bluuebunny/crossref_metadata_2025_split huggingface dataset:
111 THE INFLUENCE OF THE ANDAGO® ON GAIT PARAMETERS AMONG OLDER ADULTS IN THE POST-ACUTE REHABILITATION SETTING: A PILOT STUDY
Authors: Fay A , Synott E , McDaid E , Barrett E 
Published: October 2022

Abstract

Background
Electromechanical devices incorporating body-weight support have been developed to enable a repetitive approach to gait rehabilitation whilst decreasing physical strain on treating therapists. The Andago® gait trainer provides dynamic body weight support for individuals while simultaneously enabling them to walk overground. The purpose of this study was to compare the effect of the Andago® versus conventional overground walking on gait parameters, fear of falling (FOF) and ratings of perceived exertion in a post-acute rehabilitation population.

Methods
Patients undergoing rehabilitation were randomly assigned to the Andago® or conventional walking condition on day one with the alternate testing condition completed on day two. Participants completed a 10-metre walk test where stride length, walking speed and cadence were recorded. Participants then undertook a 20-minute gait re-education session where number of steps, distance walked and number of siting breaks were recorded. Ratings of perceived exertion (BORG) and FOF scores were recorded at minutes 1, 10 and 20.

Results
Twenty-seven participants (mean age 78 (SD 9.2), female 55.6%(n=15)) completed the study. Reasons for rehabilitation included neurological (51.8%; n= 14), orthopaedic (33.3%; n=9) and medical conditions (14.8%; n=4). Forty-four percent of participants (n=12) had a mild cognitive impairment. Body weight support ranged from 10% to 17% (mean 11%, SD 2). No significant differences in the 10-metre walk test were found between conditions. A reduction in the number of sitting breaks (p &lt;0.05) and FOF at minutes 10 (p&lt;0.05) and 20 (p&lt;0.05) was found in favour of the Andago® during the gait re-education session.

Conclusion
Preliminary results suggest the Andago® is a feasible modality for gait re-education in patients undergoing rehabilitation, being at least comparable to conventional overground gait training. A reduction in FOF in patients coupled with decreased physical strain on therapists may provide opportunities for more intensive practice and warrants further investigation.
118 ARE CLIENTS SATISFIED WITH INTEGRATED CARE? CLIENT FEEDBACK ON DISCHARGE FROM A DOMICILIARY-BASED MULTIDISCIPLINARY INTEGRATED CARE SERVICE
Authors: Porter S , Cannon E 
Published: October 2022

Abstract

Background
The Integrated Care Team for Older Persons (ICTOP) team was established in November 2017. The process of client feedback was not developed at this time. Team members received feedback from clients and families in an “ad hoc” basis. There was no formalised method of collecting data. From collating this data in a formal manner, the aim was to evaluate and reflect on the data received to improve on client experience and practice development of the ICTOP Team

Methods
Qualitative study design. The feedback questionnaire was adapted from the Integrated Care Team Older Persons, Community Healthcare East. It is a seven item questionnaire with an additional section for open ended comment and or suggestion for team improvement. A client-feedback form was sent to clients discharged from the ICTOP service during the months January-August 2020 inclusive (n= 97). Completed feedback anonymised forms were received and information collated (n=56). The respondent rate was 57.7%. Thematic analysis was utilised to appraise recurring themes in the open-ended section of the completed forms

Results
All participants agreed that they were satisfied with ICTOP intervention and were involved with decisions regarding their care. 66% of Participants also provided individual comments which were overwhelmingly positive with 7% providing recommendation for service development. All Participants would recommend this team/service to another older person.

