bluuebunny/crossref_metadata_2025_split huggingface dataset:
171 THE ‘WISH TO DIE’ AMONGST OLDER PEOPLE IN IRELAND IN THE CONTEXT OF THE DYING WITH DIGNITY BILL
Authors: Briggs R , Ward M , Kenny R A 
Published: February 2023

Abstract

Background
‘Wish to Die’ (WTD) involves thoughts of or wishes for one’s own death or that one would be better off dead.
Assisted dying is the act of deliberately providing medical assistance to another person who wishes to end their own life. Currently, in Ireland, it is illegal to provide such assistance to people with WTD or suicidal ideation. However, a new bill that would legalise assisted dying for those with terminal illnesses, the Dying with Dignity Bill 2020, is due to be considered by lawmakers in Ireland in the coming months.
In order to inform discussion around this complex issue, we examine the prevalence and longitudinal course of WTD in a large population-representative sample of older people.

Methods
To define WTD, participants were asked: ‘In the last month, have you felt that you would rather be dead?’
Depressive symptoms were measured using the CES-D.
Mortality data were compiled by linking administrative death records to individual-level survey data from the study.

Results
At Wave 1, 3.5% of participants (279/8,174) reported WTD. Both persistent loneliness (OR 5.73 (95% CI 3.41–9.64)) and depressive symptoms (OR 6.12 (95% CI 4.33–8.67)) were independently associated with WTD.
Of participants who first reported WTD at Wave 1 or 2, 72% did not report WTD when reassessed after 2 years, and the prevalence of depressive symptoms (−44%) and loneliness (−19%) was more likely to decline in this group at follow-up.
Fifteen per cent of participants expressing WTD at Wave 1 died during a 6-year follow-up.

Conclusion
WTD amongst community-dwelling older people is frequently transient and is strongly linked with the course of depressive symptoms and loneliness.
An enhanced focus on improving access to mental health care and addressing social isolation in older people should therefore be a public health priority, particularly in the current context of the Covid-19 pandemic.
191 FRAILTY PREVALENCE AMONG GERIATRIC HOSPITAL INPATIENTS, AND ITS ASSOCIATION WITH ECONOMIC INDICATORS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 467,779 INPATIENTS
Authors: Doody P , Asamane E A , Aunger J A , Swales B , Lord J M , Greig C A , Whittaker A C 
Published: February 2023

Abstract

Background
Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators.

Methods
Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality.

Results
Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 7/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators.

Conclusion
Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.
204 FRAILTY BUT NOT AGE IS ASSOCIATED WITH IMPAIRED ORTHOSTATIC CEREBRAL OXYGENATION
Authors: Pérez-Denia L , Claffey P , Byrne L , Rice C , Kenny R A 
Published: February 2023

Abstract

Background
The effects of age and frailty on cerebrovascular function are poorly understood. Here we investigate the hypotheses that aging, and frailty are accompanied by impaired regulation of cerebral oxygenation during standing in a patient population of older adults.

Methods
We recruited patients from a national Falls and Syncope service. All patients underwent an active stand test (5–10 min lying, 3 min standing) with continuous monitoring of blood pressure (BP) and heart rate. Tissue saturation index (TSI) was concurrently measured using near-infrared spectroscopy and its recovery measured at 30s after standing. Frailty was assessed as a comorbidity count using a 27-item questionnaire. Robust linear regression was used to investigate the association between TSI, age and frailty in a multivariate model with covariate adjustment, including the concurrent BP values. A p-value &lt;0.05 was considered significant.

Results
304 patients (median(IQR): 71(14) years, 57% females) were recruited. Age was not associated with cerebral oxygenation after standing (β: −0.001 (−0.017 0.015), p = 0.899), even after stratification by sex (males: β: −0.010 (−0.045 0.024), p = 0.558, females: β: 0.000 (−0.017 0.018), p = 0.967). Frailty, was associated with a lower TSI at 30s after standing (β: −0.153 (−0.248–0.058), p = 0.002). After sex stratification, no associations with frailty were observed in males (β: −0.052 (−0.226 0.123), p = 0.557), while frailer females demonstrated a lower TSI at 30 seconds after standing (β: −0.179 (−0.294–0.063), p = 0.003) despite BP correction.

Conclusion
Our results suggest alternative mechanisms of cerebral oxygenation regulation independent of blood pressure (and presumably cerebral autoregulation) are involved in frailty related impairments of brain haemodynamics which are also independent of ageing. Such impairments represent novel biomarkers of frailty and represent potentially novel modifiable risk factors (independent of BP management) of hypoperfusion related disorders in clinical ageing.
207 IMPLEMENTATION OF A FRAILTY CARE BUNDLE (FCB) IN ACUTE AND REHABILITATION SETTINGS
Authors: Naughton C , Cummins H , Foubert M , Barry F , Wills T , McCullagh R , Ahern E 
Published: February 2023

Abstract

Background
During hospitalisation older adults are at greater risk of hospital associated decline (HAD), attributed to hospital processes that fail to prioritise fundamental care related to mobility, nutrition and cognitive health.
The study aims to enable the nursing and multidisciplinary team to prioritise early mobilisation, optimise nutrition and cognitive engagement in patients aged 60 years and older.

