bluuebunny/crossref_metadata_2025_split huggingface dataset:
160 A CLOSED-LOOP AUDIT EXAMINING THE USE OF PROPHYLACTIC ANTI-COAGULATION IN OLDER ADULTS ADMITTED TO A SPECIALIST GERIATRIC SERVICE
Authors: Brar SK , Sheehan O , Martin R , Rasheed M 
Published: October 2022

Abstract

Background
Guidelines recommend prescription of Prophylactic Anticoagulation (PA) to all hospitalized older adults unless a contraindication exits. In many cases this does not happen at the time of admission increasing the risk of thromboembolic events. We aimed to assess the use of PA across the medicine for the geriatric service of a level 3 hospital (average daily census of service 120) then use quality improvement to achieve our goal of 95% prescription of prophylactic anticoagulation when appropriate.

Methods
Medication kardexes and clinical notes were reviewed to collect variables including age, length of stay, creatinine clearance, weight, mobility status, use and dose of antithrombotic medications and documentation of reason if not prescribed. Following initial data collection, cause and effect analysis was performed to identify reasons for under-prescription and small tests of change were conducted across 4 PDSA cycles before data collection was repeated.

Results
Initial data collection revealed that only 80% of older adults admitted to the service were receiving prophylactic anticoagulation. Cause and effect analysis identified many reasons for failure to prescribe PA including inadequate history taking, lack of clinician education and training, poor documentation, lack of handover between clinicians, failure to complete medication reconciliation on admission and lack of pharmacy support on some wards. Each of these contributory factors were addressed in turn. After a month of QI activities prescription of PA improved to 83% and by 3 months 98.1% (104/106) of patients were receiving PA with only 2 patients for whom PA was not prescribed without clear documentation of the reason.

Conclusion
Sustained quality improvement resulted in a culture change across our service improving rates of appropriate prescription of PA and raising the quality of care delivered to older adults. This model of quality improvement is now being replicated across our department to address other gaps in service delivery.
162 A REVIEW OF THE GENERAL PRACTITIONER REFERRALS TO A RAPID ACCESS FRAILTY ASSESSMENT UNIT IN A MODEL-3 HOSPITAL
Authors: Kitic DB , Ibrahim M , McGlynn J , O'Keane C , Donnelly T , Kemple O 
Published: October 2022

Abstract

Background
The Rapid Access Frailty assessment unit (RAFAU) was set up in February 2021 and is run by a Raft (Rapid access frailty team). This is a dedicated multidisciplinary team in a model three hospital to review frail older patients to improve outcomes and admission avoidance. They review patients in the Emergency department as well as the assessment unit and on the ward for inpatient frailty reviews. The team is expanding as new roles are incorporated into the team and our service has evolved into a five day a week rapid access service.

Methods
We examined the number of GP referrals to our RAFU since May 2021 to March 2022 and the outcome of the review. Data was collected on all patients attending the RAFAU over an 11-month period. We selected all GP referrals which produced a cohort of 259 referrals to the unit.

Results
A total of 259 referrals were reviewed in RAFAU clinics. Mean age was 70-75 years old 60% were female, 40 % male. Reason for referral included: 38 % medical reasons, 32% cognitive issues, 18 % mobility ,7 % falls. Overall, 41% of referred patients had Clinical frailty scale score of 1-3, 16 % had a clinical frailty scale of 4, 8% clinical frailty scale of 5, 9% clinical frailty scale of 6, 5% clinical frailty scale of 7.The outcome of this cohort were as follows: 86 % needed further follow up, 9% were discharged and 1% admitted.

Conclusion
The RAFAU gives an alternative referral destination to GP’s for rapid review of frail older patients and thus potentially avoiding ED referral and admission. The vast majority of these referrals were for review of medical issues and cognitive assessment. The majority of patients required ongoing specialist frailty services and we hope to expand our service in the future.
167 ASSISTED DECISION-MAKING (CAPACITY) ACT 2015: KNOWLEDGE AND ATTITUDES AMONG HOSPITAL DOCTORS
Authors: Ragab I , O'Brien M , Martin A 
Published: October 2022

Abstract

Background
Assessing capacity is part of our daily practice, and an important pillar of patient centred care. Assisted Decision-Making (Capacity) Act 2015, which is due to commence in June 2022, is an act to provide reform of the law to assist patients who require help in making decisions in a manner that will ensure their autonomy, dignity, and best interests. This study aimed to investigate the knowledge, attitudes, and confidence of hospital doctors regarding this act.

