bluuebunny/crossref_metadata_2025_split huggingface dataset:
132 GERIATRIC REHABILITATION IN THE COVID-19 ERA: SERVICE INNOVATION AND PATIENT OUTCOMES
Authors: Flood E , Browne L , Kurian S , Lynch C , Doyle M , Jordan A , Varghese R , Mello S 
Published: February 2023

Abstract

Background
The COVID-19 pandemic fundamentally changed the way rehabilitation services are delivered, with focus placed on individual in-room therapy and cessation of group sessions. Sparks Innovation and National Lottery funding was obtained to implement the ‘In-Room Rehabilitation and Well-being Initiative’. This provided patients with individual physiotherapy equipment to use in their room thus maximizing time spent active during periods of isolation. We aim to describe service innovation occurring in a post-acute geriatric rehabilitation hospital during the COVID-19 era, and the resultant patient outcomes.

Methods
Rehabilitation was provided to patients in-line with evidence-based practice and national infection prevention and control guidelines. Patients who were deemed appropriate by the multi-disciplinary team were provided with in-room therapy equipment. Prospective data was collected on service and patient outcomes. Functional outcome measurements were collected on admission and discharge and compared using a paired t-test.

Results
Rehabilitation was provided to 260 patients, average age 80.5 years (range 63–98) with 46.5% male. The majority of patients were admitted with ortho-geriatric diagnoses or general deconditioning following illness (70%). The patients were complex with multiple medical, functional, and psychosocial care needs, as indicated by an average Rehabilitation Complexity Score of 11/20, with 100% of patients requiring daily therapy. Average length of stay (LOS) was 30.7 days (range 3–169), with 85% of patients discharged home. Performance in activities of daily living (Barthel Index: 62 vs 79, p &lt; 0.0001), and mobility (Cumulative Ambulatory Score: 3.8 vs 5.3, p &lt; 0.0001) significantly improved from admission to discharge.

Conclusion
Despite ward closures, disruption to rehabilitation due to COVID-19 illness, and limitations on group therapies, our service achieved positive patient outcomes through innovation and delivery of high-quality evidence-based rehabilitation. Compared to the past eight years, 2020 had the lowest LOS and highest number of patients discharged home.
134 PREVALENCE OF SARCOPENIA AND ASSOCIATED FACTORS IN OLDER ADULTS ATTENDING A DAY HOSPITAL SERVICE IN IRELAND
Authors: Connolly K , Cunningham C , Murphy N , Romero-Ortuno R , Horgan F 
Published: February 2023

Abstract

Background
Sarcopenia is a muscle disease that is linked to the effects of ageing, chronic diseases, physical inactivity, and poor nutrition. In Ireland, there is a lack of readily available information on sarcopenia in older adults. The aim of this study was to describe the prevalence and associated factors of sarcopenia in community dwelling older adults attending a day hospital service in Ireland, using the European Working Group of Sarcopenia in Older People (EWGSOP) 2019 guidelines.

Methods
An observational cross-sectional study was conducted, where a consecutive series of older adults attending a day hospital service were invited to participate. The measure of primary interest was the diagnosis of sarcopenia using the EWGSOP 2019 guidelines. Muscle strength was assessed using both, handheld grip strength and the Five Times Sit to Stand Test. Muscle mass was assessed using appendicular skeletal mass adjusted for height using raw data from Bio Impedance Analysis. Physical performance was measured using the Short Physical Performance Battery and the Timed Up and Go Test. We also collected other Comprehensive Geriatric Assessment measures including cognition, nutrition, frailty and physical activity.

Results
A total of 134 participants took part in the study. The mean age was 81.7 (SD +/− 7.1). Sixty-one percent (N = 82) were female. The prevalence of sarcopenia ranged from 27–37% depending on the assessment tool used to assess muscle strength. Sarcopenia was associated with older age, frailty, reduced nutritional state, poor physical performance and reduced anthropometric measures, irrespective of how muscle strength was measured. Independently associated factors differed depending on muscle strength test, except for older age.

