bluuebunny/crossref_metadata_2025_split huggingface dataset:
298 AN AUDIT OF HEALTH PROFESSIONALS’ KNOWLEDGE OF PARKINSON’S DISEASE AND ITS MEDICATION MANAGEMENT FOR HOSPITALISED PATIENTS
Authors: Connolly E , Reidy C , Murphy A , Pope G , Cooke J , Bambrick P , O'Regan N , Mulcahy R 
Published: October 2022

Abstract

Background
Studies have shown that patients with Parkinson’s Disease (PD) have a higher rate of hospitalisation and longer lengths of stay than their age matched controls. Good inpatient management is key to maintaining functional ability and preventing complications, but many PD patients deteriorate while in hospital. Patients with PD are often on multiple time sensitive medications. This study aims to assess healthcare workers knowledge of PD, medications used to treat it and how they should be prescribed and administered.

Methods
A convenience sample survey was distributed to doctors, nurses and other health care professionals over a five-week period. This survey included multiple choice questions and open-ended short answer questions. Results were collated and analysed on Microsoft Excel.

Results
71 surveys were returned - 34 from doctors, 23 from nurses and the 14 others included pharmacists, physios and dieticians. Only 11 (15%) participants correctly identified all PD medications listed in the survey with Sinemet being the most recognised drug (n= 68). Non motor symptoms of PD correctly identified by participants included constipation (n=54, 76%), hallucinations (n=48, 68%) and anosmia (n=18, 25%). 32 participants (45%) were unable to correctly identify when to administer PD medications in relation to mealtimes. 29 participants surveyed (41%) would consider inserting a nasogastric tube for a patient who was fasting and unable to take oral medications. 12 participants (17%) did not know that Sinemet could be given via nasogastric tube.

Conclusion
This survey highlights a gap in knowledge of Parkinson’s Disease and its management. Participants displayed poor knowledge regarding optimum timing of medication administration and management of patients who are fasting. These findings suggest that education sessions and hospital specific guidelines regarding the management and administration of PD medications would assist healthcare professionals with a view to improving patient outcomes and preventing complications.
300 ESTABLISHING THE PREVALENCE OF OSTEOPOROTIC FRACTURES IN IRELAND
Authors: Bhujwalla S , Sorensen J , Carey JJ , Dockery F 
Published: October 2022

Abstract

Background
Fragility/low-trauma fractures are a major burden on health care, yet many could be prevented through Fracture Liaison Services (FLS). An Irish national FLS database (FLSDB) has recently been established and a reliable estimate of fracture numbers per locality is needed to measure FLS efficiency. Currently the Irish FLSDB uses the UK estimate of 1:4 hip vs. non-hip fracture numbers. We wanted to explore its accuracy in an Irish population.

Methods
We looked at all plain x-ray reports from six individual weeks across two years in our hospital. We selected those aged &gt;50yrs with a reported new fracture. We determined the ratio of hip:non-hip fractures and of those admitted vs. discharged. We cross checked these against admitted fracture numbers from NQAIS (National Quality Assurance Information System) for the same 6 weeks. We then looked at all admissions Irish Emergency Departments during 2018-2019 with a new fracture aged &gt;50yrs. We compared hip:non-hip fracture ratio of these vs. our local data.

Results
From 7,654 x-ray reports, 222 new fracture patients were identified. An additional 29 patients sustained fractures during this time period, either CT/MRI diagnoses or managed as fractures despite negative radiology report. NQAIS missed 21 admitted fractures (uncoded). The ratio admitted:discharged fractures in our audit was 2:3. Ratio of patients with hip:non-hip fractures was 1:9.5. Nationally there were 33,627 fracture patients aged &gt;50y admitted to Irish hospitals in 2018-9, and of these, the hip:non-hip fracture ratio was 1:3. Adding estimated numbers of fracture patients not admitted (based on our local data) gives at least a 1:9 hip:non-hip ratio nationally.

Conclusion
Fracture numbers in Ireland are markedly underestimated if extrapolating from UK estimates. This has implications for service planning for Irish FLS, if rising fracture numbers are to be addressed.
301 BENEFITS OF ENVIRONMENTAL MUSIC THERAPY IN AN ACUTE HOSPITAL
Authors: Cassidy M , Hayes R , Nevin R , Griffin A , Herbst J , Mealy B , Walsh K , Donnelly R , Harrison H , Jariol A , Joseph L , Carroll KM 
Published: October 2022

Abstract

Background
Environmental Music Therapy (EMT) uses live music played by a music therapist to enhance the surrounding environment and is increasingly used in clinical settings. Studies show that EMT may reduce anxiety, enhance wellbeing, promote better communication between patients and staff, and reduce patient perception of waiting times in hospital. We aimed to explore the benefit of EMT for older adults in a geriatric outpatient setting and on rehabilitation wards.