Methods
This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and attitudes about capacity assessment. The second section contained practical scenarios to test knowledge around the new framework for decision support under the Act.

Results
Of the 670 consultants and non-consultant hospital doctors (NCHD) surveyed, an 11% response rate was achieved (75 respondents), 44% were consultants 56% were NCHD. 43% reported to lack confidence in assessing capacity. 92% felt that they needed more training regarding the act. Also, 80% agreed the act will have an impact on our practice. 80% thought capacity was carried out by a certain specialty (mostly Psychiatry and Geriatrics). In the decision support scenarios 18-27% of responders felt they did not know what the appropriate level of decision support was. In each scenario, with the exception of one, the most frequent response was the correct one but responses were widely distributed on most questions.

Conclusion
Despite the lack of a representative sample, doctors’ knowledge about capacity seems to have improved compared to previously carried out studies. However, our study appears to indicate a significant knowledge gap and further training is needed regarding the Assisted Decision-Making (Capacity) Act 2015 proposed to commence next month. Mandatory training on the act should be considered by HSE and the professional training bodies.
168 AN EXPLORATION OF ATRIAL FIBRILLATION AND ANTICOAGULATION IN STROKE PATIENTS WHO UNDERGO THROMBECTOMY IN A TERTIARY THROMBECTOMY CENTRE
Authors: Murphy J , Kelly R , Cathasaigh CN , Murphy D , Cloney T , Hayes K , Arrigan G , O'Sullivan A , Barry P , James K , Healy L 
Published: October 2022

Abstract

Background
Atrial Fibrillation is a significant cause of ischaemic stroke. Prevalence of atrial fibrillation in patients requiring thrombectomy is approximately 33%. Embolic thrombi which develop due to Atrial fibrillation may become targets for clot removal by thrombectomy in appropriate patients. Anticoagulation is one of the mainstays of treatment for atrial fibrillation.

Methods
A list of patients who had thrombectomy performed for ischaemic stroke in 2021 was compiled. Charts were reviewed to establish the prevalence of atrial fibrillation and the rates of appropriate dosing of anticoagulant. Of those who were not anticoagulated, we aimed to establish if there was a clear reason for this. This was performed in a tertiary referral centre with 24/7 access to thrombectomy.

Results
97 patients had thrombectomy performed for ischaemic stroke in 2021. 34/97(35%) had atrial fibrillation (21/97 pre-existing , 13/97 newly diagnosed on admission). 15/21 were anticoagulated and 6/21 were not anticoagulated at the time of their stroke. 5/6 had a clear reason documented for stopping anticoagulation. One patient had stopped anticoagulation due to cost. Of those with atrial fibrillation who were anticoagulated at the time of their stroke, 11 were anticoagulated with a Direct-Acting AntiCoagulant (DOAC) and four were anticoagulated with Warfarin. Of the Warfarin group, just one patients’ INR was therapeutic at the time of their stroke. Of the DOAC group, all were on the appropriate dose.

Conclusion
Stroke patients requiring thrombectomy are a group who may suffer the largest strokes. Incidence of atrial fibrillation was similar to previous studies. It was encouraging that there was a documented reason for all patients who were not anticoagulated, and that the DOAC dose was appropriate. Issues with therapeutic levels of Warfarin are further highlighted here. This study concludes that we may not be as bad at anticoagulation as we may think.
179 WHAT IS THE RISK OF FALLS DUE TO PSYCHOTROPIC MEDICATIONS IN A LARGE POPULATION-REPRESENTATIVE COHORT OF COMMUNITY-DWELLING OLDER PEOPLE?
Authors: Gallagher E , Mehmood M , Lavan A , Kenny RA , Briggs R 
Published: October 2022

Abstract

Background
Psychotropic medications including antidepressants, anticholinergics, benzodiazepines, ‘Z’ drugs and antipsychotics, are frequently identified as Falls Risk Increasing Drugs (FRIDS), yet there is a relative lack of robust data detailing the prospective risk of falls associated with these drug classes.