Conclusion
Older people accessing integrated care delivered in their home reported a positive experience and appreciated the MDT input. Receiving feedback on the service enables the team to understand the effect and experience of treatment, interventions and interactions with our clients.
119 ENHANCING THE QUALITY OF STROKE CARE IN IRELAND - DEVELOPMENT OF AN IRISH NATIONAL STROKE AUDIT
Authors: Moran CN , Jeffares I , Merriman NA , McCormack J , Harbison J , Sexton E , Williams D , Kelly PJ , Horgan F , Collins R , Bhreacáin M Ní , Byrne E , Thornton J , Tully C , Hickey A 
Published: October 2022

Abstract

Background
Population ageing, stroke treatment advances, changing models of care, and between-hospital heterogeneity in stroke outcomes demonstrate the necessity of continual audit of stroke care to support quality improvement at local and national levels, and to enhance patient recovery and wellbeing. This project aims to identify the core minimum datasets for acute and non-acute stroke care, and Patient-Reported Outcome Measures (PROMs), for integration in to the newly-developed Irish National Audit of Stroke (INAS), in addition to identifying resourcing needs and implementation procedures.

Methods
In Phase 1, a minimum dataset for acute stroke care was identified based on a scoping review of international practice and available guidelines. Phase 2 (ongoing) involves identifying datasets for non-acute rehabilitative and follow-up care based on a scoping review of international practice, iterative cycles of qualitative stakeholder engagement, and systematic review of PROMs. In Phase 3, a review of resourcing and data collection procedures used in stroke audits internationally will be used to produce an implementation strategy for data collection, contextualised to the Irish healthcare system.

Results
Twenty-one eligible international stroke registries were identified from the scoping review. Within Phase 1, core clinical and thrombectomy items in the Irish registry were benchmarked against internationally-collected items to identify common items and to generate an inventory of items that other registries collect that Ireland does not. Based on consensus agreement on the most frequently-occurring international items, as reviewed by key stakeholders, a core minimum dataset for audit of acute stroke care was delivered.

Conclusion
These minimum datasets shall act as the “gold standard” for evaluating stroke care in Ireland, by not only incorporating structure, process, and care quality outcome indicators, but also PROMs. The resultant datasets may inform policy and quality improvement initiatives, and shape health service delivery across the trajectory of stroke care, from hyper-acute care, to rehabilitation, and return to the community.
121 INVESTIGATING THE RELATIONSHIP BETWEEN PROBABLE SARCOPENIA AND ORTHOSTATIC HYPOTENSION: FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: Duggan E , Murphy CH , Knight SP , Davis JRC , O'Halloran AM , Kenny RA , Romero-Ortuno R 
Published: October 2022

Abstract

Background
Sarcopenia and Orthostatic Hypotension (OH) are emerging age-related health burdens associated with adverse outcomes including falls and functional decline. Despite a possible pathophysiological link, the association between the two disorders is not well established. We sought to further investigate this relationship in The Irish Longitudinal Study on Ageing (TILDA).

Methods
Data from 2,858 participants at wave 3 of TILDA was analysed. Probable sarcopenia was defined as per the European Working Group on Sarcopenia in Older People revised cut-offs: Hand-Grip Strength (HGS) &lt;27kg in men, &lt;16kg in women and/or five-chair stand test (5CST) time &gt;15s. Participants underwent an active stand orthostatic test with non-invasive beat-to-beat blood pressure monitoring. Multivariable logistic regression models adjusting for age, sex, anthropometrics, cardiovascular diseases, medications and fear of falling were used to determine whether probable sarcopenia was a predictor of OH at multiple time-points after standing.

Results
In multivariable analysis, HGS was an independent predictor of OH at 30s, 40s, 60s (P&lt;0.01), 120s and 180s (P&lt;0.05) but not initial OH at 10s or 20s (P=0.531, 0.464) or consensus OH (P=0.064). 5CST time was only associated with OH at 120s (P=0.030). At follow up in wave 5, four years later, those with HGS-defined probable sarcopenia had higher proportions of recurrent falls (10.5% vs 5.7%, P = 0.014), fear of falling with activity limitation (12.4% vs 6.9%, P = 0.011), hospital admission (24.2% vs 12.5%, P &lt; 0.001) and death (4.8% vs 1.9%, P = 0.006) when compared to the non-sarcopenic group.

