bluuebunny/crossref_metadata_2025_split huggingface dataset:
231 NURSING HOME RESIDENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH FALLS
Authors: O'Connor A , Fallon A , Noonan C , McElwaine P , Kennelly S 
Published: October 2022

Abstract

Background
Nursing Home Residents (NHR) are the most-frail group of older persons, with many comorbidities that increase their risk of falling. Falls are a frequent reason for ED attendance by NHR’s as it is for all older persons, but little is reported on their characteristics and outcomes specifically.

Methods
A prospective cohort study of all NH presentations with falls to the ED of a university teaching hospital over a one-year period. Detailed operational and clinical phenotype characteristics, and outcomes were recorded in all instances.

Results
There were 519 ED presentations by 344 NHR over one year. Almost half of all presentations (48.2%, 250/519), were as result of a fall, by 172 residents. The majority were female (137/250, 55%), with an average age of 77.8 years (±10.8). Many, 84.3% (145/172), had a prior fall in the past six-months. Almost half had a diagnosis of dementia (124/250, 49.6%). A third mobilised with a Zimmer-frame (83/250), and 10.8% (27/250) wheelchair. 33.2% (83/250) had visual impairment. The mean Barthel Index was 9.55 (±5.12) indicating high-dependency. NHRs fallers frequently attended ED outside routine working hours, with 36.8% (92/250) and 27.6% (69/250) presenting after 5pm (Monday to Friday), or at the weekend respectively. 54.8% of patients were admitted (137/250), and only 25.6% of patients had review by a GP prior to ED-referral (64/250). The average Length Of Stay (aLOS) for admitted NHR fallers was 10.4 (±9.1) days. Injurious falls were noted in only 10.4% (26/250) presentations. aLOS for those admitted with documented injuries (14/26, 54%) was 5.0 days (±7.0, n=14).

Conclusion
NH residents have complex clinical needs and falls is a frequent reason for attending ED. Better access to “out of hours” clinical support within the NH, and better integrated falls prevention programmes/ care pathways between NHs and primary/secondary services are necessary to enhance care and optimise falls prevention.
237 POTENTIALLY INAPPROPRIATE PRESCRIBING IN HOSPITALISED FRAIL OLDER ADULTS: DEVELOPMENT OF THE OPTI-3S PRELIMINARY STATEMENTS
Authors: Ali AH , McMahon N , Ryder S 
Published: October 2022

Abstract

Background
Few assessment criteria exist for Potentially Inappropriate Medications (PIMs) in the hospital setting. This study aims to develop the preliminary statements of OPTI-3S, criteria for optimising medicines by stopping, stepping down or switching to safer alternatives. These are designed to be of value to clinical practitioners in the routine care of hospitalised, frail older adults.

Methods
A systematic literature review was conducted in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, CINAHL, EMBASE and Scopus (2010-2021). Search terms included the concepts of inappropriate prescribing, deprescribing and the target population (e.g. older, frail, hospitalized). This was supplemented with a PubMed focused search (2010-2021) using key words pertaining to the index diseases/conditions or inappropriate medications. The structured reviews included clinical based guidelines, PIMs lists, systematic/non-systematic reviews, or clinical/observational trials that assessed safe and/or effective use of medications in older adults. The preliminary statements were then drafted based on the available relevant evidence.

Results
Searches yielded ~1500 articles. These were included in structured reviews, yielding a total of 109 initial statements across seven physiological systems, and one patient-centred point of care (perioperative care). In addition to detailed PIMs statements (n=98), 11 statements address clinically important Potential Prescribing Omissions (PPOs) (e.g. anticoagulant underdosing) and altered blood pressure and glycaemic targets. Uniquely for criteria of this kind, 23 statements suggest PIMs be considered based on the different frailty levels, according to the Clinical Frailty Scale. 11/98 PIMs statements concern prescribing cascades and suggest tapering regimens for six inappropriate medication classes (e.g. antipsychotics, benzodiazepines). Several statements address medication appropriateness in other frailty related circumstances (e.g. non-compliance, overlapping co-morbidities, feeding tube incompatibility, pill burden/ polypharmacy).

