bluuebunny/crossref_metadata_2025_split huggingface dataset:
197 Transitions of older adults with dementia to and from acute general hospital and nursing home settings
Authors: George R M , Carey E , O'Malley T 
Published: September 2023

Abstract

Background
The life span of human beings is unceasingly growing. Keeping in line with global trends of ageing populations with increasingly complex needs, it is expected that there will be an increase in the number of people moving into nursing homes in Ireland. Frailty and dementia are two risk factors associated with ageing. Considering the high percentage of older persons diagnosed with dementia and co-morbidities living in nursing homes or long-term care facilities, patients’ transfer, to and from the hospital is a main concern.

Methods
A qualitative descriptive study design was used to examine nurses’ experiences of transitioning older adults with dementia between nursing homes and acute care settings. Ethical approval was obtained. By means of purposive sampling, data collected via semi-structured interviews with 10 nurse participants, were transcribed and analysed using thematic analysis and NVIVO 12. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data using the six stages of Braun and Clarke.

Results
Conceptualised from data analysis four key themes include ‘Complexity of caring and minimising stress’, ‘Continuum of supports and services’, ‘Clinical journey with deteriorating health’, and ‘Futuristic Planning’. To establish the trustworthiness of the findings researcher was guided by Lincoln and Guba’s strategies and checked using the Joanna Briggs Institute critical appraisal tool.

Conclusion
The findings highlight the need to integrate primary, community, and acute care services in providing safe and effective treatment for older adults with dementia in nursing homes. In addition, it provides insight for policymakers and educators to consider introducing novel services and initiatives to reduce the number of nursing home resident transfers. Further research exploration of the feasibility of reducing hospital admissions of persons with dementia from Nursing Homes is required to substantiate the concept of hospital avoidance and integrated care for persons with dementia.
219 Delirium snapshot—inpatient rates and demographics of delirium in an Irish university teaching hospital
Authors: Doherty R , Murphy E , Sheehan O , O'Connor M 
Published: September 2023

Abstract

Background
Delirium has been repeatedly demonstrated to increase morbidity and mortality both in the inpatient setting and post-discharge. This study sets out to examine the rates and demographics of delirium in the inpatient setting and identify significant risk factors for its development.

Methods
Data was collected on inpatients on a single day (13/12/22) using an internet application developed by the Hospital’s Quality and Improvement Department. Biographical data, length of stay (LOS), source of admission, admission diagnosis, clinical diagnosis of delirium and/or dementia and preadmission and current continence data were gathered from medical or nursing notes. Data was analysed and statistical significance determined via Pearson’s Chi-Squared Test.

Results
Data was available for 309 inpatients. The point prevalence of delirium was 25.2% (78/309). About half of delirious patients were female (41/78) and (38/78) had a previous diagnosis of dementia (p = &lt;0.01). Almost a quarter of the cohort had pre-existing cognitive impairment (73/309, 23.6%). Nursing home residents had the highest percentage of delirium 17/42 (40.5%) by admission source (p = 0.01). Delirium prevalence increased with age reaching 37.5% in those over 90 years, (p = 0.03). Delirium was more prevalent in those with a longer LOS (19.8% LOS &lt;7 days compared to 44.6% LOS &gt;7 days). Delirium rates were higher in those incontinent or catheterized both at baseline and during admission (p = &lt;0.01), as well as in those requiring assistance with mobility (p = &lt;0.01).

Conclusion
Approximately a quarter of all inpatients experienced delirium during their admission. However, these figures were significantly higher in at risk categories such as those aged ≥70, Nursing Home residents and those with cognitive impairment. Despite extensive awareness and education of the risks of delirium, its prevalence remains too high. Further interventions are urgently needed.
222 Incontinence acquired during hospitalisation: targets for improving standards of care
Authors: Murphy E , Geoghegan C , Toole G O , Leonard S , Crowley K , Hassan H , O’Connor M 
Published: September 2023

Abstract

Background
Urinary incontinence is common in older adults, frequently underreported and consequently under-treated. Up to 15% of patients with hospital-acquired incontinence will have persistent incontinence afterwards. We performed an audit in a Level 3 hospital examining documentation of continence, pad use and call bell use in order to identify areas where continence care can be improved.

