bluuebunny/crossref_metadata_2025_split huggingface dataset:
130 PREDICTORS OF DRIVING STATUS IN OLDER IRISH ADULTS ATTENDING A GERIATRIC OUTPATIENT SERVICE
Authors: Moloney K , O'Flaherty N , Ahmad R , Laird E , Hughes C , McNulty H , Ward M , Strain J J , Molloy A M , Cunningham C , McCarroll K 
Published: February 2023

Abstract

Background
The main mode of transportation in Ireland remains travel by car. Transport mobility is important for older adults in accessing shops, healthcare, services, community and in maintaining relationships. Cessation of driving is associated with negative effects on mental health, loneliness and physical health. We aimed to explore factors associated with driving status in older adults living in an urban environment.

Methods
Study included adults aged greater than 65 years attending a geriatric outpatient service in an urban environment and recruited as part of the TUDA (Trinity Ulster, Department of Agriculture) study. We excluded those with a MMSE (Mini-Mental State Exam) less than 24 as we aimed to include only non-dementia patients. Physical frailty was measured with the Timed Up and Go (TUG) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with driving status were explored in multinomial regression models.

Results
1978 adults, mean age 77.7 ± 7.1 years, 76.0% were female. 35.5% were current drivers but this differed by age category 45.9% (65–75 years), 25% (75–85 years) and 12.5% (85+ years). 28.1% were past drivers. Positive independent predictors of current driving were younger age (P &lt; 0.001), male gender (P &lt; 0.001), married status (P = 0.01), higher socioeconomic status (P &lt; 0.0001) while negative predictors included physical frailty (TUG, P &lt; 0.001), visual impairment (P = 0.01), stroke (P &lt; 0.001), depression (P &lt; 0.001) and self reported loneliness (P = 0.01).

Conclusion
One third of patients attending a geriatric outpatients in an urban environment were currently driving which is much lower than in the general older Irish population. However, our study included frail adults living in more deprived socioeconomic areas and had a high proportion of females who had never learned to drive. Furthermore, access to urban public transport may be a factor. Non-drivers were more likely to have depression and report loneliness independent of other factors highlighting its negative impact.
257 POSITIVE HEALTH AND AGING FOR OLDER IRISH TRAVELLERS AND OLDER PEOPLE WHO HAVE EXPERIENCED HOMELESSNESS: LIFE-COURSE MEANINGS AND DETERMINANTS
Authors: Walsh K , Carroll C , Scharf T , O’Donovan D 
Published: February 2023

Abstract

Background
The position of marginalized groups of older people remains neglected in positive health and aging (PHA) agendas, whether they concern healthy, active or positive aging. Questions exist around the meaning of such constructs, and the factors that enable disadvantaged populations to achieve equitable later-life experiences. In focusing on two such groups, this study investigates the constituent dimensions of PHA for older Irish Travellers and older people who have experienced homelessness, and the role of life-course and structural determinants in constructing PHA trajectories for these groups.

Methods
The study involves a multi-method qualitative, participatory voice-led methodology, but the analysis draws primarily on 49 in-depth life-course interviews with the populations.

Results
In addition to five interconnected dimensions of PHA, four determinants related to life-course experiences and structural factors are identified: social relations; material and accommodation circumstances; formal supports and systems; and critical transitions and resilience.

Conclusion
While illustrating the validity of PHA agendas for these groups when understood through their lived experiences, the findings highlight the significant deprivations and risks to rights that must be accounted for to secure meaningful gains in PHA for the groups.
32 SIMULATION-BASED EDUCATION FOR ACUTE STROKE
Authors: Crowley P , Saramago I , Cannon R , McGrath K 
Published: February 2023

Abstract

Background
Acute stroke requires efficient multi-disciplinary collaboration to deliver time-sensitive treatment in a prompt and effective manner. The European Stroke Organization (ESO) recommends simulation-based education (SBE) for stroke care. Studies have shown SBE improves door-to-needle times, which predict better patient outcomes.
SimStars was a competition, run by the National Doctors Training and Planning leads for the South-SouthWest Hospitals Group, to develop in-situ SBE scenarios.
We developed a SBE program for acute stroke in an Irish teaching hospital.

