bluuebunny/crossref_metadata_2025_split huggingface dataset:
181 UNDERSTANDING OLDER ADULTS’ PERCEPTIONS AND EXPERIENCES OF NOVELTY: A PILOT STUDY
Authors: Tsabary C , Hopper L , Kilcullen S , Gallagher P 
Published: October 2022

Abstract

Background
Our institution is currently developing a technology solution to support adults to live well at home for longer. As the system develops, there is an emerging emphasis on strict structure/routine in older adults’ activities of daily living. In contrast, engagement in novel experiences is widely endorsed as a buffer against cognitive decline. Despite this, there is scant research into the perceptions and experiences of novelty in older adults. Understanding older adults’ views on novelty is necessary to inform the advancement of the current project.

Methods
A multiple-methods, exploratory approach was used. A 90-minute focus group was held with 4 older adults to explore their conceptualisations of novelty, discussing what constitutes a novel experience and gauging the value placed on routine and novelty in daily life. Questionnaires measuring Mental Well-Being (MWB), personality, Novelty-Need Satisfaction (NNS), and preference for routine were subsequently completed by each participant.

Results
Four main themes emerged from the qualitative data. They comprised the contrast between planned and unplanned novel experiences, the influence of context on the enjoyment of novelty, the value of the vicarious experience of novelty and the challenge associated with change at a social/global level. The quantitative data revealed that 91.9% of the variation in MWB is attributed to its relationship with NNS.

Conclusion
The focus group served as a strong foundation; especially into the contextual influence of both internal (psychological/attitude-related) and external (environmental/social) factors upon the enjoyment of novelty; as well as indicating that further research is merited into the contrasting views on planned and unplanned novel experiences. The quantitative data corroborate the importance of maintaining novelty in older age. Understanding how to preserve novelty while supporting routines will allow assistive technology projects such as this, to adopt a holistic approach and encourage consideration for this aspect of life, often neglected in the lives of older adults.
186 FRAILTY IN HOSPITALISED OLDER ADULTS AND THEIR SPOUSES: A CROSS-SECTIONAL STUDY
Authors: Pelow L , French H 
Published: October 2022

Abstract

Background
Hospital admissions are a critical time-point for assessing frailty. Frail older adults have high utilisation of healthcare resources and many require on-going care. Often spouses provide this care, however caregiving can lead to increased frailty in the caregiver. A description of frailty and caregiving within marital dyads has not been explored previously, in relation to hospital admissions.

Methods
Aim: To measure the frequency and describe the characteristics of frailty in hospitalised older adults and their spouse. Objectives were to: (1) Describe frailty, physical and cognitive performance in patients and spouses; (2) Determine frailty correlations between dyads; (3) Establish if patients are more likely to have spouses of the same frailty classification; (4) Describe caregiving within the context of frailty. Participants were recruited from geriatric and stroke services from October 2019-March 2020. Fried Frailty Phenotype (FFP) was used to test frailty. Clinical Frailty Scale, Grip Strength, Montreal Cognitive Assessment, Timed Up and Go, Geriatric Depression Scale and self-reported: mobility status, caregiving status, number of falls and number of hospital admissions were also assessed to describe the population.

Results
Data from 27 dyads that participated and consented were analysed using SPSS. A total of 15 patients (55.5%) and four spouses (14.8%) were classified as frail. Of 15 frail patients, four had frail spouses, five had pre-frail spouses and six had robust spouses. No pre-frail or robust patients had frail spouses. Spearman’s Correlational analysis showed no correlation in FFP between patient and spouse (r=0.24, p=0.23). Participants that provided care (44.4%) accounted for 5 patients (frail n=4) and 19 spouses (frail n=4).

