bluuebunny/crossref_metadata_2025_split huggingface dataset:
48 The collaboration of oncology Clinical Nurse Specialists and Public Health Nurses in comprehensive geriatric assessments in patients undergoing Cancer treatment
Authors: Callaghan C , Chase C 
Published: September 2023

Abstract

Background
Cancer is a widespread health issue, with the number of people &gt;70 diagnosed in 2020, reaching 7.2 million (37% of all cases) worldwide. This is expected to double by 2040. Valid and reliable tools to assess older patients undergoing cancer therapy are necessary to reduce toxicities, decrease delays, and better guide dose modifications. There are performance assessment tools used in oncology, however, they are subjective and have limited use for toxicity risk stratification. Currently, patients do not routinely have a frailty assessment in the oncology setting. Public Health Nurses (PHN) often know these individuals before commencing treatment, they may have a therapeutic relationship with the patient and family, and are in a prime position to perform a frailty assessment which can detect vulnerabilities and age related issues associated with mortality. Moreover, collaboration between Acute services and primary care may enhance CGA’s and improve patient care.

Methods
Two case studies are examined, where collaboration of Acute services and Primary care improved patient outcomes and quality of life.

Results
Case study 1: PHN identified early toxicities of treatment, Rockwood Scale used, Liaised with acute oncology CNS (Clinical Nurse Specialist) and dose of treatment modified, resulting in completion of treatment and avoidance of unnecessary hospital admissions. Case study 2: CNS contacted PHN as concerned about patient on treatment, G8 frailty score: 7 (very vulnerable). PHN supported a Comprehensive Geriatric Assessment (CGA). On discussion with Oncology team, treatment modified, and supports such as OT, Dietician and Physiotherapy were added.

Conclusion
Recommendations for practice include a role for combined Geriatric Oncology services, and also the use of in depth assessment tools in older patients to prevent treatment related toxicity. Collaboration of acute oncology and primary care teams may help identify earlier the need for CGA and enhance integration of care pathways.
69 ‘The model ward’: a stroke and specialist gerontology ward in a level three hospital in Ireland
Authors: Paponette B , Ahmed M , Bilal M , McGurk C , Hickey P 
Published: September 2023

Abstract

Background
A model ward adheres to formal processes and combines input from all members of the Multi-Disciplinary Team (MDT) from admission to discharge ensuring high quality patient care. A stroke and specialist gerontology ward in a level three hospital in Ireland leads this approach with MDT meetings every morning. Research has demonstrated that pre-round MDT meetings decreases length of stay, increases patient safety and enhances patient and staff experience. This audit evaluated the impact of pre-round MDT meetings on a stroke and specialist gerontology ward in a level 3 hospital in Ireland, as per NICE and New South Wales guidelines.

Methods
The audit was conducted between 25/04/2023 and 26/04/2023 via questionnaire consisting of 10 closed and 2 open ended questions. Staff members who attend meetings completed questionnaires and responses were confidential. 20 questionnaires were completed.

Results
100% of members (n = 20) found pre-round MDT meetings useful, aided with better delivery of care, reduced daily stresses and all key disciplines were represented. 85% (n = 17) stated it hastened patient discharge. 90% (n = 18) reported all opinions are brought together openly and patient-centred goals are established. 95% (n = 19) found overall aims, next steps and timeframes are agreed and the meetings make them feel unified. 80% (n = 15) of members previously worked on wards with no pre-round MDT meetings. Of those 15, 87% (n = 13) saw an improvement in patient care compared to other wards. 50% (n = 10) of members recommended no improvements necessary for meetings, 30% (n = 6) recommended earlier meetings, 15% (n = 3) would like more disciplines represented and 5% (n = 1) recommended alteration of seating positions for inclusivity. Currently consultants and registrars sit at the main table.