Methods
Medical doctors and nursing staff are included in the SBE scenario as candidates/target learners. Patients are played by role-players. Anonymised data and neuroimaging from real patients is utilized to maximize fidelity to real life. Other participants, such as paramedics, can be included to facilitate scenarios as required.
Candidates are briefed before each scenario. Clear learning objectives are set. All participants are provided with a script outlining their roles. Candidates are appraised using standard evaluation forms. A de-brief is undertaken to reinforce learning objectives.

Results
We qualified for the final of SimStars by establishing a SBE program for acute stroke, including a video of a simulated scenario that can be utilized for demonstration purposes. 100% of candidates who have participated in the SBE program so far have stated that it made a valuable contribution to their learning in the field of stroke care.

Conclusion
Stroke has been described as an exemplar of how SBE may benefit training along an entire clinical pathway. Scenarios can be adapted to cover an endless variety of stroke-related situations. SBE has been shown to improve hyper-acute clinical pathway performance and outcomes.
73 THE NEW CHRONIC DISEASE MANAGEMENT PROGRAMME FOR GENERAL PRACTITIONERS: MAKING THE CASE FOR ITS REVISION TO INCLUDE DEMENTIA
Authors: Pierce M , Cahill S 
Published: February 2023

Abstract

Background
A significant component of the new contract for general practitioners is the chronic disease management programme (CDMP for GPs). Although dementia can be framed as a chronic disease, it was not included in this programme. Its exclusion raises a number of questions including: Should dementia be framed as a chronic disease? Is it feasible to include dementia in a future revised CDMP for GPs? What are the likely benefits and potential risks?

Methods
This presentation focuses on two elements of a larger mixed-methods study, namely: (i) in-depth analysis of the CDMP for GPs, involving a review of the programme’s three main components to test the feasibility of extending it to incorporate dementia; and (ii) qualitative content analysis of data from semi-structured interviews with 12 stakeholders whose expertise is in dementia, chronic disease or both. Both elements were informed by a literature review.

Results
No consensus was found about whether dementia should be framed as a chronic disease. Results showed that it is feasible to extend the annual preventative programme of the CDMP for GPs to include additional modifiable dementia risk factors. While opportunistic case finding for identifying undiagnosed dementia cannot be recommended, a tool is available that would enable GPs identify people with dementia for enrolment on the structured treatment programme. Expected benefits from including dementia in the CDMP for GPs include integrated care pathways, better GP access and record-keeping and greater emphasis on primary and secondary prevention. Expected risks include excessive costs, caregiver burden, increased GP workload and sub-optimal care due to lack of specialist dementia training.

Conclusion
There is a compelling case to support dementia risk reduction in the CDMP for GPs. However, the programme’s current emphasis on self-management and rigidly planned visits could prove problematic for people with dementia and would need substantial revision.
100 SCREENING FOR SLEEP DISTURBANCE AS PART OF THE COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Mc Carthy C E , O'Malley K , Geoghegan J , Mannion E , Costello M , Murphy R , Reddin C , Waters R , O'Donnell M , Robinson S , Canavan M 
Published: February 2023

Abstract

Background
Sleep disturbance is common in the older patient, and has been associated with many common comorbidities, falls, impaired quality of life, and mortality. Sleep disturbance screening and management are important elements of the comprehensive geriatric assessment (CGA). There are few sleep disturbance assessment tools, however, that have been validated for use in older patients, or in those with cognitive impairment. We sought to review the assessment and management of sleep disturbance within a regional integrated care outreach programme (ICOP), where the RU-SATED tool had been used.

Methods
From March–June’21 the notes of 30 consecutive patients, presenting to ICOP with cognitive complaints, were reviewed. Demographic and sleep disturbance data were collected, in addition to whether advice, treatment or further assessment for sleep disturbance was documented. Feedback from staff on the utility of the RU-SATED tool was also sought.

Results
Of those reviewed, the mean age was 80.3 (SD = 7.8), and the mean Montreal Cognitive Assessment score (MOCA) was 17.7 (SD = 5.9). Where data was available, the mean RU-SATED score was 7.6 (SD = 1.9), and 42% were frail (n = 11). The most commonly endorsed sleep symptom was sleep onset latency/sleep maintenance issues (n = 16). RU-SATED score did not significantly predict age, MOCA or frailty (p &gt; 0.1 for all). Advice, treatment or further assessment of sleep disturbance was offered to 23% of patients (n = 7), and this was not predicted by overall RU-SATED score or by individual question responses (p &gt; 0.1 for all). Staff also stated that they found elements of the tool difficult to explain and interpret.