Methods
Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) were included and followed from Waves 1 to 5 (Mean 7.6 years follow-up). Incidence of falls was ascertained by self-report and unexplained falls were defined as falls not caused by a slip or trip with no apparent cause. Medication lists were examined for medications of interest. Logistic Regression models, reporting odds ratio with 95% confidence intervals, were used to assess the association between medication classes and incident fall types and were adjusted for relevant covariates.

Results
2,090 participants were included (mean age at baseline 72 years, 53% female). During follow-up, over half of participants (52%, n=1,089) had a fall, with one quarter (25%, n=526) reporting an unexplained fall and almost one fifth (19%, n=394) reporting a fall causing injury. Anti-depressants were associated with an increased risk of falling (OR=3.01, 1.98-4.58, p&lt;0.001), injurious falls (OR=1.96, 1.37-2.81, p&lt;0.001) and unexplained falls (OR=2.71, 1.88-3.91, p&lt;0.001) in fully adjusted models. Anti-cholinergic medications were associated with an increased risk of falling (OR=1.79, 1.11-2.88, p=0.017) and of unexplained falls (OR=1.89, 1.19-3.01, p=0.007). ‘Z’ drugs were associated with an increased risk of falling (OR=2.96, 1.64-5.32, p&lt;0.001) and of injurious falls (OR=2.05, 1.26-3.34, p=0.004). Benzodiazepines and Anti-psychotics were not associated with incident falls in fully adjusted models.

Conclusion
Anti-depressants, anti-cholinergic medications and ‘Z’ drugs are independently associated with an increased falls risk. Given the profound impact falls can have on functional trajectory and quality of life, regular review of ongoing need for these medications should be central to the comprehensive geriatric assessment.
183 DEVELOPING AND FACILITATING ONLINE INTERGENERATIONAL CAFÉS
Authors: Tuohy D , Cassidy I , Carey E , Graham M , McCarthy J , Murphy J , Morrissey K , Shanahan J , Tuohy T 
Published: October 2022

Abstract

Background
Many older people throughout their lives will require nursing care, consequentially most nurses will care for older people during their career. It is important that older people and student nurses are provided with shared learning opportunities so that professional caring partnerships can be nurtured and realised for mutual benefit. Intergenerational projects offer opportunities for intergenerational learning. However, few projects explore student nurse-older person dyads and how these can be integrated within undergraduate pre-registration programmes. This paper describes the development and facilitation of online older person-student nurse intergenerational cafés.

Methods
The project was managed by a design team comprising senior administration, lecturers in BSc Nursing programmes and a lecturer in Design for Health and Wellbeing. The ‘world café’ concept along with values of enablement and participation underpinned the design. The initiative was planned to align with a year three community care module. Regular online team meetings were held to agree the aims and outcomes for student nurse-older person cohorts, decide recruitment strategies, agree the process and format of facilitation. Older people were recruited through retirement, church, volunteer, social and sporting organisations, media and also using snowballing methods.

Results
Both student nurse and older person cohorts were offered support on how to access and participate in the café. Participants attended one of three online cafés hosted through Microsoft Teams. Each café followed the same format: 1) Group meeting convened with all participants; 2) Breakout small group ‘table’ discussions with student nurse-older people participants and design team facilitation; 3) The café was reconvened to whole group meeting where feedback was collated to elicit shared learning.

Conclusion
The initiative proved successful and there is merit in embedding intergenerational cafés into professionally accredited health care programmes. Through sharing life experiences and perspectives, intergenerational barriers can be reduced and new insights developed on person-centred gerontological care.
184 THE EFFECTS OF MEDICINE OPTIMISATION BY A CONSULTANT PHARMACIST IN A 'HOSPITAL AT HOME' SETTING
Authors: Ryan K , Darcy C , Miller-Anderson R 
Published: October 2022

Abstract

Background
Hospital at Home is a rapidly growing initiative whereby patients are offered hospital equivalent interventions at their home. Given that patient numbers under the care of this team are often smaller than those on inpatient hospital wards, there is often more time to develop a personalised approach to medicine optimisation.

Methods
All 42 patients under the care of the local 'Hospital at Home' team had their medication reviewed by the team's Consultant Pharmacist for Older People. Using the STOP START tool with information from patients and carers each patient's medication was optimised.

