bluuebunny/crossref_metadata_2025_split huggingface dataset:
169 Cost-effectiveness analysis of geriatrician-led perioperative services in district general hospitals
Authors: Hall H , Paveley A , Tite M , Clayton A , Godfrey L , Dhesi J , Gupta S , Mandal A 
Published: September 2023

Abstract

Background
Perioperative care for Older People undergoing Surgery (POPS) services using Comprehensive Geriatric Assessment (CGA) and optimisation methodology in the perioperative setting are clinically and cost effective. Originally described within a tertiary centre, the POPS model has been successfully translated to district general hospital (DGH) settings. The aim of this project was to deliver a cost-effective, CGA-based perioperative service for older people at an NHS trust operating across two geographically separate district general hospitals, with support from the newly established POPS Network, an initiative designed to scale up POPS services across the NHS.

Methods
A POPS service had been informally provided by two consultant physicians since 2017, but the service was formalised through the NHS Elect POPS network in 2021. Data were collected from 50 consecutive patients reviewed in POPS outpatient clinic, over a six-week period. Patients with polypharmacy (defined as prescription of five or more drugs) were identified and the number of medications deprescribed was catalogued. The number of specialty referrals or additional outpatient appointments avoided by early CGA was also recorded. Additionally, prospective data on drugs deprescribed on 90 consecutive surgical inpatients were analysed. Economic evaluation was conducted by the trust’s financial and pharmacy departments.

Results
For POPS outpatients, through prevention of onward specialty referral or other outpatient appointments (mean 2.54 per patient), cost saving was calculated at £803 per patient. This generated an extrapolated annual saving of £385,440 at each site. For inpatients, pharmacological optimisation led to an estimated annual cost saving of £239,000, with on average two medications deprescribed per patient. Subsequent benefits realisation analysis at 18 months demonstrated that these results remain consistent.

Conclusion
POPS services within DGHs, when delivered by clinicians who practise holistically, have a significant positive financial impact through pharmacovigilance and by preventing unnecessary specialty referrals and outpatient appointments. These cost savings of over £500,000 have easily funded the substantive service.
239 Predictors of raised bone turnover markers after transitioning to Zoledronic acid from denosumab
Authors: Bradley E , Fitzpatrick D , McLoughlin S , Maher N , Carraher J , O'Carroll C , Steen G , Fallon N , Lannon R , McCarroll K 
Published: September 2023

Abstract

Background
Denosumab is a commonly used to treat osteoporosis though if stopped there is a rebound increase in bone turnover and vertebral fracture risk. Treatment with Zoledronic Acid (ZA) after denosumab discontinuation is recommended to reduce this risk, though in some patients a second ZA infusion may be required six months later to maintain adequate suppression of Bone Turnover Markers (BTM). We aimed to assess the proportion of patients with a sub-therapeutically suppressed BTM after a single dose of ZA post denosumab cessation and explore for predictors of this.

Methods
We identified patients at our bone health clinic who received ZA 6 to 9 months after the last and final denosumab injection. BTM measured was cross linked C-Telopeptide type I collagen (CTX). Sub-therapeutic BTM response was defined as a CTX &gt;0.300 ng/ml. Logistic regression was used to explore for prectiors of CTX &gt;0.300 including age, body mass index (BMI), denosumab duration and lumbar spine bone mineral density (BMD).

Results
There were 88 patients, 93% female with a mean age of 67 years. Median duration of denosumab therapy was 5.0 years and 44% had osteoporosis prior to transitioning to ZA. Mean CTX after ZA (median 127 days post ZA) was 0.252. However, 45% had a CTX &gt;0.300 and in these patients the median value was 0.412. Older age (p = 0.045), longer denosumab duration (p = 0.010) and lower BMD at the spine (p = 0.008) were associated with a CTX &gt;0.30.