Conclusion
Probable sarcopenia as measured by HGS, but not 5CST time is an independent predictor of orthostatic hypotension, especially in the blood pressure recovery phase 30-60s after standing. The increased rates of adverse outcomes in this group underline the importance of identification of probable sarcopenia in those at risk of OH and falls.
123 LEVELS OF PHYSICAL PERFORMANCE AND PHYSICAL ACTIVITY IN OLDER ATTENDEES AT A BONE HEALTH CLINIC
Authors: McDonagh L , McCarroll K , Lannon R , Cunningham C , Connolly K , Murphy N , Horgan F 
Published: October 2022

Abstract

Background
Osteoporosis and sarcopenia are two common conditions seen in community-dwelling older adults. Limited information on physical performance and activity exists in older adults at risk of osteo-sarcopenia. The aim of this study was to examine levels of physical performance and physical activity in patients attending a bone health clinic.

Methods
A cross-sectional study was conducted. Community-dwelling older adults attending a bone health clinic in an acute Irish hospital were invited to participate. Primary outcome measures for physical performance and activity were: grip strength, the Short Physical Performance Battery (SPPB), the Timed Up and Go test (TUG) and the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included: Bone Mineral Density T-scores, diagnosis of probable sarcopenia, osteo-sarcopenia, frailty, fractures and falls history.

Results
104 participants took part in the study. Median age was 76 (IQR 12), ranging from 65 to 91 years. Females accounted for the majority (88.5%) of recruited participants. Osteoporosis was present in 63% and osteopenia in 31%. Low physical activity levels were identified in 29%. Probable sarcopenia ranged from 17 to 37%. Osteo-sarcopenia was identified in 9 to 33% depending on four possible definitions. The most common associations with osteo-sarcopenia were frailty (CFS) and low BMI. Using reduced multivariate regression analysis, physical performance (grip strength, SPPB, TUG) and physical activity (IPAQ) were negatively associated with increased age, comorbidities, frailty and falls. Increased age was associated with all four variables analysed. Comorbidities was associated with grip strength (p=0.005), SPPB (p=0.01), TUG (p=0.041). Frailty (CFS) was associated with SPPB (p&lt; .001), TUG (p&lt; .001), and IPAQ (p&lt; .001). Fall(s) history was associated with SPPB (p&lt; .001) and TUG (p=0.028).

Conclusion
A high proportion of participants were classified as having osteoporosis, probable sarcopenia and osteo-sarcopenia. Completing physical performance and activity measures could provide useful information to clinicians about patients and their potential risks/deficits.
131 USE OF FDG-PET BRAIN IMAGING IN THE DIAGNOSIS AND MANAGEMENT OF DEMENTIA IN A UNIVERSITY HOSPITAL
Authors: Marks E , Doyle K , Magennis B , O'Connell M , McGreevy C 
Published: October 2022

Abstract

Background
Neuroimaging is an increasingly important tool dementia work-up. Subtype diagnosis helps predict the course of the disease, aiding prognostication and management. Amyloid-beta peptide is intrinsic to the pathogenesis of Alzheimer’s disease (AD), forming characteristic neuritic plaques which can be imaged in vivo on positron emission tomography (PET) scans. NICE recommendations advise use of PET imaging if dementia sub-type diagnosis is unclear and AD is suspected. We sought to establish the referral patterns for FDG-PET brain scans for patients aged 60 and over in a university hospital and to establish whether this imaging modality contributed to a change in diagnosis or treatment.

Methods
Requests for FDG-PET CT brain from 2019 – 2022 were retrospectively reviewed. Information was obtained from clinical notes and patient information software. Patient demographics, indication for scan, source of referral and whether imaging results led to a change in diagnosis or treatment was recorded.

Results
A total of 32 patients were reviewed, with a mean age of 65 years (13 females; 41%). We further analysed the 25 who were aged over 60; this subgroup had a mean age of 70 (9 females; 36%). All 25 patients were appropriately referred to assess for dementia subtype. A revision in diagnosis based on PET imaging was made in 17 (68%) cases. In 9 (30%) cases, results prompted change in dementia-specific pharmacological treatment, including donepezil and memantine. A further 6 (24%) had pharmacological treatment for non-cognitive symptoms of dementia adjusted, such as anti-depressants or anti-psychotics. The majority of referrals had come from neurologists (n = 15; 60%) rather than geriatricians (n = 10; 40%). The final diagnosis was AD in 12 cases (48%) and fronto-temporal dementia in 3 cases (12%).