Methods
Data were gathered on all inpatient at a single timepoint. Biographical data, admission diagnoses, diagnosis of dementia, delirium and urinary incontinence, use of diuretics and urinary incontinence medications, toileting plans, continence care bundles and mobility status were gathered from medical notes, nursing notes and drug charts.

Results
The dataset comprised 309 patients. 9% were continent pre-admission and now had incontinence or occasional accidents. 72% of these were admitted &gt;15 days. 17% had a diagnosis of dementia and 48% delirium. 31% were on diuretics. 14% were independently mobile. 44% of patients were wearing pads, one in two of whom were continent or had only occasional accidents. 15% of patients had a continence status documented in the medical admission proforma, 29% had a continence care bundle and 36% a toileting plan recorded. Patients whose continence status was documented at admission were more likely to have a toileting plan and continence care bundle than those without a documented continence status. 20% of patients did not have a call-bell in reach. In the population that required assistance to mobilise, 23% did not have a call-bell, 52% of which were incontinent.

Conclusion
Long duration of admission, diuretics, delirium and dependent mobility were all risk factors for hospital-acquired incontinence. Pads were used indiscriminately, regardless of continence status. A significant proportion of patients had no access to a call-bell, placing those who could not mobilise independently at risk of incontinence. Our study identifies a number of areas for improvement to promote continence throughout a person’s inpatient stay.
227 An evaluation of pharmacist-delivered medication education in a frailty at the front door interdisciplinary team
Authors: Cahill M , Pillay I , Silvari V , Kennedy E 
Published: September 2023

Abstract

Background
Adverse Drg Events (ADEs) are a significant cause of Emergency Department (ED) visits, with a major impact on healthcare resource utilisation. An Inter-disciplinary Team (IDT) in-service day identified pharmacy-delivered education as a priority. Education suited to the diversity of the team is key. This study aimed to evaluate pharmacist-delivered medication education to a Frailty at the Front Door (FFD) interdisciplinary team and assess the degree of importance the FFD team place on medication education.

Methods
Pharmacist–delivered medication education was conveyed via i) daily board rounds, where issues arising in relation to medication are discussed and ii) the ‘medication minute’, where education topics pertinent to frail older people are presented in a micro learning style applicable for all members. An anonymised, mixed methods questionnaire (open/closed questions) was distributed to the members of the FFD, which consisted of: Consultant Geriatrician, Registrar, Physiotherapists, Occupational therapists, Dietician, Speech and Language Therapist and Clinical Nurse Manager. The questionnaire ranked the effectiveness of the pharmacist mediated medication education using a Likert scale ranging from not at all effective/relevant to extremely effective/relevant. Data were analysed using descriptive statistics.

Results
Eight (89%) FFD members completed the questionnaire. 37.5% (n = 3) respondents rated board round education as effective or extremely effective. 87% (n = 7) respondents rated the ‘medication minutes’ as extremely effective. 100% (n = 8) respondents said medication education led to improved patient outcomes. 100% (n = 8) of respondents said that understanding patient’s medication was either very or extremely relevant within their role on the interdisciplinary team.

Conclusion
There is no published evaluation of medication education for IDTs. This IDT agreed that medication education is both relevant and effective for all members, leading to improved patient outcomes. The most effective method was the ‘medication minute’. Work is needed to develop a National model of medication education for IDTs.
236 Assessing communication of duration of Dual Antiplatelet Therapy on discharge letters: an acute stroke unit audit
Authors: Hussien A , Durcan R , Abdalla Y 
Published: September 2023

Abstract

Background
Short term Dual Anti-Platelet Therapy (DAPT) is commonly used for secondary prevention of major acute ischemic stroke events. However, long-term DAPT is associated with increased risk of bleeding without reduction in cardiovascular events. Proton pump inhibitors (PPI) are often co-prescribed for prevention of gastroduodenal toxicity of DAPT, but long-term use has potential side effects. This audit aims to assess if clear instructions are provided regarding to duration of DAPT prescription in stroke medicine unit in tertiary referral hospital.