Methods
Four wards were recruited, two orthopaedic trauma and two orthopaedic rehabilitation. Following situational analysis on each ward, we used behaviour change theory COM-B (capability, opportunity motivation) to align the intervention components to barriers. These included inter-professional communication (mobility board with patient goals, nurse & physiotherapy huddles, daily mobility record); staff knowledge (education, coaching, posters); nutrition opportunities (assisted mealtimes, MUST tool, enhanced snack rounds) and cognition (patient information leaflet, distraction activity resources).
Data collection included observational audits of mobility measuring: % mean time walking, % patients sitting out of bed, % patients walked at last once, and nutrition: % of meals half or less eaten at baseline and 12-week follow-up. Each ward was observed from 8am to 5pm.

Results
In total mobility audit data was collected on 124 patients (pre =63, post 61), mean age 78 years (SD13.8) and 63% female. Mean data across the four wards are presented.
There were small positive changes in two mobility indicators: patients sitting out of bed (pre 69% vs post 76%); % patients walked at least once (pre 53% vs post 62%); there was no change in mean % time spent walking (pre 9% vs post 8%). Nutrition indicator: % meals &lt;half eaten (pre 57.6% vs post 53%).

Conclusion
The FCB showed some promising trends in prioritising mobilisation and nutrition. Implementation relies on ward manager leadership, nursing team cohesion, and active role modelling from the MDT. Sustainability is likely to require ongoing facilitation resource.
210 A SYSTEMATIC REVIEW OF LONG-TERM OUTCOME COLLECTION FOLLOWING HIP FRACTURE IN IRELAND FROM 2005 TO 2021
Authors: Walsh M , Cunningham C , Brent L , Savin B , Fitzgerald M , Blake C 
Published: February 2023

Abstract

Background
The Irish Hip Fracture Database (IHFD) drives clinical improvements across 16 acute hospitals for over 3,500 patients annually. The IHFD aims to begin recording long-term outcomes. Past practice in Ireland could inform this activity. This review aims to identify and summarise studies that have collected long-term outcomes following hip fracture in Ireland.

Methods
A search of electronic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) and grey literature was conducted in July 2021 for articles, abstracts, theses and reports. Search terms related to hip fracture and Ireland. Studies published from 2005–2021 were included if post-hospital discharge data were collected in the Republic of Ireland for patients with hip fracture. Study and patient characteristics, data collection methods and long-term outcomes were extracted.

Results
From all sources, 21 articles, 3 theses and 84 abstracts from 18 clinical sites were identified. Numbers of patients with hip fracture ranged from 9 to 2,483 (median 168) across publications. The most common outcome recorded was mortality (59% of publications), most frequently at 30 days and/or one year. Ascertainment methods for mortality included electronic patient records, online death notices, phone calls to family or general practitioners and the national death register. Non-mortality long-term outcomes were assessed in 64% of publications, most commonly through outpatient or virtual clinics or phone calls. They included place of residence, function, mobility and bone-health status at time-points of 30 days, 6 weeks, 3, 4, 6 or 12 months. Only 11 publications followed patients past the 1 year time-point. One third of publications did not report data collection methods.

Conclusion
Meta-analyses of results will provide estimates of mortality rates and other key hip fracture outcomes. Some long-term outcomes have been collected at most hospitals treating acute hip fracture in Ireland in the last 15 years. Qualitative research in needed to identify facilitators of follow-up to inform practice nationally.
239 IS ORTHOSTATIC HYPOTENSION ASSOCIATED WITH ALTERED CEREBRAL PERFUSION DURING ACTIVE STANDING?
Authors: Claffey P , Pérez-Denia L , Dyer A , McNicholas T , Briggs R , Finucane C , Kenny R A 
Published: February 2023

Abstract

Background
Orthostatic Hypotension (OH) is associated with poor health outcomes in later life including depression, cognitive impairment, frailty and falls. Whilst it is hypothesised that OH compromises cerebral autoregulation leading to hypoperfusion, this has not been robustly demonstrated to date. This study investigated the association between OH and cerebral perfusion during orthostasis using a non-invasive surrogate of cerebral perfusion, Near Infrared Spectroscopy (NIRS).

