Middle managers have a crucial role in implementing integrated care service models, but very little research has been undertaken on their experiences. A key element of the National Clinical Programme for Older People’s support for the implementation of the National Older Person’s Service Model is the establishment of Community Specialist Teams for Older People (CST-OP). These interdisciplinary teams are critical to supporting older people with complex care needs necessitating integrated care. Operational Team Leads (OTLs) are responsible for coordinating the interdisciplinary team effort to meet that aim. This research is focused on capturing OTLs experiences as they commence their roles in supporting inter-professional collaboration to achieve integrated care.

Methods
We employed a qualitative case study design. The unit of analysis was the process of OTLs establishing their roles over two-time points. A total of 18 OTLs participated in interviews (n = 11), and focus groups (n = 7) documentary summaries were reviewed.

Results
OTLs are creating networks to share knowledge to advance their work Key factors impacting some OTLs included a lack of induction and preparation for the role. They noted a need for national centralised resources and guidance, national standards development, education and networking and feedback loops. Locally there are some tensions in role clarity and clear reporting lines. Work is required to position the CSTs within community governance structures. Developing a team’s vision, mission and goals, building trust and ensuring psychological safety are necessary. Resources on how to undertake change were stressed. Recognition by OTLs of managing expectations of their role as they focus on shifting from acute to the community with some recruitment challenges, need for a shared ICT system, and enabling collaborative team spaces.

Conclusion
The role of managers within integrated care systems is evolving. There is an evidence gap in understanding the operations of implementing integrated care for older people. This research responds to these gaps and will be shared across the CSTs network.