Conclusion
Frailty in dyads is heterogeneous. Caregivers are commonly frail and provide care to frail partners. Older adults admitted to hospital should be assessed for frailty. If the patient has a spouse, especially if the patient is frail, their spouse should be assessed for frailty.
187 ‘OUR LANGUAGE’: AN INITIATIVE TO RAISE STAFF AWARENESS OF THE IMPACT OF OUR CHOICE OF WORDS ON PATIENTS
Authors: Staveley R , Armstrong E , Barry E 
Published: October 2022

Abstract

Background
In a hospital specialising in older persons’ rehabilitation, the Speech & Language Therapy team (SLT) commenced an initiative to raise awareness of the impact of all staff’s language on patients. Our language can either support or undermine patient well-being. Supportive language is easy-to-follow, everyday English and respects each person’s autonomy (‘Would you like help to eat?’). Unnecessary jargon or impersonal words can be undermining (e.g. ‘He needs supervision with feeding’). This is supported by national and international guidance tools such as the online ‘Plain Language Style Guide’ by the Health Service Executive Health Promotion Unit and National Adult Literacy Agency.

Methods
Quality improvement methodology was adopted to facilitate an ongoing, flexible approach. SLT delivered pilot workshops on person-centred language to ward staff. Afterward, staff spent a week self-identifying examples of language that could be improved during their work day. Examples were collated and presented back to teams. Online feedback surveys were conducted. Trolley rounds were then rolled out with quiz-style exercises to raise staff awareness across the hospital. Examples of person-centred language generated by staff were shown on rolling videos in key areas across the hospital.

Results
Staff engaged actively in workshop and trolley activities generating a range of examples of more person-centred language. Surveys revealed a new awareness of the need to adapt our language. Several months later, staff continue to demonstrate increased vigilance with their choice of words and regularly consult SLT for advice on language in clinical sessions, documentation or signage. There is still room for improvement in the language used in other areas such as Care Planning Meetings and clinical documentation.

Conclusion
This initiative has started to increase staff awareness of the importance of our choice of words to patient well-being. With the support of hospital management, this initiative will be continued, reviewed and reported on a rolling basis.
203 TRANSITIONS TO LONG-TERM CARE: EXPERIENCE OF A COHORT OF COMMUNITY-DWELLING OLDER ADULTS RECEIVING INTEGRATED CARE
Authors: Mahon CM , Dunne A , Garcia R , Martin R , Kennelly SM 
Published: October 2022

Abstract

Background
Data from the Nursing Home support scheme 2018 (NHSS) shows the majority of applications to the NHSS come from acute hospitals (44%) followed by referrals from the community (38%). We examined this transition in a cohort of community dwelling older adults to assess how many transition from home to nursing home and, when admission to nursing home from hospital occurred, the indications for same.

Methods
Retrospective examination of Integrated Care Team (ICT) and Acute Hospital data from 2019 in respect of a cohort of older adults. Transitions in care to nursing home including residence at time of admission, last acute hospital presentation prior to nursing home admission and commencement of NHSS application recorded.

Results
319 patients referred to the integrated care service in 2019, average age 81 and 58% female, predominantly from outpatient clinics in the Medicine for the Older Person’s service. 47 patients had moved to nursing home; within this cohort 14 (29.7%) transitioned from home, 28 (59.6%) transitioning after acute hospital admission. Main reasons for presentation to hospital were: Intercurrent acute illness (n=11); Falls (n=6); progression of dementia (n=4). Fair Deal application commenced in community by ICT in 20 of the 47 (42.5%) patients including 8 of 28 patients (28.5%) admitted to hospital prior to moving to nursing home.

Conclusion
This preliminary evaluation highlights the importance of advance care planning in this population when acute hospital admissions can be difficult to predict. Involvement of the ICT can help this transition and lead to shorter hospital stays.
212 FATIGUE EXPERIENCED BY ADULTS WITH LONG-COVID WAS NOT ASSOCIATED WITH AN EMG-DERIVED MUSCLE FATIGUE INDEX
Authors: Xue F , Duggan E , Jennings G , Monaghan A , Romero-Ortuno R 
Published: October 2022

Abstract

Background
One of the most prominent challenges of the COVID-19 pandemic is the emergence of the post-COVID-19 syndrome or ‘long-COVID’ following the acute phase of the viral infection. With a plethora of debilitating symptoms across many physiological systems, the pathophysiology of long-COVID remains elusive and subject of intense research efforts. Adults with long COVID are often affected by prolonged fatigue, which could be linked to neuromuscular function impairment. We hypothesised that there might be a correlation between subjective fatigue and an Electromyograph(EMG)-derived muscle fatigue index in adults with long-COVID.