Conclusion
The results highlight the valuable impact of pre-round MDT meetings in providing continuous patient-centred care. This suggests further exploration by potential implementation of these meetings on other wards in hospitals.
71 NIH-AARP: Association of caregiving with lifestyle cardiovascular disease risk factors
Authors: Costello M , Judge C , Reddin C , McCarthy C , Murphy R , McDermott C , Smyth A , O’Donnell M , Canavan M 
Published: September 2023

Abstract

Background
Adult caregiving has been associated with adverse effects on cardiovascular risk factors and health outcomes, with most research focused on caregivers of individuals with dementia and single risk factors. We sought to explore the association of adult and child caregiving, across a spectrum of intensity, with multiple lifestyle risk factors.

Methods
We evaluated the association of caregiving with behavioural and metabolic cardiovascular risk factors, using unconditional logistic regression analyses in the NIH-AARP Diet and Health Study.

Results
While the overall association of self-reported caregiving with cardiovascular risk factors suggested a mostly positive relationship with healthy lifestyle traits (other than sleep duration), our findings also revealed that higher duration caregiving of adults (≥7 hours per week) was associated with an increased frequency of unhealthy behaviours, including diet, and smoking.

Conclusion
Our findings suggest that the association of caregiving and behavioural cardiovascular risk factors differ by type and intensity of caregiving.
73 A pilot of introducing Comprehensive Geriatric Assessment (CGA) in older patients admitted to an acute hospital to prevent acute re-hospitalisation
Authors: Sohail A A , Cooney E 
Published: September 2023

Abstract

Background
Recurrent hospitalisation is increasingly observed in older adults aged 65 or above and, is associated with increased risk of adverse outcomes including delayed recovery, increased morbidity, and mortality. We introduced Performa-based, Multi-Disciplinary Team (MDT) driven Comprehensive Geriatric Assessment (CGA) as a model of care of older patients admitted to an acute Irish hospital, and to see its impact in preventing acute re-hospitalisation after an acute admission.

Methods
CGA was performed, on inpatients aged 65 or older, admitted to a designated ward which had multidisciplinary team access, via a designed and prescribed Performa, by Advanced Nurse Practitioner and interventions suggested by it, were offered to those patients. The pilot continued for three months. Patients who underwent CGA, were monitored for re-admission at 3 months from the date of their discharge via hospital patient management system. Data was compiled and studied via Microsoft excel spread sheet.

Results
28 patients were admitted to the designated ward who underwent the CGA during the time frame of the pilot. 26 (92.8%) patients did neither present to ED nor were admitted to hospital in the immediate 3 months post discharge from the hospital. CGA resulted in various multidisciplinary interventions/referrals on all patients which were studied as secondary aims. The major interventions were MDT referrals (physiotherapy 100%, occupational therapy 85.7%, Swallow Therapists 46.4% and dietetic referrals 32.1%) and deprescribing (50% of patients).

Conclusion
The pilot showed reduced acute re-hospitalisation rates in older patients undergoing CGA, and an attempt to adopt CGA as model of care in acute hospitals to prevent acute re-hospitalisation in such patients. In the model, CGA also offered multiple interventions including MDT referrals/interventions and deprescribing. Further powered research replicating similar results, is needed to explore and adopt such CGA based models of care in older inpatients in acute hospitals.
128 Foot problems in older persons attending a day hospital
Authors: Carey G , Farrell E , Crowe M 
Published: September 2023

Abstract

Background
Foot problems may contribute to pain and falls in older people. We documented the prevalence of foot problems in older persons attending a Day Hospital for rehabilitation.

Methods
Symptoms of foot pain and prevalence of foot problems and inappropriate footwear were documented by 2 physiotherapists using a ‘foot problem score’ in consecutive referrals by consultant geriatricians to an offsite day hospital with rehabilitation expertise over a 3-month period. Subjects were categorised into 2 groups depending on whether they had none/only one fall or multiple falls in previous 12 months.

Results
Sixty-seven patients, age 72–93 years were included in the study. The most common foot problem was hallux valgus in 62 patients (93%) of whom 41(66%) and 4(6.5%) had moderate or severe deviation respectively. Other findings included corn/callus in 37(55%) patients, toenail abnormality in 30(44.7%) whilst only one patient was found to have an ulcer. Seventeen patients (25.4%) complained of painful feet. Twenty-nine patients (43%) were multiple fallers (2 or more falls in previous 12 months) of whom 13(44.8%) complained of foot pain compared to only 4/38(10.5%) of patients with none or only one fall over previous 12 months complaining of foot pain (p = 0.0014). Footwear was deemed inappropriate in 18.8% of patients whilst 56.3% were attending chiropody.