Methods
Retrospective analysis Electronic Medical Records (EMRs; discharge and clinical letters) who were admitted with TIA or AIS in 3-month period, excluding those who were transferred back to their referring hospital.

Results
100 patients’ EMRs were reviewed. 34 were discharged on DAPT. 21 patients were reviewed in stroke OPD while 6 were readmitted to hospital. DAPT duration was documented in Discharge Letters (DL) of 28 patients (82%). In 28 (82%) patients, recommended durations of DAPT were documented in DL, 5(18%) of those were still inappropriately on DAPT on returning to OPD/readmission. 1 out of the 6 patients with no clear documentation of DAPT duration on DL were still inappropriately on DAPT. 22 patients were co-prescribed PPI, 19 of those had no documented recommended plan for PPI post completion of DAPT, and 12 of those were still on PPI on returning to OPD/readmission. 3 patients had a documented plan for PPI post completion of DAPT, 2 were still on PPI on returning to OPD/readmission.

Conclusion
Results were presented in stroke unit teaching. Key recommendations included education of NCHDs regarding clear documentation and communication with patients, pharmacists and GPs. Improvement in EMRs to highlight DAPT plan. Regular audits in this area.
238 An age related acute medical unit: creating an age-attuned model of acute care
Authors: Kelly L , Byrne M , Harding N , Humphreys S , Murphy M , Hayden D 
Published: September 2023

Abstract

Background
Multi-morbidity increases with age and older adults are more likely to present to acute hospital services with complex health states/Geriatric syndromes. For people with underlying physical or cognitive illnesses, these issues can be compounded by the built environment of acute hospitals. Meeting the needs of a frail older population is a key challenge for acute hospital services. The main aims of this development quality improvement project were to create a dedicated Age-related acute medical unit using the concept of universal design, with dedicated, Gerontological staffing including a Registered Advanced Nurse Practitioner (RANP) in Gerontology.

Methods
A project team was convened with representation from Geriatric nursing, Geriatric Medicine, Health and Social Care Professionals (HSCP), Estates, Technical services and the executive management team. An appropriate area was identified on the acute floor which was co-located with a newly developed Acute Medical Unit. Using a universal design approach, a 4-cubicle Age Related Assessment Unit (ARAU) including a dedicated multidisciplinary assessment room was created. The role of the RANP in ARAU was developed to provide comprehensive geriatric assessment to older medical patients presenting to unscheduled care.

Results
Following the implementation of the ARAU there has been a 40% increase in the number of unscheduled older patients (&gt;65’s) assessed in the Acute Medical Unit (Q1 2019 to Q1 2023).

Conclusion
Operating within a defined scope of practice, the RANP in ARAU/AMU provides advanced specialist geriatric nursing skills and knowledge allowing for the identification of medical, psychosocial and functional needs of older adults for older adults who present to unscheduled care with common geriatric syndromes.
241 ‘Please consider bone assessment’: improving the identification and management of Vertebral Fractures by a ‘Fracture Liaison Service’
Authors: McGurk C , Ali A , Carvalho J , Ong J , McPartland A , Rooney B , O'Sullivan F 
Published: September 2023

Abstract

Background
Osteoporotic fractures are a major public health problem due to an ageing population causing profound disability and reduced quality of life. Vertebral Fractures (VFs) are the second most common osteoporotic fracture with nearly 1 in 4 women having one in their lifetime. Furthermore, a VF is a significant warning sign for another fracture in the following year—known as ‘imminent fracture risk’. Despite this early opportunity for clinical intervention with bone protective medication, VFs are frequently under-diagnosed and under-treated. This observational study aimed to look at the point prevalence of VFs picked up on radiology reports and compare with those identified by the ‘Fracture Liaison Service’ (FLS).

Methods
The PACs office ran a search for all MRI spine, CT-TAP and a plain radiographic film reports from January 2021 until April 2023 with the terms ‘vertebrae’ and ‘compression’ in the text. Inclusion criteria was all patients &gt;65 without major trauma with a radiologist defined osteoporotic VF. Using excel, we cross-referenced the proportion of these already know to the FLS.