Conclusion
Literature provides a large body of evidence to support prescribing optimization. This has been distilled into consensus-based statements, which should guide hospital-based health care professionals caring for frail older adults.
239 PATIENT PERCEPTIONS OF THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE
Authors: Davis AJ , Kenny L , Delaney A , Doyle C , Sweeney A , Nally SM , Namara RM 
Published: October 2022

Abstract

Background
The EDITH service provides an alternative to Emergency Department (ED) attendance for the older adult by providing emergency care in the person home. It is imperative to explore how this service is received by the key stakeholders in order to ensure it is meeting the needs of older adults and to improve and diversify same.

Methods
A patient feedback survey was circulated to patients and family members who received the EDITH service. A postal option and a QR code leading to an online option were utilised. 50 surveys were randomly selected for inclusion. Quantitative data was analysed via paper count method and thematic analysis was completed for the qualitative data.

Results
74% rated the service as “excellent”, 22% “very good” and 4% “good”. Alternative options to the service were identified as “going to ED” 22% , “going to GP” 22%, “waited until they would get better” 4%, “waited until they got worse” 2%, “would do nothing” 6%. 80% rated the combined expertise of a doctor and OT as “extremely important”, 94% rated the home visit aspect as “extremely important” and 90% rated ED avoidance as “extremely important”. Key themes that emerged regarding what the service does well included “personalised care”, “ED avoidance”, “compassion” and “timeliness of service”. Areas for improvement included “improving communication loop to both patients and/or community services! and “ability to directly access the service”. 95% of respondents advised they would or have already recommended the service to others. Of note, a key theme in the comments section was the need for a similar service in other hospitals.

Conclusion
The EDITH service appears to be meeting stake-holders expectations, areas for improvement have been identified and are currently being addressed. It is imperative to obtain the perception of the service user and to tailor interventions accordingly, this feedback is invaluable in order to meet future service needs.
240 STANDARDISING POST-FALL MEDICAL REVIEWS FOR HOSPITAL INPATIENTS
Authors: Daly S , Gibbons C , Callaly E , Gaynor E 
Published: October 2022

Abstract

Background
Falls are the most common adverse incident of inpatients in Irish hospitals. 6% of inpatient falls cause serious injury. Older inpatients have the highest risk of falling and the highest risk of injury. The post-fall medical review is critical to assess why a patient fell, did the fall cause injury and for the introduction of measures to prevent future falls. We assessed the quality of the post fall reviews in a large hospital. We then introduced a standardised post-fall medical review pro forma and reassessed the quality of the reviews.

Methods
We reviewed 18 charts of patients that fell in hospital and assessed the documentation of the post fall review in terms of the inclusion of key elements such as patient identifiers, history, examination, injury management and future falls prevention. We then introduced a post-fall standardised pro-forma on five wards in the hospital and following this assessed 19 charts of patients who had fallen looking at the same key elements of the post fall review. We compared the quality of the post-fall review before and after the introduction of the pro forma.

Results
The post-falls medical review pro forma improved the quality of the post fall medical review. Hip Trauma: 11.1% of doctors asked about hip strike prior to proforma versus 100% who asked with the proforma. Joint examination: 50% assessed this prior to the proforma versus 100% with the pro-forma. Other aspects of the review that improved included head-strike assessment (89% versus 100%), loss of consciousness history (61% versus 95%), medication reviewed (22% versus 68%) and vital signs assessed (67% versus 95%).