Conclusion
A large proportion (45%) had subtherapeutic BTM suppression 3 to 6 months after receiving ZA post stopping denosumab and this was predicted by older age, lower spine BMD and longer denosumab duration. Guidelines suggest a second ZA infusion at 6 months in such patients. If transitioning to ZA, findings highlight the importance of optimising BMD first, especially in older adults with longer denosumab therapy.
248 Influence of self-efficacy on older adults’ perspectives and engagement with technology
Authors: O'Neill M , Walsh K , Poli A , Vogel C 
Published: September 2023

Abstract

Background
Self-efficacy has been demonstrated to influence individuals’ perspectives and preferences in relation to technology use, and informs disparities observed among older adults in terms of their access and use of information communication technology. However, research exploring the effects of technological self-efficacy on the consequent virtual engagement among older adults is scarce. The relationship between self-efficacy and varying levels of technology use and proficiency needs to be considered. These factors not only shape older adults’ perspectives on technology use but also impact their adaptation and engagement in critical areas of daily life: including information access, advocacy, and social participation. This paper investigates the relationship between the adoption of and attitudes towards technology among older people, the role of self-efficacy in informing these attitudes, and the level of use or perceived usefulness of technology.

Methods
The study draws on in-depth interviews with older adult members (n = 40) and stakeholders (n = 30) of a nationally representative membership-based grassroots older adult organisation in Ireland. The semi-structured interviews explored individuals’ experiences of technology use, focusing on daily routines, social connectedness, information access, and civic participation.

Results
Findings reveal that narratives about daily routines involving technology are influenced by perceptions of self-efficacy in relation to technology in general. However, this self-efficacy is also influenced by other factors that influenced interaction with technology in the daily lives of older people. Dependence on social support can paradoxically impair self-efficacy when such support is withdrawn. An ideology of individual responsibility sometimes led participants to view themselves as the problem when struggling with digital engagement, contributing to a lack of confidence and motivation.

Conclusion
While technology development for older people is progressing, there is less consideration of the correlation between technology adoption rates and self-efficacy. This paper proposes interventions to empower individuals, enrich virtual engagement, and reduce technological inequalities. Understanding these dynamics could help shape inclusive technological engagement practices and policies for older adults.
256 How prevalent are markers of blood pressure instability on Ambulatory Blood Pressure Monitoring of older people with falls, faints & dizziness?
Authors: Madden R , Briggs R 
Published: September 2023

Abstract

Background
In older people with BP-related falls, the mechanisms that usually tightly control Blood Pressure (BP) may be less efficient, leading to BP instability. This may manifest as specific markers on Ambulatory Blood Pressure Monitoring (ABPM), including BP variability, BP dipping and absence of nocturnal dipping/reverse dipping. The aim of this study therefore is to ascertain the prevalence of APBM markers of BP Instability among older people with falls/faints/dizziness and examine if there is an age-gradient seen for these markers.

Methods
ABPM data (minimum 25 BP values measured across 24 hours) was collected for 83 consecutive patients aged ≥70 years attending a tertiary-referral Falls & Syncope Unit with falls, fainting or dizziness. Data analysed included BP Variability (standard deviation (SD) of BP values, i.e. measurement of the oscillation of BP measurements); Nocturnal dipping (decrease in average night BP compared to average day BP) and BP dips (number of systolic BP values &lt;100 mm Hg).
Results: Of the analysed ABPMs(n = 83, mean age 78 years, 48% female), mean number of readings per device was 34.6 (33.7–35.5). The average SD for overall systolic BP was 15.9. Over 15% of patients had an average SD ≥20 for systolic BP based on the full ABPM, reflecting high levels of BP variability. There was a significant age gradient seen for nocturnal dipping with mean change −0.30 (−9.3–8.8) in those aged ≥85 years compared to +10.9(7.3–14.6) in the 70–74 years age group. The mean number of systolic BP values&lt;100 mm Hg was 2.9 (1.7–4.0).