Methods
As part of a neuro-cardiovascular instability assessment protocol, participants were asked to squeeze the thigh muscles as hard as possible for ten seconds during both supine resting and after active and passive standing (head-up tilt) tests. Surface EMG was used to capture on each leg the physiological activity of the vastus lateralis and rectus femoris during the squeezes, from which the muscle fatigue index was computed based on both the mean and median frequencies of each 10-second maximum prompted muscle contraction. Using two-sided Spearman correlation coefficients, we examined the associations between the muscle fatigue indices and self-reported fatigue measured by the Chalder Fatigue Scale (CFQ).

Results
108 participants were included, 77 female and 31 male, with a mean age of 46 (range 25-78) years, 22% of whom were hospitalised in the acute phase of SARS-CoV-2 infection. Strong intercorrelations were found between the muscle fatigue indices derived from the mean and median frequencies of thigh muscle contractions. However, no significant correlations were detected between the muscle fatigue indices and CFQ scores.

Conclusion
Self-reported fatigue as measured by the CFQ was not associated with an EMG-derived muscle fatigue index in this long-COVID cohort.
215 WHAT VALUE DOES OCCUPATIONAL THERAPY ADD TO THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE?
Authors: Davis AJ , Delaney A , Doyle C , Sweeney A , Nally SM , Namara RM 
Published: October 2022

Abstract

Background
The EDITH team has provided an alternative care pathway for older adults with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation.

Methods
To assess consistency in OT practice and assessment, an audit was completed of OT logbooks and electronic patient data. Paper count method was used. Data gathered with regards to OT process and assessment.

Results
100% of patients had at least 1 type of OT assessment (e.g functional, home environment, falls prevention, cognitive etc), 80% had at least 2 and 43% had 3 or more types of OT assessments. 100% of patients had Clinical Frailty Scores completed, 100% had their living situation and level of care supports assessed and documented. 43% of patients received onwards referrals to community supports, day hospital, voluntary supports etc.

Conclusion
The OTs complete a thorough and multifactorial assessment of the older adult within the context of their home environment. This holistic assessment approach adds significant value to the overall EDITH assessment and service. It also ensures appropriate and relevant onwards referrals are completed. It is imperative to ensure value for money with regards to health care services. In line with the HSE “Value Improvement Programme” it is timely to review OT services and ensure they are delivering consistent, high quality and high value services for our stakeholders.
219 A SOLITARY AWARENESS - PROFILING TIME TO RECOGNITION OF MEMORY LOSS IN A TERTIARY MEMORY SERVICE
Authors: McHale C , Dookhy J , Dolphin H , Fallon A , O'Toole R , Merron G , Kennelly S 
Published: October 2022

Abstract

Background
Approximately 64,000 people live with dementia in Ireland with expected increases to 150,000 by 2045. Best practice recommends that patients benefit from timely diagnosis. Whilst the presence of cognitive impairment should prompt early referral for diagnostic clarity, patients frequently present with well-established symptoms. In order to understand this phenomenon it is important to understand the way in which symptoms are recognised by the person, companions and casual observers.

Methods
A chart review was carried out on a convenience sample of patients (n=61) diagnosed with dementia where scores were available from Clinical Dementia Rating Scale (CDR) and AD8. Data extracted included global scores and answers to direct questions regarding symptom recognition by patient and companion. Diagnosis was confirmed using the Electronic Patient Record.

Results
Mean age was 75 (range 57-87). Diagnostic breakdown comprised: Alzheimer Dementia (AD) in 67% (n=41), mixed AD/Vascular Dementia (VaD) in 19.6% (n=12); behavioural variant Fronterotemporal Dementia (bvFTD) in 1.6% (n=1), Dementia with Lewey Bodies (DLB) in 1.6% (n=1), Primary Progressive Aphasia (PPA) in 4.9% (n=3), Primary Parkinson’s Dementia (PPD) in 1.6% (n=1) and VaD in 1.6% (n=1). Average CDR Global Scale was 1.0 and average AD8 score 6/8. Family noticed symptoms of dementia an average of 12 months longer than the person themself. The incidence of anosognosia was 19% (n=12) and associated with a diagnosis of AD (91.6 %, n=11). Where anosognosia existed, symptoms of memory loss had been identified by family up to 60 months before diagnosis, with average time to recognition of 24 months. For 75% of this anosognosia group, family reported indiscernible symptoms on casual inspection (n=9).