Conclusion
The introduction of a standardised post fall review pro forma improves the quality of this important medical review. It is a useful aid for doctors and provides a framework to follow when reviewing the patient.
249 MINIMALLY-EFFECTIVE PHYSICAL ACTIVITY DOSE FOR GENERALIZED ANXIETY DISORDER AMONG OLDER ADULTS: PRELIMINARY FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: Herring M , Rasmussen CL , Kenny RA , Laird E 
Published: October 2022

Abstract

Background
Among older adults, Generalized Anxiety Disorder (GAD), a debilitating condition characterized by persistent excessive worry, is associated with poorer quality of life and estimated cost to the individual of €1,864 annually. Meeting recommended Physical Activity (PA) levels has been associated with lower odds of GAD; however, the minimally-sufficient dose associated with benefits is currently unknown. Herein, we quantified the association between different PA doses and worry symptoms and GAD status among older adults across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods
PA was measured at each wave using the short-form International Physical Activity Questionnaire. Five dose categories were examined (0, 1-&lt;600, 600-&lt;1,200, 1,200-&lt;2,400, and ≥2,400 MET.min.week-1). At all waves, worry symptoms were assessed using the abbreviated Penn State Worry Questionnaire continuous score; a score of ≥23 classified GAD status. Additionally, for Waves 2-5, the CIDI GAD quantified diagnosis of GAD during the past 12 months. Poisson regression with Stata quantified associations between PA dose and GAD and worry symptoms, adjusted for age, health/lifestyle variables and antipsychotics/anxiolytic medication.

Results
Among 2,200 participants, compared to lowest PA dose, only the highest PA dose (i.e., ≥2,400 MET.min.week-1) was significantly associated with 35% lower odds of GAD (OR=0.65; 95%CI: 0.51, 0.82; p≤0.001). For continuous worry symptoms, meeting the recommendation of at least 600 MET.min.week-1 was significantly, inversely associated with worry symptoms (coefficient= –0.02; 95%CI: –0.033, –0.005; p≤0.009). Female sex, less education, taking anxiolytics, and current smoking were also associated with greater odds of GAD and greater worry severity.

Conclusion
High physical activity dose was associated with lower odds of GAD over 10 years among older adults. Present findings suggest that older adults, particularly females and smokers, may need to exceed recommended physical activity levels to protect against GAD.
253 DELIRIUM IDENTIFICATION AT INITIAL TRIAGE IN AN IRISH EMERGENCY DEPARTMENT SETTING
Authors: Jennings E , McLoughlin K , Maher G , O’Sullivan J , Gilligan P , Dockery F 
Published: October 2022

Abstract

Background
Over 10% of older adults are affected by delirium on presentation to Emergency Departments (ED), with many more developing it during a prolonged ED stay. Early detection is key to delirium management, but the diagnosis is often missed, with over 50% of delirium going undetected in the ED. In 2019 the HSE guideline on Early Identification and Management of Delirium in the ED recommended that all those over 65 years be screened on presentation to ED using the 4AT, a validated instrument in delirium screening. Through our ED’s delirium working group, we conducted a baseline audit on current rates of screening for delirium, ahead of a quality improvement project on management of patients with, or at risk of delirium in our ED.

Methods
A retrospective review was conducted of consecutive patients &gt;65yrs who presented to ED in one month with the following terms mentioned in the presenting complaint at triage: confusion/delirium/memory/speech/language disturbance/agitation i.e. terms that could indicate possible delirium as considered by the triage practitioner. We also recorded whether a 4AT was recorded. An additional 50 charts from the consecutive series were randomly selected and examined for probable delirium on presentation which was not captured at triage.

Results
n=23/1,597 (&lt;1%) had possible delirium recorded at triage as per our criteria. In-depth case note review supported the diagnosis of delirium in 20 of the 23 initially identified at triage. Only 5 of these had a documented 4AT score. Of the additional 50 charts screened, a further 6 had likely delirium of whom n=3 had a 4AT score completed. N=16 required hospital admission.

Conclusion
Delirium screening and detection rates at ED triage are less than expected, and below the 2019 national screening recommendations. Implementing same in any busy ED is challenging. We are developing a multifaceted educational program to address this and plan a repeat audit following implementation.
256 THE DEVELOPMENT OF A PATIENT AND CARER INFORMATION LEAFLET FOR PATIENTS FOLLOWING HIP FRACTURE
Authors: Rafferty M , Murphy D , Creech J , Dukelow T , Ahern E 
Published: October 2022

Abstract

Background
Consistent delivery of high-quality information to family and caregivers can significantly improve patient experience and care during and after hospital admission. This became especially important with limited visiting hours during the COVID pandemic and our unit noted the need for appropriate written information. We aimed to complete a search of available resources nationally and internationally and develop our own information pack for distribution to our patients.