Conclusion
The prevalence of sarcopenia in the day hospital ranged from 27–37%. The assessment tool used to assess muscle strength influenced both the prevalence and associated factors of sarcopenia, suggesting scope for further research.
142 FRAILTY IDENTIFICATION AND INTERDISCIPLINARY ASSESSMENT OF OLDER PEOPLE IN THE EMERGENCY DEPARTMENT
Authors: Edge L , Cunningham C , Murphy N , Dillon A , Flynn S , O'Shaughnessy Í , Davis A , O'Rourke B , Brossier L , Doran C , Hennessy A , Kennedy U , McMahon G , McNamara R , Shields D , Staunton P , Horgan F 
Published: February 2023

Abstract

Background
Older People are attending Emergency Departments (EDs) in increasing numbers but the optimal assessment measures to use have yet to be established. This study examined the clinical utility of different assessments of strength, functional mobility, sarcopenia, cognition and frailty used by the physiotherapist in an interdisciplinary team (IDT) in the ED and determined any associations with clinical outcomes.

Methods
This observational cross-sectional study recruited adults ≥70 years who were assessed by an IDT on weekdays during working hours. Demographic variables such as age, gender, social situation, baseline mobility, falls and clinical measures such as Clinical Frailty Scale (CFS), 4AT, hand-held dynamometry, calf circumference and functional mobility in ED were recorded. Clinical outcomes were admission to hospital, discharge from ED with onward referral (ambulatory care or community) and discharge from ED with no referral. Ethical approval was obtained and SPSS was used for statistical analysis.

Results
Two hundred and fifty four participants were recruited, 58.3% female, mean age 80.23 (SD 6.56). Median CFS was 4 (IRQ 2.0), range 1–7 with 32.7% (n = 83) considered frail. Sarcopenia prevalence was 89.3% using grip strength and 7.1% using calf circumference. Grip strength predicted frailty even after adjusting for age (p &lt; 0.0001), gender (p &lt; 0.0001) and falls (p = 0.043). Admission to hospital was predicted by major diagnostic category (p = 0.016) and inability to sit to stand independently in ED (p &lt; 0.0001). Seventy percent (n = 179) of participants were discharged from ED, with 27.6% referred to ambulatory care or community services. Onward referral was predicted by frailty (p = 0.016) and falls in the last six months (p = 0.028).

Conclusion
Grip strength in addition to a validated tool such as CFS may assist an experienced IDT in identifying frailty, which can in turn inform decision-making regarding ED disposition and pathways of care for older people. Functional assessment in the ED is also important to determine the need for hospital admission.
151 THERAPY OUTCOME MEASURES IN AN OLDER PERSONS REHABILITATION UNIT
Authors: Joyce O , Black C , Armitage D , McDermott J , Healy A , O'Hara C , Flynn B , Costello M , McDonald M 
Published: February 2023

Abstract

Background
The mission of an older person’s sub-acute rehabilitation unit is to improve the individual’s function and quality of life. This is achieved through patient and multidisciplinary team (MDT) collaboration. The MDT collect Therapy Outcome Measure (TOM) (Enderby and John 2015) data to measure the effectiveness of rehabilitation and facilitate analysis of patient and service outcomes. This abstract will present 6 months of data collection with the aim of evaluating the impact of MDT intervention from January 2021.

Methods
The MDT meet weekly to jointly record patient TOM scores on admission and discharge. The TOM scales used are; multifactorial conditions, stroke and neurological disorder. The patient is scored from 0–5 in four domains; impairment, activity, participation and well-being. There are 11 parts to the scale with 0.5 scores permitted (Enderby and John 2015).

Results
Data was analysed on 62 patients. Across an episode of rehabilitation an increase of 0.5 or more on the TOM is a clinically significant (positive) change. 84% of patients had an overall improvement in the total TOM score. There was an average overall increase of 2.6 points on the scale which equates to a 25% overall change. 63% improved in the domain of impairment, 77% in activity, 73% in participation and 66% in wellbeing. 100% of patients post-stroke, 81% with multifactorial conditions and 75% with neurological conditions experienced an overall improvement.