Conclusion
Although the numbers are small, we have not found the RU-SATED tool to be helpful in guiding the management of sleep disturbance in our cohort. A more practical CGA tool is currently in development by the ICOP service.
101 FACTORS ASSOCIATED WITH FEAR OF FALLING IN OLDER IRISH ADULTS
Authors: Brennan F , Laird E , Hughes C , McNulty H , Ward M , Strain J J , Molloy A M , Cunningham C , McCarroll K 
Published: February 2023

Abstract

Background
Fear of falling is common in older adults and is associated with social isolation, reduced quality of life, depression and increased mortality. We aimed to investigate the factors associated with fear of falling in a cohort of older Irish adults.

Methods
Our study included adults aged ≥60 years attending outpatient services and recruited as part of the TUDA (Trinity, Ulster and Department of Agriculture) study. Physical frailty was measured with the Timed Up and Go (TUG), cognition with the Mini Mental State Examination (MMSE) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with fear of falling were explored in multinomial regression models.

Results
5185 adults were included, 67.3% female and mean age 74.0 ± 8.3 yrs. Fear of falling varied by age: 39.4% (60-70 yrs), 51.2% (70-80 yrs), 70.4% (80 + yrs). Independent positive predictors of fear of falling were age (beta 0.01, P = 0.030), female gender (OR 2.6, CI 2.2–3.2, P &lt; 0.001), fall in the previous year (OR 1.9, CI 1.6–2.3, P &lt; 0.001), depression (CES-D ≥ 16) (OR 1.7, CI 1.3–2.2, P &lt; 0.001), use of osteoporosis medications (OR 1.3, CI 1.1–1.6, P = 0.002), self reported dizziness on standing (OR 1.5, CI 1.3–1.8, P &lt; 0.001), physical frailty (TUG &gt;12 seconds, OR 1.30, CI 1.1–1.6, P = 0.004) and limiting outside activities (OR 16.3, CI 13.8–19.3, P &lt; 0.001).

Conclusion
We identified a high prevalence of fear of falling, though our study sample included frail older adults attending geriatric outpatient services. Those who fell in the last year and who were female were about twice as likely to fear falling. It was also more likely in those who were physically frailer, taking osteoporosis medications and reporting orthostatic symptoms. Notably those with a fear of falling were 70% more likely to be depressed and 16 times more likely to limit outside activities highlighting its negative impact.
103 ORTHOGERIATRIC SERVICES IN THE FACE OF COVID-19
Authors: Davey N , McFeely A , Doyle P , Stankard A , Coveney S , Alsubie N , O'Connor J , Conlon B , Monahan P , Byrne P , Britton D , Halpin T , McShane S , Sohail I , Lynch O , Basit M , NiBhuachalla B , Mulroy M , O'Brien H 
Published: February 2023

Abstract

Background
Nationally agreed standards improve the level of care delivered to all older, frail, multi-morbid patients presenting with hip fractures. Dedicated Orthogeriatric services allow for these standards to be achieved in a multi-disciplinary team (MDT) setting. As the COVID-19 pandemic reached our shores, the model of care set out by the Irish Hip Fracture Standards (IHFS) was under threat. Our dedicated Orthopaedic Trauma ward became an acute COVID ward and the Orthogeriatric service was re-deployed to acute medicine for Quarter 2.

Methods
Using the Irish Hip Fracture Database, local data was analysed and compared with national data from Quarter 1 to 4 (Q1–4) in 2020.

Results
When comparing local IHFS’s with national figures, ongoing challenges and future goals are highlighted.
In 2020, there were 222 hip fracture patients (mean age 81.8 years) in our hospital. Standard 1, time to the ward &lt;4 hours, stands at 71% locally (national average 33%). Standard 2, time to theatre &lt;48 hours, is an ongoing challenge and remains at 66% (national average 75%). Standard 3, pressure ulcer rate, was the same as the national average at 3%. Standards 4, 5 and 6 in our hospital stand at 87% (national averages of 82%, 91% and 85% respectively).
In Q1, 56%, or over 1 in every 2 patients with hip fractures, met all of the Irish Hip Fracture Standards in our hospital. In Q2, only 18% of patients met all of the IHFS’s. Q3 saw improvements with 47% of all hip fracture patients achieving all IHFS’s. Q4 showed maintenance with 45% of all patients achieving all IHFS’s.