Methods
Literature search was conducted for available patient and carer information resources nationally and internationally including grey literature search. Key areas and patient priorities were identified. We then began developing a patient information booklet for distribution in our unit.

Results
We identified several key areas to be included in our information pack including what to expect during the hospital admission. This included pre-operative care, operative management, post-operative care especially delirium, pain, nutrition and continence promotion. Information regarding post-discharge care including off-site rehabilitation, rehabilitation at home and future actions including bone health and falls prevention interventions with home modification advice was also included. We developed a patient and caregiver information leaflet for our unit using data from the Irish Hip Fracture Database and our local unit practices and pathways to ensure information was relevant to our patients.

Conclusion
We completed the design of a patient and caregiver information leaflet highlighting important aspects of care post hip fracture in our unit.
264 FREEDOM AND LONELINESS: SPOUSAL DEMENTIA CARE-GIVERS AND THE NURSING HOME TRANSITION
Authors: Power JM , Holton E , Warters A , Simons R , Pertl M , O'Sullivan R , O'Philbin L , Lawlor B 
Published: October 2022

Abstract

Background
Many persons with dementia transition to nursing home care, but little is known about the impact, positive and negative, that this may have on the social isolation and loneliness of their spouse.

Methods
Using our existing theoretical synthesis of loneliness to provide sensitising concepts, we conducted a deductive grounded theory study of loneliness during the nursing home transitions. We recruited 11 spousal participants to engage in semi-structured remote interviews during 2021.

Results
Participants provided their own definitions of loneliness, and spoke about their life history of loneliness, the loneliness associated with living with a spouse with dementia, and the loneliness, and alleviation of loneliness through re-engagement with social contacts, associated with their spouse moving to the nursing home. Participants agreed with the idea that loneliness has a physical feeling. More distal parts of the theoretical synthesis, such as the influence that culture and gender have on loneliness, were not corroborated by the findings.

Conclusion
We conclude that loneliness is a frequent experience among spousal caregivers whose spouse has moved to nursing home care, but that loneliness is also associated with living with a spouse with dementia. Loneliness in this population was aggravated by the COVID-19 pandemic and associated lockdowns. Further research steps will involve more targeted interviewing to focus on the link between transitions and loneliness in this and in other populations.
265 A PHYSIOTHERAPY-LED TRANSITION TO HOME INTERVENTION FOR OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE: A PILOT FEASIBILITY RANDOMISED-CONTROLLED TRIAL
Authors: Conneely M , Holmes A , O'Connor M , Leahy A , Gabr A , Saleh A , Okpaje B , Corey G , Barry L , Griffin A , O'Shaughnessy Í , Ryan L , Synott A , McCarthy A , Carroll I , Leahy S , Trepél D , Ryan D , Robinson K , Galvin R 
Published: October 2022

Abstract

Background
Older adults frequently attend the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. A presentation to an ED can be viewed as an opportunity to assess those at risk of adverse outcomes and initiate a care plan in those deemed as ‘high risk'. Our aim was to evaluate the feasibility of a physiotherapy led integrated care intervention for older adults discharged from the ED (ED-PLUS).

Methods
Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (Trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. Functional decline was examined post-intervention using the Barthel Index. All outcomes were assessed by a research nurse blinded to group allocation.

Results
29 participants were recruited, indicating 97% of our recruitment target. 90% of participants completed the ED-PLUS intervention. All participants expressed positive feedback about the intervention. The incidence of functional decline at 6 weeks was 10% in the ED-PLUS group versus 70-89% in the usual care and CGA-only groups.