Conclusion
Older patients attending with falls/faints/dizziness demonstrate significant BP variability, aberrant nocturnal dipping profiles and frequent systolic BP values dipping below 100 mm Hg. Further work is required to establish if these ABPM aberrancies are reliable predictors of future falls and potentially modifiable targets to reduce falls burden among older people.
259 Understanding carer harm- insights from family carers of people living with dementia and dementia professionals
Authors: Donnelly S , O'Brien M , Dunne N 
Published: September 2023

Abstract

Background
‘Carer harm’ is when carers experience violence or become subject to controlling or coercive behaviour, either on an incidental or systematic basis, resulting in physical, psychological and/or sexual harm. Little is known however about the harm experienced by carers at the hands of the person to whom they provide care. Challenges are often faced by social workers and other professionals when care and violence intersect, and a service user is the alleged perpetrator of abuse against their family carer. This study explores the concept of carer harm from the perspective of family carers of People Living with Dementia (PLwD) and dementia professionals.

Methods
The project deploys an engaged research approach that produced knowledge in collaboration with family carers and professionals. Work Package 1 involved narrative interviews with four family carers of PLwD who self-identified as experiencing carer harm. Work Package 2 involved two focus groups. One with Family Carers Ireland staff and one with dementia professionals. Work Package 3 comprised one World Café Co-Design Workshop with family carers, professionals, and service providers where education and training materials were developed.

Results
Findings indicate high levels of unmet need and psychological distress with family carers of PLwD regularly experiencing verbal and physical aggression. Stigma and shame were identified as barriers for family carers in disclosing their experiences of carer harm. Professionals reflected on their immense feelings of helplessness and frustration about their inability to respond, highlighting the link between carer harm and the absence of appropriate condition-responsive services.

Conclusion
Information booklets for family carers of PLwD were developed to raise awareness of carer harm and to empower family carers to protect themselves and seek help. A practice guide was also developed for professionals and support organisations in order to improve our understanding of and responses to, those experiencing carer harm.
291 Improving the collateral history for older people admitted to hospital: the 6 Cs
Authors: Doyle K , Lavan A , Briggs R 
Published: September 2023

Abstract

Background
Despite its central role in diagnostic formulation in unwell older adults, particularly those with memory problems, little scrutiny has been applied to Collateral History (CH) taking from how/when it should be performed, what information should be gathered and how it should be assimilated.
This quality improvement project aims to address this by improving processes around collateral history taking for older patients.

Methods
The objectives of this project were to: (i) Establish information that should be included in the CH, (ii) Assess if this information is currently being collected and (iii) Use this to inform a proforma to assist with CH taking. Health-Care Professionals (HCPs) involved in the care of older people ranked information from CH in terms of relevance/importance (online survey). An audit was performed on a sample of consecutive patients aged ≥65 years admitted under the geriatric medicine service from 01/02/2023–17/02/2023, to assess compliance with and content of collateral histories against our HCP survey.

Results
41 HCPs (13/41 (32%) medical, 6/41 (15%) nurse specialists, 15/41 (37%) physiotherapists/occupational therapists, 7/41 (17%) medical social workers) were surveyed. They ranked baseline and recent changes in cognition, function and mobility as key features of the CH. CHs were completed in 70% (35/50) of admissions (n = 50, mean 83 years, 42% documented cognitive impairment). Baseline cognition and function were documented in less than half of collateral histories, change in cognition in 18/35 (51%); change in function in 10/35 (29%). Baseline mobility was documented in 20/35 (57%); change in mobility in 9/35 (26%). Findings then informed an electronic patient record (EPR) proforma: ‘The 6 Cs of the Collateral History’ (Consent, Contact, Cognition, Change (Function/Mobility), Communication, Conclusion).

Conclusion
Compliance with, and content of, CHs vary widely. This QI project aims to address this by using an EPR proforma, co-designed by clinicians involved in the care of older people, to prompt/structure CH taking.
8 A prospective audit on outpatient clinical activity in a consultant-led general medical and specialist geriatric clinic
Authors: Jeyaseelan A , Casey A , O'Donnell E , Gillett A , Reardon M 
Published: September 2023

Abstract

Background
It is recognised that there is a significant unprecedented pent-up demand on Irish healthcare services due to the COVID-19 pandemic. This has resulted in lengthy acute hospital scheduled care waitlists. We identified a national protocol that provides guidance in the area of outpatient waiting list management. The aim of this audit was to determine if our practice was consistent with national guidance.