Results
This data was analysed by a research pharmacist and anticholinergic burden, Eadon score, pill burden, adverse drug events and average direct drug cost savings were identified. All residents had their medication optimised. 5.25 clinical interventions per resident 81% were Eadon Grade 4. Medication appropriateness improved with downwards trend, pre and post intervention. The mean anticholinergic burden reduced to less than 3. (pre 3.63 vs post 2.63). An overall reduction in pill burden; for every 1 drug started 3 drugs were stopped (mean number of drugs 16 vs 13, pre and post intervention respectively). 50% of residents had an adverse drug event (causing harm) identified. Average direct drug costs savings of £385.28 per patient per annum.

Conclusion
This research shows the importance of the role of the 'Consultant Pharmacist for OIder People' in medicine optimisation in the 'Hospital at Home' team. It also highlights the benefit of the 'Hospital at Home' service to facilitate the often time-consuming task of effective medicine optimisation.
185 CURRENT CHALLENGES IN MANAGING MULTIMORBID OLDER PATIENTS WITH ATRIAL FIBRILLATION – A PAN-EUROPEAN PERSPECTIVE
Authors: Lee G , Baker E , Desteghe L , Heidbuchel H , Merino J , Collins R 
Published: October 2022

Abstract

Background
Atrial Fibrillation (AF) is the most common cardiac arrhythmia and associated with a substantial burden to patients and health systems globally and its prevalence is increasing as the population ages.

Methods
An online survey was distributed as part of a Horizon 2020 project (EHRA-PATHS) with the aim of evaluating how AF multimorbidity is currently addressed by clinicians, to characterize the treatment structure and to assess current interdisciplinary management of multimorbid AF. The survey included 21 questions and free-text option for comments on detection, assessment and management of AF-related comorbidities.

Results
A total of 451 responses were received with 339 responses eligible for inclusion with the highest response rate from United Kingdom, Spain and Ireland (n=149, 44%). From all responses, 221 were male (66%), 300 (91.5%) were physicians and 196 (57.8%) were working in academic university teaching hospitals. Half of the respondents managed between 20 to 50 patients per month with multimorbid AF. The survey revealed varying rates of specialist services and referral to these services such as diabetes and heart failure across Europe. Academic university teaching hospitals offered greater numbers of specialist services compared to non-teaching hospitals (e.g. anticoagulation clinic 92 (47%) vs 50 (35%), p&lt;0.03). 67% (n=227) of respondents reported that approximately 40% of patients with multimorbid AF need onwards referral to other specialist clinicians. Barriers to referring to specialist services for AF comorbidities were identified and included lack of integrated care model (n=174, 51%), organisational or institutional issues (n=145, 43%) and issues with patient adherence (n=126, 37%). Respondents identified areas where patient outcomes could be improved: better access to patient lifestyle modifications; improved organisation flexibility to enable innovation; greater access to evidence-based guidelines; and better interdisciplinary collaboration.

Conclusion
The survey demonstrated the need for systematic, integrated management of AF-related comorbidities in older people and the results will inform the next stage of the EHRA-PATHS project.
188 A REVIEW OF THE REABLEMENT PROGRAM WHICH INCLUDES THERAPY ASSISTANTS WITHIN THE AMBULATORY HUB
Authors: Conaty J , Smith B , Sweeney M 
Published: October 2022

Abstract

Background
The Ambulatory Hub for the older person commenced in May 2021 in line with the Enhanced Community Care Implementation Guidance documents. From a client and carer perspective, the hub provides a single point of access and a co-ordinated approach to the client's care needs with a focus on frailty. The Reablement service is provided alongside the Hub team providing a specialist Occupational Therapy and Physiotherapy geriatric assessment. Depending on the outcome of the assessment and needs identified, the client can avail of the Reablement program. Each patient will have an individualised therapy program which is carried out by the therapy assistants in the client’s home. The Reablement program aims to provide care in line with the “Right Care, Right Place, Right Team, Right Time” ethos.

Methods
The charts of 20 clients who completed the Reablement program were reviewed. The data collected included the number of visits by the Occupational Therapist, Physiotherapist and therapy assistants. Feedback from the client and their family was sought and documented.