Conclusion
The data objectively shows positive patient outcomes in older persons rehabilitation. Individuals experienced the most positive change in their activity and participation function and high levels of change are also evident in impairment levels and well-being. Overall, TOM is a very useful MDT outcome measure tool. It has been successfully implemented and maintained in the service and facilitates the ongoing analysis of individual and service outcomes to understand the impact of intervention.
184 ‘THROUGH THE LENS OF A CAMERA’—USING PHOTOVOICE TO EXPLORE OLDER ADULTS PERCEPTIONS AND EXPERIENCES OF COMMUNITY AMBULATION
Authors: Conroy B , Murphy N , Cunningham C , Horgan F 
Published: February 2023

Abstract

Background
The ability of an older adult to walk independently outdoors in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. The study qualitatively explored older persons’ perceptions and experiences of the variables associated with their ability to walk outdoors in their community, through the use of photographs and discussion.

Methods
This qualitative study employed Photovoice Methodology (Wang and Burris, 1997). Inclusion criteria were community dwelling older adults over 65 years old, attending a day hospital, able to ambulate at least 10 metres with/without an assistive device and no visual or fine motor limitations that would preclude using a camera. Participants attended an information session and received and practiced with a single use camera. Over one week they took photographs of perceived barriers or facilitators to community ambulation. The developed photographs formed the basis for focus group discussions. Focus groups were recorded; transcribed and thematic analysis was used to identify key themes.

Results
Eight participants, mean age of 78.8 years completed the Photovoice substudy. Five of the participants were female and six lived alone. One participant had experienced a fall in the past six months. Three key themes were identified; personal, environmental and strategic factors, all associated with an older adults’ ability to ambulate in the community. Each of these themes had a number of subthemes highlighting barriers and facilitators to community ambulation in this population.

Conclusion
This novel study design was well received. It provided real life experiences, insights and rich valuable data that may not be captured by other means. The findings demonstrate the multifactorial nature of independent community ambulation, both the personal and environmental factors associated with independent community ambulation in older adults. Physiotherapists should adopt a broader, holistic approach to the assessment and treatment of older adults, to promote the achievement of independent community ambulation.
213 A STRUCTURED CONTENT ANALYSIS OF THE WEBSITES OF NURSING HOMES WITH RESPECT TO LGBT-INCLUSIVITY
Authors: O’Malley K , Waters R 
Published: February 2023

Abstract

Background
The challenges associated with ageing can be amplified for individuals who identify as Lesbian Gay Bisexual or Transgender (LGBT). As a cohort, they are more likely to enter long term care at an earlier age than their non-LGBT counterparts. Many LGBT older adults fear negative bias in their interactions with health and social care services, and perceive nursing homes as potentially unwelcoming and insensitive to their needs. Nursing home websites outline the services and facilities available to residents, and can offer an insight into their culture and values. This research sought to examine the LGBT-inclusivity of nursing homes websites in a single catchment area catering to both an urban and rural population.

Methods
A total of 41 nursing homes and long term care facilities were identified, of which 24 had websites. A structured content analysis of these websites was performed, with respect to; 1) LGBT-inclusive symbols; 2) Messaging directly addressing LGBT individuals; 3) Presence of a diversity/inclusion statement; 4) Explicit reference to LGBT individuals or sexual orientation in a diversity/inclusion statement; 5) Use of heteronormative imagery; and 6) Use of LGBT-inclusive imagery. Data was manually recorded and uploaded to an excel document for analysis.

Results
None of websites featured LGBT-inclusive symbols or directly addressed LGBT individuals. 8% (n = 2) included a statement on diversity and inclusion, however only 4% (n = 1) explicitly referenced sexual orientation. In terms of visual content, 16% (n = 4) of websites included heteronormative photographs with none featuring LGBT-inclusive imagery.