Methods
Four hundred and ninety one participants (58% female, median age 65, IQR 38–92) attending a falls and syncope service underwent measurement of beat-to-beat blood pressure (BP) by finometry and real-time frontal lobe perfusion (% TSI: Tissue Saturation Index) by NIRS during the active stand manoeuvre. We examined the association between OH and change in cerebral perfusion (delta TSI) using mixed-effects linear regression, with adjustment for important clinical covariates.

Results
Nearly two-fifths of the sample (189/491,38.5%) met criteria for OH occurring between 30 and 120 seconds after standing. Using mixed effects linear regression models, we observed a significant relationship between OH and TSI at the same timepoint (β −0.53, −0.59 to −0.46, p &lt; 0.001) which persisted following adjustment for confounders including age, sex, baseline blood pressure, cerebrovascular and cardiovascular disease, depression/anxiety, diabetes, systolic blood pressure, antihypertensives, and antidepressants (β −0.51, −0.58 to −0.44, p &lt; 0.001). Cerebral perfusion levels differed for those with OH compared to those without.

Conclusion
OH is independently associated with lower frontal lobe cerebral perfusion. This association may indicate disruption to dynamic cerebral autoregulation and explain the significant link between OH and poor health outcomes.
240 A COMPARISON OF THE ISAR AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED RE-ATTENDANCE IN OLDER ED ATTENDERS
Authors: Leahy A , Corey G , O'Neill A , Higginbotham O , Devlin C , Barry L , Cummins N , Gabr A , Shanahan E , Shchetkovsky D , Ryan D , O'Connor M , Galvin R 
Published: February 2023

Abstract

Background
Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale (CFS) are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.

Methods
This was a prospective cohort study. Patients over 65 were recruited, baseline demographics were obtained and a research nurse assessed them using both the CFS and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.

Results
419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). At baseline, the median ISAR was 2 and CFS was 5. The mortality rate was 5.4% and the rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score ≥ 2 was 1.84 (1.12, 3.02) and CFS &gt; 4 was 1.85 (1.08, 3.16). The ISAR tool ≥2 had a sensitivity of 74% (95% CI = 62.44, 83.99) and specificity of 41% (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS &gt; 4 had a sensitivity of 71% (95% CI = 57.79, 82.70) and specificity of 45% (95% CI = 39.33, 51.23) for ED re-attendance.

Conclusion
The ISAR tool ≥2 was more sensitive at predicting ED reattendance at one month in comparison to the CFS. We advocate to use this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
241 IMPLEMENTATION OF AN INTRACEREBRAL CEREBRAL HAEMORRHAGE CARE BUNDLE
Authors: Gabr A , Cunningham N , Kennedy C , Mohamed A , Okpaje B , Saleh A , Leahy A , El-Kholy K , Carrol I , Paulose S , Daly N , Harnett A , Buckley E , Kiely P , McManus J , Peters C , Quinn C , Prendiville T , Lyons D , Watts M , O’Keefe D , Galvin R , Murphy S , O'Connor M 
Published: February 2023

Abstract

Background
Mortality for Intracerebral haemorrhage (ICH) is 31% (Irish National Audit Stroke, 2019). An ICH care bundle focusing on acute anticoagulation reversal, blood pressure lowering, and a neurosurgical care pathway was associated with improved survival. Translating evidence-based medicine into clinical practice is challenging. The aim of this study was to determine feasibility and outcomes of implementation of a care bundle.

Methods
An ICH care bundle was developed using an iterative process involving expert stakeholder review of the evidence-based literature. A pre-and-post quasi-experimental research design was employed to evaluate this intervention. Baseline data were collected before implementation (January 2016-June 2018). Implementation took place in a staged manner in a single university teaching hospital with multiple ‘Plan Do Study Act cycles’ (June 2018 to January 2021). Data on compliance, process measures and outcomes were collected.

Results
Systolic blood pressure (first 24-hours) and anticoagulant reversal were significantly better controlled post-implementation (χ2 (1, N = 91) = 5.34, P = 0.02), (χ2 (1, N = 25) = 5.85, P = 0.016), respectively. DNAR orders were significantly lower in the post-implementation group (χ2 (1, N = 25) = 5.85, P = 0.029). However, ‘Do Not Actively Resuscitate’ status did not significantly differ when accounting for low GCS as a surrogate measure for poor prognosis (χ2 (1, N = 34) = 0.00, P = 0.966). Modified Rankin Scale on discharge did not differ significantly pre-and-post-implementation (z = −0.075, P = 0.94). A greater proportion of patients survived in the post-implementation group; however, this was not statistically significant (χ2 (1, N = 133) = 0.77, P = 0.38). Length of stay significantly increased post implementation.