Conclusion
The higher prevalence of foot problems and foot pain in this survey compared to a similar survey (1) in community dwelling older persons may reflect increased comorbidities in this day hospital population and the adverse effects of foot pain on balance and function. Foot and footwear assessment should be incorporated into comprehensive geriatric assessment.
135 OptiCogs: feasibility of a multicomponent intervention to rehabilitate people with cognitive impairment post-stroke
Authors: O'Donoghue M , Boland P , Taylor S , Hennessy E , Murphy E , Leahy S , McManus J , Lisiecka D , Purtill H , Galvin R , Hayes S 
Published: September 2023

Abstract

Background
Stroke is a leading cause of death and disability worldwide. Despite the prevalence and associated burden of cognitive impairment post-stroke, there is uncertainty regarding optimal cognitive rehabilitation for people post-stroke. This study aimed to assess whether a multicomponent intervention, OptiCogs, is feasible, acceptable and safe for people with cognitive impairment post-stroke. A secondary aim was to explore changes in cognitive function, fatigue, quality of life, physical function and occupational performance.

Methods
A feasibility study was conducted where people post-stroke with cognitive impairment enrolled in a 6-week multicomponent intervention. The primary outcomes recorded included response rate, recruitment rate, retention rate, adherence to the intervention protocol, adverse events and acceptability of the intervention to people post-stroke. Secondary outcomes included (i) change in cognitive functioning, (ii) fatigue, (iii) quality of life (iv) physical function, and (v) patient-reported occupational performance. The Consolidated Standards of Reporting Trials extension reporting guidelines were followed, for pilot and feasibility studies, to standardise the conduct and reporting of this study.

Results
The response rate was 10.9%. Nine eligible participants were enrolled during the 4 month recruitment period, with eight participants completing the entire six-week intervention, as well as the pre and post-intervention outcome measures. There were no reported adverse events. Participants were satisfied with the intervention and found it acceptable overall. Results of the secondary outcomes were promising for cognitive function (Pre: 63.3 ± 23.9 to Post: 69 ± 24.6), fatigue (Pre: 52.5 ± 7.3 to Post: 45.6 ± 7.2), quality of life (Pre: 131.0 ± 26.3 to Post: 169.9 ± 15.3), physical function (Pre: 15.5 ± 6.3 to Post: 15.8 ± 5.3) and occupational performance (Pre: 9.3 ± 2.3 to Post: 22.9 ± 4.2).

Conclusion
Preliminary results suggest low-modest recruitment and high retention rates to the OptiCogs intervention. Changes in cognitive function, fatigue, quality of life and self-reported occupational performance show improvement from pre to post-intervention. These potential benefits require further testing in a definitive trial.
137 Harnessing technology to augment comprehensive geriatric assessment for older adults with frailty in CRISP admissions
Authors: Doyle M , Mathew J , Ryan D , McDonagh R 
Published: September 2023

Abstract

Background
The Community Rehabilitation Inpatient Specialist Program (CRISP) is an Advance Nurse Practitioner (RANP) led program that provides direct access for community-dwelling older adults to short-term (2-weeks) in-patient, intensive multidisciplinary rehabilitation based on a Comprehensive Geriatric Assessment (CGA). Patients attending the CRISP program are typically frail and have complex, multi-morbid medical backgrounds, many having multiple falls prior to admission. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk. Ambulatory blood pressure monitoring (ABPM) is recognised as especially helpful for identifying hypotension in older adults, where antihypertensive treatment should be individualised. The novel use of 24-hour ABPM in this setting offers these patients early diagnostics and early treatment options.

Methods
For patients, whom the CGA deems ABPM would be beneficial, monitors are fitted by the RANP as they return home for weekend leave mid-program. Results are promptly available to the RANP/Consultant Geriatrician and treatment plans are initiated and monitored throughout the remainder of the inpatient stay.