Conclusion
PET scans are a useful functional imaging modality which can help to differentiate dementia subtypes and influence management.
133 A CO-ORDINATED EFFORT: THE ADDITION OF A REHABILITATION COORDINATOR TO GERIATRICIAN LED OLDER PERSONS REHABILITATION SERVICES
Authors: McDaid E , Boyle N , Cogan L , O'Shea D 
Published: October 2022

Abstract

Background
It is well recognised that acute illness and hospitalisation can be associated with significant deterioration in mobility and function in older people. Flow to appropriate rehabilitation services has impacts not only on individual recovery but also in efficient utilisation of healthcare resources. This study describes the impact of a therapy trained Rehabilitation Coordinator (RC) on access to off-site inpatient and day hospital specialist rehabilitation services.

Methods
Over 6 months the rehabilitation coordinator collaborated with acute and community services to triage, assess and effectively utilise off-site specialist rehabilitation services with specific reference to role development, feasibility and safety. Key performance indicators measured included assessments completed, time from referral to assessment, time from accepted to transferred, number of admissions and length of stay. This data was compared against a 6-month control.

Results
The rehabilitation coordinator was involved in over 445 assessments (n=258 patients) in the 6 months of the study. Trusted assessment by the RC was assessed as equivalent to assessments completed by Consultant Geriatricians. COVID restrictions resulted in a reduction in available rehabilitation beds between the control and pilot periods. There was a 22% increase in rehabilitation admissions and a 63% reduction in mean length of stay during the pilot period. There was also a reduction in average time from referral to assessment (1.5 working days versus 5.6 workings days); and time to transfer to rehabilitation (2.1 days versus 6.7 days). New pathways of care developed included rapid access to day hospital care from acute inpatient care. Additional benefits were seen in RC-led education, quality improvement and research projects.

Conclusion
The addition of a rehabilitation coordinator enhanced patient access to and progress through inpatient and outpatient older person’s rehabilitation services. The RC provided both oversight and continuity of care throughout the patient journey between hospital and home.
134 ADULT SAFEGUARDING, HUMAN RIGHTS AND PEOPLE LIVING WITH DEMENTIA IN NURSING HOMES: CO-PRODUCING RECOMMENDATIONS FOR BEST PRACTICE
Authors: Donnelly S , Brennan HR , Quinlan K , O'Shea J , Quaid K , Golden F , Keating M , Mackall S , Parfitt R , Paley G 
Published: October 2022

Abstract

Background
People living with dementia (PLwD) in nursing homes have the right to be safe and to live a life free from harm and abuse; all persons are entitled to this right, regardless of their circumstances or where they live. PLwD are at greater risk of abuse and neglect than those without a diagnosis. Such abuse often goes unnoticed, because dementia may affect a person’s ability to recognise abuse or to report it. In 2021, the Alzheimer Society of Ireland’s Irish Dementia Working Group (IDGW) commissioned the development of a briefing paper to outline the key issues relating to upholding the human rights and safeguarding of PLwD in nursing homes including concrete recommendations for policy and practice.

Methods
A scoping review of the existing literature on this topic was carried out. This was supplemented by adopting a snowball strategy to identify additional relevant literature. Three co-design online sessions were convened with members of the IDWG in order to discuss and agree on the general content and members also provided suggestions for additional research or policy papers that should be included. Co-design sessions were also used to brainstorm and reach a consensus as a group on recommendations.

Results
This project identified a number of specific risk factors for PLwD, including organisational abuse, the need to move towards a restraint-free environment, addressing barriers to reporting of abuse and promoting agency and autonomy within safeguarding processes. A number of policy and legislative gaps in our current adult safeguarding framework were identified making it more difficult to adequately protect PLwD in nursing homes.