Conclusion
An ICH care bundle was developed based on expert stakeholder feedback. The feasibility of implementing this bundle of care was demonstrated in a real-world clinical practice setting. A cluster-randomized trial or a large registry study is the next step to evaluate the overall impact of this care bundle on patient outcomes.
29 USING QUALITY IMPROVEMENT METHODOLOGY TO VISUALISE CHANGE INTERVENTIONS TO IMPROVE MANAGING THE UNWELL CARE HOME RESIDENT
Authors: Trolan C 
Published: February 2023

Abstract

Background
The COVID19 pandemic highlighted deficiencies in the recognition, monitoring, escalation and de-escalation of the acutely unwell care home resident. RESTORE2 is endorsed by the British Geriatric Society as the preferred tool for use in a care home setting. It incorporates: recognition of soft-signs; NEWS2 (National Early Warning Score 2); and SBAR-D (Situation Background Assessment Recommendation-Decision). Implementing RESTORE2 required a series of change interventions in a mesosystem environment in intermediate care bed-based rehabilitation setting in an independent care home.

Methods
The Flow Coaching Academy ‘5Vs’ Framework was used. A vision of ‘CHAIN of CARE’ was developed (Care Home Assessment of Intervention Need and Communicate Act Review Evaluate). Stake-holder mapping was undertaken. A Sinek Circle distilled intentions. A global aim led to specific aims and informed driver diagrams. Problems and risks were mapped out with an Ishikawa diagram. A high-level process map of future state was and cross-functional swim-lane chart for RESTORE2 use were devised. A clinical value compass map was used to consider outcomes. PDSA cycles were used.

Results
The FCA Framework methodology, albeit without the ability to undertake ‘Big Room’ meetings due to the COVID19 pandemic restrictions, enabled the development of a care-home tailored Treatment Escalation Plan; an electronic template Nursing Handover; Multidisciplinary Safety Brief; training of all nursing team in RESTORE2; and use of NEWS2 for all residents in the intermediate care setting. Additional prompt for how to use RESTORE2 was developed.

Conclusion
Bringing about complex change in a complex mesosystem benefits from different techniques than microsystem change methodology. The 5Vs: Visualisation, Vision, Value, eVidence and inVolvement in the FCA Framework are an effective approach. The residents’ voice was largely absent in the pressures of the COVID19 pandemic.
‘The Chain of Care’ proved helpful in visualising the global aims for the clinical team.
42 EXPLORING THE IMPACT OF AGE AND FRAILTY STATUS ON THE IMMUNE RESPONSE TO COVID-19 ILLNESS USING DETAILED IMMUNO-PHENOTYPING
Authors: Dyer A , Townsend L , Naughton A , Kiersey R , Holden D , Gardiner M , Dunne J , O'Farrelly C , Cheallaigh C N , Conlon N , Bourke N 
Published: February 2023

Abstract

Background
Whilst age and frailty are independently associated with mortality in COVID-19 illness, the underlying immunological mechanisms explaining this remain unexplored. We aimed to explore the impact of age and frailty on the acute immune response to COVID-19 illness.

Methods
We recruited older (aged 65+; n = 33) and younger (aged 20–50; n = 43) participants with acute COVID-19 illness for clinical assessment and detailed immunophenotyping for T-cell, neutrophil, monocyte and inflammatory markers using flow cytometry. We additionally assessed circulating levels of several important pro-inflammatory cytokines. Wilxocon rank-sum, chi-square tests and linear regression were used to examine the impact of age and frailty (Clinical Frailty Score 3–9) on the immune response in COVID-19 illness. Results were compared to age-matched pre-pandemic controls (n = 40).

Results
COVID-19 illness was associated with a marked pro-inflammatory response (raised CRP, IL-6, IL-2R), lymphopenia and emergency myelopoesis (an expansion of non-classical/intermediate monocytes and immature neutrophils) in both age groups (all P &lt; 0.001). In comparison to younger participants (35.7 ± 8.6 years), older adults (76.7 ± 7.8 years) had a more marked reduction in naïve CD4+ and CD8+ cells and a more marked expansion of activated CD4+, CD8+ and effector CD8+ T-cells (all P &lt; 0.001). These findings were independent of illness severity (all P &lt; 0.001). In comparison to their younger counterparts, older adults had a reduced number of CD10+ neutrophils/non-classical monocytes and greater CRP, IL-6 and IL-2R (P &lt; 0.05), although results were attenuated on adjusting for COVID-19 severity. Frailty was not associated with any significant difference in immune cell population or pro-inflammatory response in acute COVID-19 illness.

Conclusion
Increasing age, but not frailty status, was associated with reduced naïve T-cells and a more marked expansion of activated/effector T-cells in acute COVID-19 illness. These findings have important implications for understanding impact of age on anti-viral and pro-inflammatory immune responses.