Results
There were 338 osteoporotic VFs diagnosed on radiological imaging between 2021 & 2023. Of these, 101 had been identified by the FLS. The median age was 77 years old. There were 228 (67.2%) females and 111 (32.8%) males.

Conclusion
This study helped to highlight that over 67.2% of the osteoporotic VFs are not being identified by the FLS. Therefore, is it assumed that timely intervention and management of their imminent fracture risk may not have been undertaken. This data is being used to drive a quality improvement project with the radiology department where any VF in women &gt;70 will be reported to include—‘please consider bone assessment’.
245 ‘Pad culture: the use of continence wear in older people in an Irish University Hospital’
Authors: McGurk C , Paponette B , Alnajjar A , Carvalho J , Ong J , Reynolds O , Williams S , Moran C , Riaz S , O'Sullivan F , Hickey P 
Published: September 2023

Abstract

Background
Incontinence in hospital patients can result in a longer length of stay, a greater risk of being discharged to a residential care setting, as well as increased healthcare and personal costs. Older adults may find it difficult to regain continence post discharge contributing to caregiver strain, social isolation and functional decline. There is evidence to suggest that there is an over-reliance on continence aids (wearable absorbent ‘pads’ & urinary catheters) for older adults in hospital. The aim of this study was to assess the prevalence of continence aids among older in-patients in an Irish University Hospital, as part of wider service improvement project.

Methods
Data was collected on consecutive in-patients 65 years or older on a single day. Medical, surgical, oncology, coronary care and medical assessment unit were included. Current incontinence aid usage and pre-admission continence aid usage was recorded, along with demographics and current mobility status.

Results
156 older adults were included. 53.5% were male and the median age was 81. A total of 57.4% (N = 89) of older patients were wearing disposable pads. Of these, 64.5% (N = 58) were not wearing continence pads pre-admission. A total of 23.2% (N = 36) had a urinary catheter inserted. Of these, 91% (N = 33) did not have a urinary catheter pre-admission. 38.3% (N = 61) of those wearing pads could mobilise either independently or with assistance of one. We also found a direct correlation between pad use and length of stay.

Conclusion
This study highlights the high prevalence of continence aid deployment in the care of older adults admitted to an acute hospital, with conversion to an aid occurring even in those who are able to mobilise independently or with supervision. Continence care and rehabilitation may benefit from inter-disciplinary assessment and management, similar to other complications of ageing and hospitalisation, such as delirium.
246 Feasibility of a delirium intervention pathway by a frailty at the front door team
Authors: Fitzgerald R , Mupada B M , Leonard A , Cronin L , Condon F , Coakley E , Martin L , Allen S , Pillay I 
Published: September 2023

Abstract

Background
Consistent success in reducing delirium incidence and related falls, cognitive and functional decline, length of stay, use of one-to-one supervision, institutionalisation, readmissions, and health-care costs (hospital and 1-year) has been demonstrated in delirium, with and without dementia. Intervention strategies reduce delirium and its adverse outcomes by 30–40%. Frailty at the Front Door (FFD) emergency department teams perform 4AT as a routine component of comprehensive geriatric assessment. The aim of this study was to benchmark delirium with and without dementia in patients assessed by a FFD team in an urban tertiary referral centre and assess feasibility of an FFD delivered inter-disciplinary delirium intervention pathway.

Methods
Age, gender, Clinical Frailty Score (CFS), 4AT, AD8 and dementia diagnosis recorded in 500 consecutive patients in a clinical excel database were analysed using descriptive statistics. An inter-disciplinary delirium pathway, consisting of blood tests, anti-cholinergic cessation, neuro-imaging, individualised patient, carer, staff education was embedded into practice and use of the pathway recorded over a subsequent 2 month period.

Results
Mean (SD) age was 83 (6.9) years. Female to male ratio was 1.5:1. Mean(SD) CFS was 5 (1.2), with CFS unrecorded in 10%. 91% (n = 456) had 4AT recorded. 50% (n = 230) had a 4AT of zero. 38% (n = 177) had a 4AT of 1–3. 25% (n = 114) had a 4AT of &gt;/=4. Of those where dementia diagnosis was recorded, n = 74, 40% (n = 29) had a 4AT of &gt;/= 4. Where AD8 was measured, 50%(n = 12) had a 4AT of &gt;/=4. The delirium intervention pathway was applied to 16% (n = 70) of the total population over a 2 month study period.