Conclusion
22 recommendations for best practice were developed by the IDWG for nursing home service providers (public and private), health and social care practitioners, policymakers, the Department of Health, HIQA and political representatives in order to collectively advocate for meaningful change.
135 A FEASIBILITY STUDY TO EXPLORE THE ROLE OF EXERCISE AND PROTEIN SUPPLEMENTATION TO TARGET FRAILTY IN PEOPLE EXPERIENCING HOMELESSNESS
Authors: Kennedy F , Romero-Ortuno R , Cheallaigh C Ní , Doyle S , Broderick J 
Published: October 2022

Abstract

Background
People who are homeless are more likely to experience poor health with acceleration of ageing commonly reported. The concept of frailty is related to age acceleration and research has shown that appropriate exercise and nutritional supplementation strategies can delay or even reverse frailty. This has not been tested in the homeless population. The aim of this study was to explore the feasibility and preliminary efficacy of an exercise intervention with protein supplementation to target physical functioning deficits and frailty in people experiencing homelessness.

Methods
A low-threshold, 'drop-in' exercise programme with protein supplementation was delivered once weekly for 16 weeks. The main recruitment site was a day-service centre for people who are homeless and have addiction issues. A one-day programme was also delivered to a connected female-only centre to offer a more inclusive service. Primary outcome was feasibility, which included recruitment and retention of participants. Secondary outcomes included frailty and nutritional status, physical function and self-reported pain.

Results
Thirty-one participants were recruited, 13 of whom were aged over 50 years. Of these older participants, there was a 100% retention rate to the main recruitment centre, with at least one repeat visit to the exercise intervention. The majority of the older participants presented as frail (6/13) or pre-frail (3/13), with 4/13 non-frail. One of these participants was malnourished, six were at risk of malnourishment and six had normal nutritional status. The possible presence of sarcopenia (eight or less on the Short Physical Performance Battery) was noted in 3/13 of participants. The majority of participants (10/13) reported chronic pain.

Conclusion
This study highlights a high level of frailty and poor physical and nutritional health in older people experiencing homelessness. High retention indicates interest in this intervention. There is a need to establish and roll out targeted interventions to optimise outcomes for this socially excluded group.
136 DIABETES IS ASSOCIATED WITH IMPAIRED PERIPHERAL AND CEREBRAL HAEMODYNAMIC RESPONSES IN OLDER ADULTS
Authors: Hernandez B , Dyer A , Nipoti B , McCrory C , Briggs R , Kennelly S , Finucane C , Romero-Ortuno R , Reilly R , Kenny RA 
Published: October 2022

Abstract

Background
Diabetes is associated with slower gait speed and adverse brain health outcomes in older adults. However, the putative mechanisms underlying these associations remain poorly explored. One such mechanism is via altered cerebral perfusion, which may represent an important intermediate phenotype in the association between diabetes and slower gait. We assessed the impact of diabetes on peripheral and cerebral haemodynamic responses during active stand as part of The Irish Longitudinal Study of Ageing (TILDA).

Methods
We assessed: (i) peripheral haemodynamic responses (heart rate, blood pressure, cardiac output) using finometry and (ii) Tissue Saturation Index (TSI) using Near-Infrared Spectroscopy (NIRS) during active stand in older adults.
Function-on-scalar regressions were used to model the impact of diabetes on the dynamic response to standing. Subsequently, multivariable linear models were used to model usual gait speed.

Results
Of 3,011 older adults (mean age: 64.2; 55.2% female) completing active stand, diabetes (n =193, 6.4%) was associated with significantly higher heart rate (mean 3.2, s.e. 0.02 bpm), higher cardiac output (mean 0.16, s.e. 0.04 L/min) and lower systolic blood pressure (mean –6.9, s.e. 1.8 mmHg) during standing. Additionally, diabetes was associated with significantly lower TSI from 10 seconds post-stand (mean –1.2%, s.e. 0.49%). Associations persisted following robust covariate adjustment. Diabetes was associated with significantly slower gait speed (-5.3 cm/s, CI (-8.4,-2.1)). In analysing the relationship between cerebral perfusion and gait speed, poorer recovery of TSI at 60-120 seconds post standing was associated with slower gait speed (0.53 cm/s slower gait speed per unit increase in TSI, p = 0.007).

Conclusion
Diabetes is associated with impaired peripheral and cerebral haemodynamic responses in addition to slower gait speed in community-dwelling older adults. Neuro-cardiovascular instability and altered cerebral perfusion may represent an important intermediate phenotype between diabetes and adverse health outcomes in older adults.