Conclusion
With the exception of one facility, none of the nursing homes acknowledged the sexual identity of residents with respect to inclusivity. None of the facilities examined were suggestive that they would be an inclusive environment for prospective LGBT residents. Greater effort is required to promote inclusivity of sexual minority individuals in the long term care setting.
223 DAY HOSPITAL DISRUPTED: LEARNING FROM THE INNOVATIVE SERVICE DELIVERY DURING COVID-19
Authors: Gilheany A , McDaid E 
Published: February 2023

Abstract

Background
Day Hospital services are a critical part of community based care for older people. In March 2020, in response to COVID-19 Day Hospital (DH) was closed and did not re-open until May 2021. An analysis was completed to review the outcomes of patients who were open cases in the Day Hospital at time of closure as well as a review of the service provided by the Day Hospital during the closure.

Methods
A retrospective service analysis was completed to examine Day Hospital activity during the closure period and multi-disciplinary intervention statistics were also collated and analysed. A second analysis was completed of patient outcomes through review of medical charts and triage documents of patients who were open cases at the time of closure in March 2020.

Results
There were 203 open Day Hospital cases at the time of closure in March 2020. During the 14 month closure period, 179 patients were triaged and supported with telehealth (548 total activities). Home based multi-disciplinary input was provided to 74 patients (176 total activities). By August 2021, 18% (n = 36) of the original Day Hospital patients had died. 65 patients (32%) were still appropriate for/required Day Hospital services and attended when the Day Hospital re-opened. The remaining 50% were discharged as they either no longer wished to, required or were appropriate to attend Day Hospital.

Conclusion
Despite prolonged disruption of normal services, the Day Hospital adapted to provide virtual and domiciliary intervention to open cases offering essential support to community dwelling frail older adults during the pandemic. This experience has enhanced the skillset and reach of the day hospital service and has led to new enhanced models of service delivery.
232 DETECTION OF POST STROKE DEPRESSION IN ACUTE STROKE UNIT AT UNIVERSITY HOSPITAL
Authors: Mohamed A , Wang J , Gabr A , Mustafa W , O'Connor M , Mulroy M 
Published: February 2023

Abstract

Background
Depression is the most common neuropsychiatric manifestation after stroke. It is associated with lower satisfaction and quality of life in stroke survivors and their families. Routine screening for mood disturbance is recommended in stroke patients {Royal College of Physicians, 2016; National Office of Clinical Audit (NOCA) 2019}. The psychological impact of a stroke can present challenges for assessment and diagnosis. We audited the assessment and diagnosis of post stroke depression in a teaching hospital.

Methods
PHQ-9 was prospectively administered to stroke patients (and also to the next of kin with patient consent) within 2 weeks of stroke and repeated at 4–6 weeks after stroke in November 2016. The Patient Health Questionnaire (PHQ—9) is a self-administered, validated screening tool for depression. Chart diagnosis or drug prescribing for depression was retrospectively assessed in the medical and nursing notes.

Results
15 of 34 admitted stroke patients were administered the paper based PHQ-9. 19 patients were excluded due to: severe cognitive impairment; aphasic; death or having been discharged.
No patient had depression diagnosed prior to admission to the hospital. One patient was diagnosed and prescribed an anti-depressant post stroke.
7 patients screened positive for depression on PHQ-9: mild depression n = 4 (27%); moderate n = 2 (13%); and severe depression n = 1 (6%). Repeat questionnaire at 4–6 weeks post stroke revealed an unchanged PHQ-9 score in n = 10 (67%); however n = 2 (11%) had deteriorated and n = 4 (22%) improved.

Conclusion
Depression was a common finding in 47% of patients post stroke and was under-recognized without a formal screening process incorporated in clinical practice. A nuanced screening process, accounting for common co-morbidities such as aphasia and cognitive impairment, was incorporated after this audit. Further guidance is being developed by the National Stroke Programme based on NOCA feedback.
234 THE IMPACT OF OLDER AGE ON CLINICAL OUTCOMES DURING THE FIRST WAVE OF THE COVID-19 PANDEMIC
Authors: Okpaje B , Gabr A , Mohamed A , Teoh T K , Mustafa W , Saleh A , Ali B , Leahy A , Stapelton P , O'Connell N , Power L , O'Connell S , O'Brien A , Shanahan E , Peters C , Galvin R , O'Connor M 
Published: February 2023

Abstract

Background
Severe acute respiratory coronavirus 2 (SARS-CoV-2) was first recorded in Ireland in February 2020. Several studies have explored the association between age and SARS-CoV-2, showing that there were poorer outcomes in older people. Our objective was to evaluate the impact of age on outcomes such as hospital length of stay, mortality, and re-hospitalisation.