Conclusion
Where symptoms of memory loss go unrecognised by patients and casual inspection, family may notice changes for up to five years. It is important to educate and empower the public regarding the benefit of a timely dementia diagnosis. Education should focus on supporting family to navigate sensitive conversations in the event of anosognosia and explore ways in which they might encourage timely review.
223 READMISSION POST STROKE: RATES AND REASONS FOR READMISSION IN THE 18 MONTHS FOLLOWING HOSPITAL DISCHARGE
Authors: Hobson H , Cogan N , Dunne S , Collins R , Ryan D 
Published: October 2022

Abstract

Background
The Irish healthcare system faces the same challenges presented to healthcare systems worldwide, ageing populations and the increasing disease burden from chronic conditions. There is a need to respond to and meet these challenges placed on an already pressurized healthcare systems originally set up to respond to acute, episodic care. It would be beneficial to review reasons for unplanned readmissions post stroke to examine whether these readmissions could be predicted, targeted and prevented and whether there are individuals who could be targeted for intervention post hospital discharge, to reduce readmission rates post stroke.

Methods
Using data from the Hospital In-Patient Enquiry (HIPE) patients were identified who had been discharged with a primary diagnosis of stroke. Data was then examined to identify whether these patients had acute hospital readmissions in the 18-month period following discharge for stroke. Using HIPE and patient discharge letters we identified the reasons for these readmissions and categorized them accordingly.

Results
A total of 224 live stroke discharges were identified from 2018. 77 patients were readmitted within 18 months of discharge. In total these 77 patients accounted for 139 admissions. Of the 77 patients that were readmitted average Length of Stay (LOS) was 19 days. Of the 77, 12 were due to recurrent stroke while 49 presented with a new complaint that fell into one of the following four categories, pneumonia, falls/fractures, dementia related, medical complications/medication related

Conclusion
There is a need to identify the unmet needs of stroke patients post hospital discharge so as to reduce the number of readmissions. This would involve screening to identify those suitable to attend a specialist multidisciplinary six-month review clinic where these patients could have onward referral to the appropriate in hospital and community services including intensive dysphagia clinics, therapy-lead spasticity clinic, upper limb rehabilitation programmes, and medical social work support for unmet needs with links to the community.
224 “OLDER PEOPLE WANT TO BE IN THEIR OWN HOMES”: THEMATIC ANALYSIS- PATIENT AND CARER FEEDBACK AFTER PATHFINDER EMERGENCY CALL RESPONSE
Authors: Bernard P , Corcoran G , O'Brien C , Ward P , Kenna L , Laura H , Mooney R , Howard W , Horgan F , Malone A , Masterson S 
Published: October 2022

Abstract

Background
Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is a growing evidence base for alternative care pathway models at the time of a low acuity emergency medical services (EMS) call. Previous research has found a high level of patient satisfaction with the Pathfinder model, in which an Advanced Paramedic and a Physiotherapist or Occupational Therapist respond to EMS calls [1]. However, the reasons underpinning this from a patient perspective have not previously been reported.

Methods
This is a qualitative study employing thematic analysis of open-ended responses recorded in 429 telephone interviews with service users (patients or their next-of-kin), who had been attended by the Pathfinder service following an EMS call.

Results
Five primary themes were identified: (1) the professionalism of the interdisciplinary clinical team; (2) “the right service, in the right place at the right time”; (3) the role of Pathfinder in “getting the ball rolling” through following up and co-ordinating referrals and services; (4) the lasting impact of the experience on the patient and their next-of-kin; (5) the value of skilled communication with the older person, as well as smooth and “tuned-in” communication across the team.