Results
In April 2023, the first month of use, APBM equipment was used for 80% (n-8) of older adults admitted to CRISP. 24-hour APBM has benefitted patients with a new diagnosis of hypertension, those with poorly controlled hypertension, patients with suspected orthostatic hypotension and those with concurrent hypertension and orthostatic hypotension where alterations to antihypertensive medication are initiated. We anticipate performing ABPM on 64 older adults in 2023 (80% of predicted admissions to CRISP).

Conclusion
The introduction of 24-hour ABPM as a diagnostic tool in this setting offers immediate diagnostic and early treatment options, reducing referrals, waiting lists and costs at over-stretched cardiac departments and increases the value of the Comprehensive Geriatric Assessment for older adults attending CRISP.
144 Personality’s association with the concordance of subjective and objective cholesterol measures: findings from the Irish longitudinal study on ageing (TILDA)
Authors: Coppola D 
Published: September 2023

Abstract

Background
With Cardiovascular Disease (CVD) as a leading cause of death in older adults, examining risk factors for CVD is crucial. High cholesterol, often addressable by lifestyle changes and medication, is a main contributor to CVD. Despite a large portion of Ireland’s (and the world’s) population having high cholesterol, this chronic illness goes undiagnosed or untreated. Personality’s demonstrated associations with overall health, self-reported health, and health behaviours makes it a key facet to examine alongside cholesterol.

Methods
Through secondary analysis of data from Waves 1 and 3 of TILDA, this research explores the intricate relationships between personality, subjective (self-reported cholesterol), and objective (bloods-measured) cholesterol. The 5 domains of personality were first cross-sectionally and longitudinally examined in relation to each manner of cholesterol measure. Overall concordance between subjective and objective results was examined. Finally, personality’s association with levels of concordance was analysed. These analyses were conducted using bivariate analyses and multinomial logistic regression.

Results
Various personality traits were univariately associated with cholesterol, with associations varying by cholesterol measure. Neuroticism was higher in participants with high subjective cholesterol, and extraversion, openness, agreeableness, and conscientiousness were higher in those with high objective cholesterol. Overall agreement between objective and subjective high cholesterol was low and only partially explained by personality traits. While substantial percentage of participants improved their bloods-measured cholesterol over time, openness was the only trait that predicted any change in cholesterol status.

Conclusion
These findings demonstrate univariate effects of personality traits on cholesterol levels. There is also evidence of discordance between subjective and objective cholesterol levels, suggesting a vast amount of the population goes undiagnosed and untreated for high cholesterol. This study’s unique findings have crucial implications for the public health sphere, demonstrating the importance of diversifying healthcare approaches and laying the groundwork for exploring personality’s associations with other cardiometabolic risk factors.
154 Tobacco smoking: impact on medication use, healthcare utilisation and hospitalisation in older adults; TILDA waves 3–4
Authors: Pisharody A , Fitzpatrick P 
Published: September 2023

Abstract

Background
Smoking is a significant cause of preventable mortality, morbidity and healthcare costs. Tobacco Free Ireland aims to reduce smoking prevalence to &lt;5% by 2025. The recently published Department of Health and HSE National Clinical Guidelines for Tobacco Control emphasise the need for healthcare professionals to address smoking cessation during hospital admissions. The aim of this study was to investigate the relationship between smoking and hospitalisation, health service utilisation and prescribed medication use.

Methods
TILDA (The Irish Longitudinal Study on Ageing) wave 3 and wave 4 datasets were used, with 5,564 participants in both wave 3 and 4. Following univariate analysis, logistic regression analysis was performed to determine the health service usage outcomes associated with smoking.

Results
On univariate analysis, primary/no education (p &lt; 0.001) and lower age group (&lt;53 years) were significantly associated with increased smoking. After adjustment for demographic variables, smokers had a reduced likelihood of attending ≥1GP appointments over the past 12 months than non/ex-smokers (adjusted Odds Ratio [OR]: 0.65, 95% Confidence Interval [CI]: 0.42–0.72). Hospitalisations during the same period were found to have no significant association with smoking (p = 0.490). Smoking was also shown to cause a reduced likelihood of having ≥1 regular medications (adjusted OR: 0.69, 95% CI: 0.57–0.85).