Methods
We performed a single-centre, retrospective observational cohort study, using an electronic microbiology database of recorded index admissions of SARS-CoV-2 positive patients aged 65 years and older during SARS-CoV-2 wave one (March 1st to May 31st 2020). PCR testing of nasopharyngeal and/or sputum samples was used to confirm positivity. Our clinical outcomes measured included hospital length of stay, mortality and re-admission rate within 6 months.

Results
153 patients 65 years and above were admitted. The male to female ratio was 1.3 with 90% admitted medically. 79 patients were aged between 65–79 years; 84 patients ≥80 years; and 12 patients ≥90 years. Mortality was 25%, 31% and 42%, respectively. Median length of stay remained 14 days for ages 65–89 rising to 17.5 days for those ≥90 years. Re-hospitalisation rates at 6 months were similar for ages 65–79 and 89–89 years at 42% and 40%, respectively. One patient (14%) over 90 years was re-hospitalised.

Conclusion
SARS-CoV-2 has disproportionately impacted on general medical services treating older hospitalised people. In our centre, mortality for patients ≥65 years was 28.1% which compared favourably with 35.6% internationally as outlined by Victor et al. (2020) based on Spanish data. Treatment of SARS-CoV-2 is not futile in older patients with 58% of nonagenarians and 69% of octogenarians surviving, however re-hospitalisation rates are high at 40%. A targeted approach to discharge support via integrated care may ameliorate this.
253 PREVALENCE OF FRAILTY IN ADULTS OVER 75 ADMITTED UNDER SURGICAL SPECIALTIES IN A TERTIARY HOSPITAL
Authors: Gannon E , Aherne E , Khan I , Nor N , Murphy J , O'Mahony E , Cloney T , Rafferty M , Stoneman S , Murphy D , Crowley P , Creed S , Byrne E , Mensch R , Lewis M , Harnedy N , O'Sullivan P , O'Connor M , O'Mahony D , Curtin D , Healy L , Ducloe T , Daly B 
Published: February 2023

Abstract

Background
The early identification and comprehensive assessment of frailty in older adult hospital inpatients is associated with improved outcomes. The aim of this study was to identify the prevalence of frailty amongst inpatients admitted under surgical services over the age of 75 in a tertiary hospital. A secondary aim was to identify older adult inpatients under surgical specialities who would benefit from Geriatric Medicine input.

Methods
Inpatients over the age of 75 admitted under Surgical specialities were identified by a search of the electronic patient information system iPIMS on 26/08/2021. Patients attending a day service or needing High Dependency or Intensive care Units were excluded. Information was collected using a paper questionnaire from patient records. Frailty was screened by using the Think FRAIL tool. The data was stored on a hospital password protected computer and analysed using Microsoft Excel.

Results
45 were patients admitted under surgical services meeting criteria were identified. The services included Orthopaedics (n = 25), General Surgery (n = 6), Vascular Surgery (n = 2), Cardiothoracic Surgery (n = 8), Neurosurgery (n = 3), and Urology (n = 1). The overall prevalence of frailty indicated by the presence of least one criteria of the Think FRAIL tool reached 75% (n = 34) of patients. A new or worsening functional impairment was present in 66% (n = 30) of patients, altered mental status 29% (n = 13), immobility 71% (n = 32), presence of home supports 60% (n = 27), and residents of long-term care accounted for 9% (n = 4). 51% (n = 23) of patients had a Comprehensive Geriatric Assessment, Orthopaedics (n = 19), Vascular Surgery (n = 1), General Surgery (n = 3). The average time to CGA was 2 days.

Conclusion
Co-management models of care like Orthogeriatrics are associated with better outcomes for patients and better outputs for hospitals. There is increasing interest in Ireland and internationally in perioperative multidisciplinary care of older adults undergoing surgery. This study highlights the need to expand co-management and collaborative models of care.