Methods
We conducted a prospective audit on a consultant-led medical and specialist geriatric clinic between January to March 2023 and collected data in relation to referral reason, triage category, waitlist times, clinic attendance, hospital admissions, inter-specialty communication and resolution of clinical problem prior to outpatient clinic attendance.

Results
We included 67 patient appointments in this audit. Median waitlist time was 15.5 weeks. There were 2 urgent referrals, both were not seen within the Clinically Recommended Timeframe (CRT). 94% were seen within the CRT. 11 patients (16.4%) failed to attend their clinic appointment, only 3 of which cancelled beforehand. 5 patients (7.5%) were inpatients during waitlist time and 4 had reason for outpatient referral addressed during their inpatient stay. 8 patients (11.9%) had same referrals sent to a second point of contact, only 5 had correspondence available in medical records at time of audit.

Conclusion
Our findings indicate that the majority of our waitlist times fall within national target recommendations, however more robust pathways need to be developed to ensure urgent referrals are seen promptly. They also indicate inter-specialty and patient communication need to be enhanced to minimise duplicate or unnecessary appointments that add to waitlist burden.
26 Audit of osteoporosis treatment in patients undergoing Orthogeriatric rehabilitation
Authors: O’Donovan C , Young C , Rafferty M , Ahern E 
Published: September 2023

Abstract

Background
There was a perceived under-prescribing of osteoporosis treatment in this population. The transition from acute hospital to rehabilitation unit presented an opportunity to check medications and institute change.

Methods
Retrospective audit of patients’ medication charts. All patients on the rehabilitation ward under the care of an Ortho-geriatrician were included. Data was anonymised and recorded in an excel file. Prescription of calcium and vitamin D (single agent or combination) and targeted osteoporosis medications were recorded. Data collection performed by the specialist registrar on a ward round with the consultant. Interventions included education of Non-Consultant Hospital Doctors (NCHDs) to encourage proactive prescribing and documentation of the bone protection plan on the transfer summary. A re-audit was undertaken at a two month interval using the same methodology.

Results
12 medication charts were examined as part of the initial audit. 10/12 had a neck of femur fracture and 2/12 had fragility fractures of the tibia/fibula requiring surgery. Zero patients were prescribed calcium alone, two vitamin D alone and 9/12 were on combination calcium and vitamin D. No patients were prescribed targeted osteoporosis treatment. 1/12 patients had a documented plan regarding bone protection. Re-audit examined 10 medication charts. 9/10 had a neck of femur fracture, 1/10 had a fracture of both the distal femur and the proximal humerus. Zero patients were prescribed calcium alone, three vitamin D alone and 6/10 were on combination calcium and vitamin D. 2/10 were prescribed oral bisphosphonate, 5/10 denosumab and 1/10 intravenous bisphosphonate. The remaining two patients did not yet have osteoporosis treatment prescribed.

Conclusion
Despite all of the initial patients being &gt;14 days post-operative the majority did not have a plan or prescription for bone protection representing a missed opportunity to prevent further fractures. Re-audit post education demonstrated an 80% improvement in prescription of osteoporosis treatment.
27 An evaluation of suicidality of those over 65 years referred to liaison psychiatry in the acute hospital setting
Authors: Flood J , Butler A 
Published: September 2023

Abstract

Background
The Mental Health Service for Older People (MHSOP) Liaison Service in North Dublin noted an exponential increase in suicide attempts in those over 65 over a period of 3 years (2020–2022). Annually in Ireland, more than 400 people die by suicide and a further 12,500 present to hospital following self-harm, of which approximately 15% are older adults (aged &gt;60). Worldwide, the age group that is most likely to die by suicide is represented by older adults, in particular men.

Methods
Analysis of referrals to the service from an established clinical database was performed to include those referred post suicide attempt or those referred for suicidal ideation or expressing a Passive Death Wish (PDW). Data was anonymized and recorded using Microsoft excel.