Conclusion
These findings highlight the need for a dedicated Orthogeriatric Service and Orthopaedic ward at all times. Going forward with the risk of future waves and the emergence of new variants, every effort should be made to maintain a comprehensive orthogeriatric service to minimise a negative impact on patient care.
104 COMPARING THE OTTAWA 3DY AND 6CIT IN DETECTING COGNITIVE IMPAIRMENT IN OLDER PATIENTS SEEN BY AN EMERGENCY DEPARTMENT THERAPY TEAM
Authors: Daly C , Maher G 
Published: February 2023

Abstract

Background
Recognising cognitive impairment in the Emergency Department (ED) is important in order to optimise outcomes for patients and to carry out a holistic assessment.
Currently the team screen routinely for delirium using the 4AT. Since 2016 the 03DY was used to screen for mild cognitive impairment however it was not being completed frequently in practice.
In a busy ED setting where time and resources are limited, one brief tool is preferable. The purpose of this investigation is to determine the most accurate cognitive screening tool to identify cognitive impairment in older adults in ED.

Methods
A literature review was completed comparing recent articles which examined the O3DY and 6CIT. The search criteria for journal articles were:
● Published within the last 10 years.
● Published in English.
● Full text only.
● Database: CINAHL.

Results
Our investigation identified that the O3DY offered the greatest sensitivity to rule out cognitive impairment.
The O3DY is quick to administer, requires no additional equipment or training, and can be completed at the patient’s bedside (BGS, 2020) which is particularly important within the ED. The 6CIT was shown to have poorer sensitivity for MCI diagnosis (Abdel-Aziz and Larner, 2014) and has a mathematical component which studies noted may not be appropriate for use in a busy clinical setting.

Conclusion
From this literature review, the O3DY has been identified as the most appropriate cognitive screening tool for our team to detect MCI in the ED. It is important to note that many of the articles reviewed highlighted that a single cognitive screen should not be used in isolation for the identification of cognitive impairment. It is unlikely that completing more than one cognitive screen is achievable in the ED however by implementing the most sensitive screening tool we can identify potential MCI and refer onwards.
11 IMPROVING CARE QUALITY IN A NURSING HOME IN JAPAN: ORGANISATIONAL RESILIENCE, ROBOTICS-AIDED CARE AND SYSTEMS APPROACH
Authors: Kodate N , Obayashi K , Masuyama S 
Published: February 2023

Abstract

Background
As one of the most rapidly ageing economies, Japan is currently faced with a shortage of care workers and relatively low intakes of migrant workers. While there is a shortage of health and social care professionals, the retention of professional staff is paradoxically becoming more difficult. The environment in domiciliary care is often associated with heavy and challenging workload. Robotics-aided care has been proposed in Japan to ameliorate the situation. While some positive effects of such a novel care model have been reported, the mechanism by which the technology-driven system improved care and residents’ quality of life remains unclear.

Methods
Using a case study approach, this paper examines one of the nursing homes in Japan where robotics-aided care was introduced. The organisational mechanism was analysed through documents and semi-structured staff interviews from the perspective of safety science. The key attributes of organisational resilience are: anticipating; responding; monitoring and learning. The paper details some of the tools that predated the introduction of the socially assistive robots and monitoring system in the care home. The interviews were conducted with 16 health and social care professionals.

Results
The results of the technological intervention itself demonstrated improved scores for the quality of life among the residents. However, the subsequent interview data highlight the significance of an organisational context in which technologies can be effectively introduced and implemented in nursing homes. The organisation had several well-trained care professionals, including the leaders, who share the mental map of ‘person-centred care’ and the ‘capability approach’. In addition, some tools were used to ‘visualise’ staff practice. Health and social care professionals pointed out some challenges surrounding the human-technology interface.