Results
The results showed that clients received on average 4 Occupational Therapy and 4 Physiotherapy sessions each. The therapy assistants provided on average 15 visits per client to support the implementation of specialist programs developed by the therapy team. The feedback from clients and family was very positive and the following feedback was received “A program like this is a great initiative”, “ It Improved my confidence”, “I’m able to cook my meals for myself again”

Conclusion
The Reablement program with the support of therapy assistants has led to a patient centred service and co-ordinated approach to the care of the client with increased client compliance. A similar service was not available in the community previously. The Reablement program has reduced the need for inpatient reablement beds which was previously the pathway of care for these clients in the community.
190 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): FACTORS ASSOCIATED WITH THE BURDEN EXPERIENCED BY CAREGIVERS OF PEOPLE WITH DEMENTIA
Authors: Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , Power D , O'Shea D , Doyle R , Blake C 
Published: October 2022

Abstract

Background
To date, little research has been carried out exploring the burden experienced by informal caregivers of People with Dementia (PwD). We explored factors that influence the burden experienced by caregivers of PwD over 12 months.

Methods
Fifty-two PwD and their informal caregivers were recruited by convenience sampling to the “CHESS” Study. Data were collected at five time points over 12 months between April 2017 and November 2019. Mixed model analyses were used to investigate associations of caregiver burden (measured by the Zarit-Burden Interview; ZBI) with factors in four domains: 1) Psychological Well-Being (PWB; measures of anxiety, depression, and caregiver distress); 2) Social Capital and Resources (SCR; incorporating access to community-based health services, transportation needs, education level, occupation and living situation of the PwD, and employment status of the caregiver); 3) Physical Fitness and Health (PFH; including the Quantitative Timed Up and Go (QTUG), baseline grip strength, indices of frailty, sensory acuity); and Managing Everyday life with Dementia (MED; incorporating measures of cognition, behavioural disturbances, functional ability, and indices of dependence of PwD.

Results
Across all domains, caregiver burden significantly increased over time (p&lt;0.001) and less burden was experienced by caregivers of older PwD (p&lt;0.05). In PWB, higher caregiver depression levels predicted higher levels of caregiver burden (p=0.033). In the SCR domain, caregivers of PwD who were independent in their transport needs experienced lower levels of burden (p=0.002). No other factors within the PFH or MED domains reached significance in predicting caregiver burden.

Conclusion
This longitudinal analysis elucidates potential predictors of caregiver burden and highlights the need for future research to be carried out in this area. In particular, psychological well-being in caregivers was shown to significantly impact on the experience of burden. Interventions to alleviate caregiver burden should be tailored to include support for psychological well-being.
201 AVAILABILITY AND APPROPRIATENESS OF STROKE SURVIVORS’ FOOTWEAR ON AN ACUTE STROKE UNIT
Authors: Condon M , Hayes H , Wedel U 
Published: October 2022

Abstract

Background
Stroke Survivors (SSs) often present with an increased fall risk due to physical, sensory, cognitive and visual impairments. Footwear has the potential to positively impact the gait and balance of SSs, while poorly fitting or unsupportive footwear is associated with falls. Research to date has focused on older adult populations. Little is known about the type of footwear SSs wear on an Acute Stroke Unit (ASU). The aim of this study was to identify the type and suitability of footwear available to SSs on an ASU.

Methods
Consecutive inpatients (&gt;18) on a 31-bed ASU were assessed on one day in May 2022. Footwear available to SSs was assessed for suitability using the Footwear Assessment Tool, a six-item tool with established inter- and intra-rater reliability. Descriptive statistics were employed to examine results.

Results
In all, 38 pairs of footwear were available to 31 patients with a median age of 72 and 61% (19/31) were male. Two or more types of footwear were available to 29% (9/31) of patients, 61% (19/31) had one type of footwear available, while 10% (3/31) had no footwear. The most common type of footwear were slippers with backs (36%; 14/38) followed by athletic shoes (21%; 8/31) and backless slippers were the last common type (3%; 1/38). Based on the Footwear Assessment Tool, less than half (47%; 18/38) of the footwear available were appropriate.

Conclusion
This study highlights the large number of SSs in an ASU who have inappropriate footwear to support their rehabilitation and safety. Ensuring SSs have suitable footwear is a simple way of promoting safety and improving mobility. Healthcare professions have a responsibility to consider footwear characteristics in the management of SSs. Evidence-based advice to patients and families on safe and appropriate footwear could improve rehabilitation outcomes while minimising falls risk.