Results
There was a highly significant difference between the number of males who were referred post suicide attempt between 2021 (n = 1) and 2022 (n = 13), with z = +3.21 p &lt; 0.001. Referrals post suicide attempt in 2021 consisted of 2% (n = 6) of all referrals to the service, and 6% (n = 20) in 2022. In 2021 the mean age of those referred was 75.16, and in 2022 was slightly lower at 72.65, with 60% of those in the 65–72 year age range. Alcohol was involved in 45% of all suicide attempts in 2022. The overall referrals to the service for suicidality (post suicide attempt and PDW) increased from 5% to 16% from 2021 to 2022 of all those referred.

Conclusion
A Suicide prevention working group was established to include members of: MHSOP, Older Persons Services, Public Health and the National Office for Suicide Prevention (NOSP) to explore evidence based suicide and self-harm prevention strategies and guidelines in order to address the multiple precipitative factors for suicidality in older persons by developing improved care pathways and integration of services.
40 Reported hydration intake of older patients in an emergency department
Authors: Patricia D , Sheil O , Roche E 
Published: September 2023

Abstract

Background
Older people are vulnerable to dehydration & inadequate fluid intake is a major contributor to preventable dehydration. Poor oral intake of fluids can be related to the inability to feed independently and having poor availability and access to fluids. This study examined older patient’s ability to access fluids in an Emergency Department (ED) setting.

Methods
A point prevalence study was undertaken in the ED over one working day. Patients in the ED who were aged over sixty five, alert conscious & no upper limb fracture were asked to participate in this survey by completing a task of pouring water from a standard ward water jug weighing 1.5 kg into a cup. In addition patients were asked a series of questions about their water intake and if they had adequate access to water in the ED. 20 patients participated in the study (11 Females 9 Males.)

Results
70% of patients were able to lift the jug and pour water into a cup without assistance. 15% of patients stated they had access to sufficient fluids. All of these patients had brought their own drinks to the ED. 85% of patients stated they did not have access to sufficient fluids. Reported fluid intake ranged from 100 mL to 2litres. 70% of patient’s fluid intake was less than 1 l over 24 hour period. 11 patients had access to a table or overbed tray to place a drink on. The preferred cold drink option was water for 85% of patients.

Conclusion
The majority of older patients in the ED reported they did not have access to sufficient fluids. Fluid intake over a 24 hour period was less than 1 litre. Older adults in the ED are at risk of dehydration. Patients preferred drink choice of water could be made more readily available in the ED setting.
45 New eBook resource: the supportive memory guide—empowering you with practical tips and useful technologies
Authors: O'Brien E , Malone K , McDonnell O , Hanlon K 
Published: September 2023

Abstract

Background
Part of the mPower programme (a Dementia Initiative in CHO 1) was to explore and create digital resources for People Living with Dementia and support community services. One of the projects led by senior Occupational Therapists in collaboration with HSE eHealth was the development of a practical resource eBook with education, practical advice and helpful assistive technologies. The aim was to create a digital resource that provides practical information and advice for People Living with Dementia, empowering them to make positive changes.

Methods
The eBook project commenced in January of 2022, the Occupational Therapists and the digital designer met twice monthly online to collaboratively develop relevant and practical content and advice covering key areas in dementia and daily living. The team provided a focus on assistive technologies and created short explanatory videos. The OTs researched and provided information on relevant apps for smart technology devices that support engagement and brain stimulation. The eBook was reviewed by the National Dementia Office, HSE digital and communications as well as Occupational Therapists and a focus group of People Living with Dementia which provided positive and helpful feedback.

Results
The eBook was completed and launched in February 2023 and covers a wide area of topics with practical advice to help people manage the impact dementia has on their daily engagement in activities and occupations. Assistive technologies, compensatory techniques, modifying activities, downloads and more are provided in the eBook. The topics covered include: Routines & Habits, Scheduling & Planning, Supportive Home Environments, Managing Medication, Simple Home Technologies, Smart Home Technologies, Smart Phones, Keeping Active & Engaged, and Links & Resources.

Conclusion
This eBook will be a valuable resource for People Living with Dementia and their families. It will be an additional tool for healthcare professionals in a time where waiting lists are high and where is some areas specialist services are limited.