Conclusion
In order to understand the effectiveness and potential issues of the ICT robotics solution in care for older people, future research should investigate the human-technology interface and the interconnectedness between work system, care processes and outcomes.
126 A QUALITY INITIATIVE TO IMPROVE THE ASSESSMENT AND RECOMMENDATION FOR TOTAL CALCIUM INTAKE
Authors: King L , Pillay I , Sayers K , Maher J , Ryan S , Donnellan C 
Published: February 2023

Abstract

Background
This study assessed factors affecting adherence to calcium supplementation, estimated total calcium intake and potential to increase dietary calcium in the frail older adult.

Methods
Frail Older Adults who completed a comprehensive geriatric assessment (CGA) between January—June 2021 were included. Those taking calcium supplements were telephoned by a Dietitian. Nursing home residents, hospital inpatients and those unable to complete a telephone questionnaire were excluded. A modified version of the Short Calcium Intake List (SCAIL) was used and potential to improve dietary calcium was assessed (1). Data was analysed using descriptive statistics.

Results
N = 50 patients were taking a calcium supplement. N = 15 were excluded. 26 women and 9 men, aged 70 -96 yrs were included. Dietary intake ranged from 250– 1904 mg. 17% (N = 6) achieved &gt;1,000 mg/day dietary calcium requirements from diet. 66% (N = 23) had potential to increase their dietary calcium. 97% (N = 34) were prescribed a Calcium supplement, ranging from 500– 2000 mg/day. Total Calcium Intake including supplementation ranged from 850 mg—2,737 mg. 82% (N = 29) exceeded their daily requirements.40% (N = 14) reported reduced compliance due to swallowing difficulties; 25%(N = 9) gastrointestinal upset; 11% (N = 4,) taste/consistency and 8% forgetting (N = 3).Dietitian recommendations included 31% (N = 11) to stop supplementation, 34% (N = 12) to reduce, 11% (N = 4) advice on managing concerns relating to supplement and 22% (N = 8) dietary education.

Conclusion
Most older adults did not meet their nutritional requirements for dietary calcium. Over two thirds could reduce or stop supplementation following dietary calcium assessment and advice. A dietary calcium estimator for the older adult, with education can be used to correct calcium intake. This modified SCAIL will be integrated into the CGA as part of a quality improvement initiative for the frail older adult.

Reference
1. Rasch L et al. (2017), Content Validity of a Short Calcium Intake List to Estimate Daily Dietary Calcium intake of Patients with Osteoporosis, Calcified Tissue International, 100(3): 271–277.
127 ‘BONE HEALTH AND FRACTURE RISK ASSESSMENT IN COPD EXACERBATIONS DURING HOSPITALISATION- ROOM FOR IMPROVEMENT?’
Authors: McGurk C , Ahheng T , Claffey P , Kiely J 
Published: February 2023

Abstract

Background
COPD increases the risk of osteoporosis and international guidelines recommend that such patients undergo fracture risk assessment, referral for densitometry and appropriate management. We aimed to identify if patients admitted to our hospital with COPD exacerbation underwent assessment and were prescribed bone protection medication.

Methods
All admissions with COPD exacerbation to an Irish level 2 hospital between July 2020 and July 2021 were identified. The discharge summaries were screened for information regarding the presence of fracture risk and bone health assessment. Discharge prescriptions were examined for calcium, vitamin d and anti-osteoporosis medications. Radiology reports were screened for fragility fractures.

Results
Between July 2020–2021, there were 3,840 presentations to the medical assessment unit. Forty-six patients were admitted with a diagnosis of COPD exacerbation, mean age 72 (56% female). Seventy eight percent were classified as having GOLD Stage D disease with 28% receiving long term oxygen therapy. Mean number of hospitalisations per year per patient was 1.91 ± 1.2. Forty-three percent had laboratory evidence of bone health assessment during admission. Only 50% of patients were discharged on vitamin d replacement; 22% on calcium supplementation and 4% on osteoporotic medications. Regarding previous fractures, 9% had evidence of fragility fracture described on radiology reports, this was not mentioned on any hospital discharge letter.

Conclusion
This study suggests that opportunities for bone health assessment and intervention may be under recognised in COPD patients. Ways to improve this may include proformas and visual aids to prompt assessment and documentation of bone health, further education to increase awareness and greater access to densitometry resources in the community. In conclusion, this study highlights that further attention to patients’ bone health assessment and commencement of appropriate treatment is warranted. Admission to hospital or clinic review for such patients provide important opportunities for intervention.