Conclusion
High adherence and retention rates were observed among participants and preliminary findings indicate a lower incidence of functional decline in the ED-PLUS group. Recruitment challenges existed in the context of COVID-19. Data collection is ongoing for six-month outcomes.
272 PHYSIOTHERAPISTS' EXPERIENCES OF WORKING IN RESIDENTIAL CARE IN THE REPUBLIC OF IRELAND DURING COVID-19
Authors: O'Callaghan S , Reilly A , O'Shea O 
Published: October 2022

Abstract

Background
COVID-19 was officially declared a pandemic in March 2020. Social distancing and visiting restrictions were introduced in Irish residential care units in March 2020. The impact of COVID-19 and associated restrictions on physiotherapists working in residential care in the Republic of Ireland (ROI) is unknown. This study aimed to explore the experience of physiotherapists working in residential care units in the ROI during the COVID-19 pandemic.

Methods
A qualitative phenomenological study design was used. Physiotherapists working in residential care units were invited to participate in one-to-one semi-structured interviews from December 2021 to March 2022. Participants were recruited via purposive and snowball sampling. Data were analysed using reflexive thematic analysis by two independent reviewers.

Results
Seven one-to-one semi-structured interviews were conducted among five female and two male physiotherapists. Four major themes emerged: (i) service adaptation (ii) communication (iii) physical and emotional impact of COVID-19 pandemic on staff and (iv) physical and emotional impact of COVID-19 pandemic on residents. A number of subthemes were identified under each theme. Participants experienced changes in service delivery including redeployment, reduced resident contact and social distancing. These changes resulted in innovation, mainly through telehealth. Participants felt communication from managers could be improved through clarity regarding protocol changes. The pandemic stimulated enhanced inter-professional communication among physiotherapists. Some participants contracted COVID-19 resulting in residual physical impairments. Participants were affected emotionally through the increased stress experienced due to COVID-19 restrictions. Residents experienced isolation due to visiting restrictions. Due to reduced physiotherapy input participants observed reduced physical functioning among residents.

Conclusion
COVID-19 and its associated restrictions had a profound impact on physiotherapists working in residential care units as well as on residents. The extent of this impact is only beginning to emerge. Planning for future pandemics should consider the long-term physical and emotional consequences of restrictions on both physiotherapists and residents.
279 INCLUSION OF OLDER PATIENTS IN CLINICAL TRIALS: A REVIEW OF A SINGLE, HIGH IMPACT, MEDICAL JOURNAL OVER A 2-YEAR PERIOD
Authors: Mc Carthy CE , Murphy R , McAteer C , Okon M , O'Donnell M 
Published: October 2022

Abstract

Background
Older patients have the highest rates of multimorbidity and prescription drug use. Despite this, previous research has found that these patients are not well represented in Randomised-Control Trials (RCTs), limiting external validity. In recent years many guidelines have been issued to help facilitate the inclusion of older patients in RCTs. We aimed to explore the inclusion of older patients in recent RCTs publications.

Methods
A single, high impact, medical journal was systematically reviewed, with all full text publications between March 2019 and March 2021 being screened. All adult, Phase III, RCTs were selected. The age descriptors of controls were extracted, in addition to information on eligibility criteria that could lead to exclusion based on age, comorbidity, or cognition.

Results
Of 123 RCT publications, the mean age was ≥65 in 42.1% and ≥75 in 8.3%, while the 75th centile age was ≥65 in 72% and ≥75 in 25%. An explicit capacity requirement was present in 41.5% and those with cognitive impairment were excluded in 15.4%. Eligibility determined at the discretion of the investigator and a life-expectancy exclusion criteria were present in 33.3% and 36.6%, respectively. A maximum age limit was present in 18.7%. No RCTs excluded on the basis of polypharmacy. The mean/75th centile age differed significantly by speciality (p&lt;0.05), oldest in cardiovascular and medical RCTs. Having a maximum age limit was significantly associated with a lower mean/75th centile age (p&lt;0.01), while having a life-expectancy exclusion criteria was associated with a higher mean/75th centile age (p&lt;0.05). The age did not differ significantly between pre/post-COVID-19 RCTs, or for other eligibility criteria studied.

Conclusion
While those ≥65 were well represented, those ≥75 were not. Eligibility criteria that could potentially lead to exclusion based on age, comorbidity, or cognition were also common, although the majority did not significantly affect age.