Conclusion
Considering the impact of smoking on health, the results appear initially counterintuitive. There are a couple of explanations. Older smokers with more severe smoking-related morbidity may not participate in the TILDA Study. In addition, the results suggest that smokers tend to avoid visiting the GP which may indicate either that smokers are unconcerned about their health or do not wish to discuss smoking. Deferral of care to a later stage may impact prognosis and costs. Further research is required to investigate the dose-effect relationship of smoking with health service utilisation in the Irish setting.
163 Examining the appropriateness of tilt-testing within a community integrated care hub for older persons services
Authors: Ryan S , Ryan S , Lynch P , Mathai V , Ramasia J , Shanahan E 
Published: September 2023

Abstract

Background
Tilt-testing has been widely used in acute hospitals for more than 20 years in Ireland. Its use in community settings has been promoted in recent years with the development of the National Integrated Care Programme for Older Persons (NICPOP). In our integrated care hub our focus lies in the assessment of falls and frailty. We propose to examine if the current rational for performing tilt-testing has showed a diagnostic yield.

Methods
We retrospectively reviewed all tilt reports in the ambulatory care hub from November 2021 to May 2023. We examined the rationale for ordering the test, the number of patients who received a diagnosis of Orthostatic Hypotension (OH) and treatment that was commenced.

Results
59 tilt reports were examined between the 18 month period. The average age of the patients were 83 (range 68–93). The male to female ratio was 1:1.3. All patients had an indicator for testing. The 5 indicators that emerged were falls, syncope, orthostatic intolerance, lying and standing blood pressure drop and dizziness. 11/59 (19%) patients had one indicator, 18/59 (31%) patients had two indicators, 15/59 (25%) patients had three indicators and 15/59 (25%) patients had four indicators for performing a tilt. OH was diagnosed in 36/59 (61%) patients of whom 9/36 (25%) had symptomatic OH during both HUT and AS, 8/36 (22%) had symptoms during HUT alone, 6/36 (17%) had symptoms during AS and 9/36 (25%) were asymptomatic throughout testing. 4/36 (11%) had no documentation regarding their symptoms during tilting. De-prescribing was performed in 16/36 (44%) patients and Midodrine was commenced in 18/36 (50%) patients with fludrocortisone being started on 2/36 (6%) patients.

Conclusion
We demonstrated a high yield from the tilt-test investigations and in combination with Ambulatory BP monitoring had a significant number of medications de-prescribed. The greater preponderance of more than one indicator for tilt-testing was greater than what we perceived.
165 Improving sarcopenia with a physiotherapy-dietetics sarcopenia management pathway in a post-acute rehabilitation unit
Authors: Nolan M , Henry J , Bradley K , O'Callaghan S 
Published: September 2023

Abstract

Background
Sarcopenia is a progressive and generalised skeletal muscle disorder. The prevalence of sarcopenia in Irish studies ranges from 30 to 41%. The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends that management of sarcopenia includes optimal protein intake and resistance training. The objectives of this study were to: (1) Implement a structured physiotherapy-dietetics sarcopenia management pathway for older persons identified as severely sarcopenic in a Post-Acute Rehabilitation Unit, to align with the (EWGSOP2) recommendations and (2) Assess the effect of the combination of protein optimisation and progressive resistance training (PRT) in reducing sarcopenia in those identified as severely sarcopenic.

Methods
Patients admitted to a post-acute rehabilitation unit from January to April 2023 were screened for sarcopenia using Grip strength and the Timed Up & Go test. All patients identified as being severely sarcopenic were referred to dietetics and attended a PRT class three times per week.

Results
There were 38 participants in this study. 73.7% were screened for sarcopenia on admission. From this, 71.4% were classified as having probable sarcopenia and 50% were identified as having severe sarcopenia. On discharge, 28.6% of participants had their sarcopenia completely reversed and 40% had their sarcopenia reduced from ‘severe’ to ‘probable’.

Conclusion
The results demonstrate that implementing a structured sarcopenia pathway for older persons in a post-acute rehabilitation unit has a positive effect on sarcopenia.