Conclusion
4AT&gt;/4 was retrospectively benchmarked at 25% in this population. Recording of dementia diagnosis and AD8 was low. Targeting existing resources to prevent delirium resulted in two-thirds of the expected population benefitting from standardised delirium prevention. Dedicated delirium resources in acute hospitals will further improve outcomes.
254 The use of delirium screening tools during acute inpatient hospital admissions: a local audit
Authors: Healy A , Whelan A , Lynch O 
Published: September 2023

Abstract

Background
According to the ‘Second Irish National Audit of Dementia Care in Acute Hospitals (INAD-2), it is estimated that 20% of all adults admitted to hospital have a diagnosis of delirium during admission. Local HSE guidelines advise that all older adults (&gt;65 years) should have a formalised delirium screening tool completed within the first 24 hours of presenting to the Emergency Department (ED).

Methods
We reviewed the medical admission documentation and subsequent medical notes in the charts of current inpatients on three Geriatric Medicine wards in the hospital. Data was collected from 56 patients over the age of 65 over a two day period.

Results
Data was collected from 56 patients. 21.4% (n = 12) had a delirium screening tool documented. Of those, 100% used 4AT testing and 100% were completed by the OPAL team (Older Person Assessment and Liaison Team)/ED Frailty Intervention Team. 5.4% (n = 3) met diagnostic criteria for delirium. 21.4% (n = 12) had delirium documented as a diagnosis on their medical admission, of which only 3 had delirium screening completed. 26.7% (n = 15) had a documented pre-existing diagnoses of dementia. Of those, 2 had a formal delirium screen documented. 25% (n = 14) were diagnosed with delirium later in their admission. Of those, 3 had a delirium screening tool completed at any point. The vocabulary used to describe delirium was also examined. Most commonly the words confusion (10) and agitated (4) were used instead of delirium. 4 had delirium subcategorised as hypoactive.

Conclusion
Delirium continues to be prevalent among our older inpatients and has been shown to be directly related to increased mortality. It is vital that we make use of the tools that are available to us to identify those at risk and those already suffering from this condition. We should prioritise appropriate delirium screening with standardised assessment tools in order to correctly identify those at risk.
263 Improving nutritional Care for Older Adults with hip fractures: insights from a multidisciplinary quality improvement workshop
Authors: Davey N , Bates N , Diggin B , Brent L , Hickey P , Horan B , O'Regan N 
Published: September 2023

Abstract

Background
Enhancing nutrition is a crucial element of hip fracture care, as malnutrition poses increased mortality risk within the initial 120 days post-hip fracture. Aiming to address key considerations and potential challenges, the National Office of Clinical Audit Orthogeriatric Network conducted a quality improvement workshop focusing on nutrition.

Methods
A workshop exploring various elements of Orthogeriatric care was conducted in September 2022. Over 30 multidisciplinary stakeholders from various hospitals and clinical programs engaged in a survey and workshops exploring key components of Comprehensive Geriatric Assessment (CGA), including nutrition.

Results
Survey results indicated strong consensus on the inclusion of nutritional assessment and monitoring within the CGA for hip fracture patients. Focused small-group discussions highlighted the adverse effects of inadequate nutrition on wound healing, bone health, energy levels, the catabolic process, and frailty. The under-recognition of nutrition was highlighted. Identified barriers to optimal nutritional care included limited dietetic support, portion sizes, modified diets, repeated fasting, unclear guidance, literacy levels, and the availability of dementia-friendly equipment. Facilitators included access to dietetics support, involving family members and catering staff, enhanced oral hydration plans, protected meal times, proactive protein-based supplements, using ‘red trays’ for assistance, and ‘sip til send’ initiatives. This topic was further explored at the subsequent online network last March with a view to developing guidance on nutritional management of older hip fractures patients.

Conclusion
To optimise clinical outcomes, individualised nutritional interventions should be tailored to patients’ specific needs, considering local resources. The development of national consensus guidance aims to provide valuable information to enhance patient outcomes.