Conclusion
Older people voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be assessed and treated in their homes at the time of an EMS call rather than automatic conveyance to the ED. They recognised the value of a skilled interdisciplinary team, with a follow-up service, that effectively positions itself between the acute hospital and community services.

Reference
1. Bernard P, Corcoran G, Kenna L, et al. Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis. Age Ageing 2021; 50(5):1854–1858.
225 OLDER PERSONS REHAB AT HOME (OPRAH) INDICATES AN EFFECTIVE ALTERNATIVE PATHWAY TO INPATIENT REHABILITATION
Authors: Coen M , Murphy R , Connolly A , O'Connor A , Doyle E , Byrne S , Carty J , Breen C , Canavan M , Waters R , Robinson S 
Published: October 2022

Abstract

Background
Older adults have longer hospital stays, higher incidence of nosocomial complications and higher readmissions rates. Older persons rehabilitation at home (OPRaH) is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. OPRaH offers a comprehensive geriatric and interdisciplinary approach. The model enables a safe and accelerated discharge from acute care to home.

Methods
Patients are identified and screened by a team coordinator. On Discharge to OPRaH the following measures were collected; basic demographics, referral source, clinical frailty score and Functional Independence Measures (FIM). Outcomes evaluated are the FIM change, readmission rates, length of inpatient stay savings and time on the service. Data from the first year of operation was analysed using descriptive statistics.

Results
109 patients have undergone rehabilitation with the service with a median age of 82 years (63-103 range). Over two thirds (68%) were classified as frail, with 44% living alone. An injurious fall was the most common reason for index hospitalisation (50%). Referral source was inpatient acute medical team in 50% of cases, with 21% from acute geriatrics , 13 % ortho geriatrics, 13% surgical. Average functional independence measure scores improved from 89 to 102 (p = 0.007). There was no difference in the magnitude of improvement by frailty status (13 vs 14, p = 0.85). The average length of stay saving was 7 days per case, with a total of 757 days saved in one year. Readmission rate within 30 days was 9.3 %. Participants highly rated the service through structured evaluation.

Conclusion
This novel service provides a valuable intervention to a wide case-mix of older adults with evidence of improvements in formal markers of functional impairment after intervention. Referral was based on definable rehabilitation goals and not just on frailty status, age, or gender.
227 UNSCHEDULED ACUTE HOSPITAL ADMISSIONS FROM A COMMUNITY REHABILITATION TEAM – GERIATRIC GIANTS OR “ACOPIA”?
Authors: Synnott P , Alookaran S , O'Malley G , Hickey P , Drumm B , O'Sullivan F 
Published: October 2022

Abstract

Background
The Integrated Care Team (founded 2018) provides community rehabilitation in the home for frail older adults. Frail older adults are at increased risk of hospitalisation, and frailty is associated with increased length of stay and mortality. This retrospective cohort study aims to explore the acute hospital admissions of this frail cohort from July 2019 to December 2021.

Methods
Patients were identified from the integrated care team database who had a discharge destination of “Acute Hospital”. Hospital IT system data and discharge summaries were used to analyse inpatient Length of Stay (LOS), presenting complaints and discharge diagnosis. The study period was from July 2019 to December 2021.

Results
67 patients were admitted to hospital during the study period from the care of the integrated care team, accounting for 98 individual hospital admissions. This accounted for 19.8% of discharges from the team during the study period, with 77% of patients discharged to community support. 23.8% of patients (n=16) had multiple admissions, with the majority of these(n=14) admitted twice. The average age of patients was 82.6 years. 58% of admitted patients were female. The longest LOS was 99 days, and shortest less than one day. The average LOS was 12.9 days for the total population. Excluding two outlier stays of 99 and 82 days, the average LOS was 11.27 days.
32% of patients presented with functional decline, 28% with falls, 18% with shortness of breath and 19% with delirium. Infections were diagnosed in 28% of patients, neurological events in 12% and bleeding diagnoses in 11% of patients. 1 patient died during admission. Only 12.2% of stays (n=12) were less than 72 hours in duration.

Conclusion
This frail patient cohort presented with a range of frailty syndromes and complications of medical comorbidities. The low prevalence of short hospital stays may reflect the ongoing role of the community team supporting patients in the community.