Methods
Harp music was played by a music therapist in the vicinity of ambulatory clinics and on rehabilitation wards for 4 hours per week (over a 2-day period) for 20 weeks. Music exposure on any given day was to an estimated 50 outpatients, as well as 50 people passing the vicinity or to about 30 patients on the rehabilitation ward. Music was selected and played in a dynamic process, responding to verbal and non-verbal reactions of patients, family, and staff. Voluntary responses were recorded and collated.

Results
There were 36 recorded responses and all reflected positively on EMT. Patients cited that the music created a welcoming space and stimulated interaction and conversation. Several patients waiting for their clinic appointment noted that it distracted from fearful expectation and was a source of comfort. Some commented that they felt more relaxed and that it reduced stress. On rehabilitation wards, patients found familiar music to be calming with nurses citing that it stimulated social interaction between patients, family and staff. Responses to EMT gave insights that resulted in patient referrals for music therapy.

Conclusion
Environmental music played by a music therapist was found to modify patient hospital experiences. In particular, it appeared to reduce self-perceived stress and stimulate positive social interaction and conversation. This supports the use of EMT to advance the integration of the arts for wellbeing in an acute hospital.
303 SCREENING INSTRUMENTS TO PREDICT ADVERSE OUTCOMES FOR UNDIFFERENTIATED OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: RESULTS OF SOAED PROSPECTIVE COHORT STUDY
Authors: Leahy A , Corey G , Purtill H , O'Neill A , Devlin C , Barry L , Cummins N , Shanahan E , Shchetkovsky D , Ryan D , O'Connor M , Galvin R 
Published: October 2022

Abstract

Background
Frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention in the acute or community setting. We assessed the validity of the ISAR (Identification of Seniors at Risk), Rockwood Clinical Frailty Scale (CFS), PRISMA-7 and InterRAI-ED at predicting adverse outcomes at 30 days and six months among older adults presenting to the ED.

Methods
A prospective cohort study of consecutive older adults (≥65 years) who presented to the ED at a University Hospital was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were performed by an experienced ED research nurse. Blinded follow-up telephone interviews were completed at 30 days and six months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity and specificity of the screening tools were calculated using 2×2 tables.

Results
419 patients were recruited with 49% female and a mean age of 76.9 years (SD 7.15). The prevalence of frailty varied across the screening tools (ISAR, 47% vs InterRAI-ED, 63%). At 30-days, mortality rate was 5.4%, ED re-attendance 16.9%, hospital readmission 13.6%, functional decline 47.1% and nursing home admission 7.3%. Older adults who screened positive for frailty demonstrated an increased risk of all adverse outcomes at 30 days and 6 months, regardless of frailty screening tool administered. All tools had a relatively high sensitivity but low specificity. The ISAR was the only tool which was statistically significant at predicting all outcomes at 30 days.

Conclusion
The ISAR, CFS, PRISMA-7 and InterRAI-ED demonstrated modest validity at predicting adverse outcomes at 30 days and 6 months. We would recommend the implementation of one of these frailty screening tools in Irish EDs to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention in the hospital or community setting.
306 GERIATRICIAN-LED COMPREHENSIVE GERIATRIC ASSESSMENT IN THE EMERGENCY DEPARTMENT: A COST-EFFECTIVE SERVICE APPROVED BY PATIENTS
Authors: Magner S , Carey S , Harrington G , Ward L , Smyth H , Purcell R , Callaly L , O'Caheny C , Pender C , Buckley B , Laguna R , Riches R , Mitchell M , Carrabine N , Ramiah V , Byrne C 
Published: October 2022

Abstract

Background
Many older people are brought to the Emergency Department (ED) who do not require acute hospital admission but there are risks to these patients if this occurs. The Frailty Intervention Team (FIT) are an interdisciplinary team based in the ED including physiotherapy, occupational therapy, speech and language therapy, dietetics, pharmacy, advanced nurse practitioners, and a geriatric registrar and consultant. They assess frail older patients and suggest alternative care pathways to admission. We aimed to investigate the impact of FIT on admission avoidance, bed days saved and to obtain patient feedback on their experience.

Methods
Routinely collected data from May 2021 to April 2022 was reviewed retrospectively. An anonymous patient feedback questionnaire was posted to 40 patients randomised from the FIT worklist between January to May 2022.

Results
2,025 Comprehensive Geriatric Assessments (CGA) were completed between May 2021 and April 2022. 38% percent of patients were discharged home, 45% of this number had follow-up arranged. 104 patients were transferred directly to an offsite bed, mostly rehabilitation. We estimate we avoided 51 admissions to the acute hospital per month, almost half of these were patients admitted to the hospital and, who we discharged to alternative care pathways or home. The average length of stay in April 2022 was 22 days – by avoiding 615 admissions between May 2021 and April 2022 we have saved 13,530 bed days at an estimated cost saving of almost €11 million. 15 completed questionnaires were returned. 73% were very satisfied with their experience. 87% felt the FIT team helped facilitate their discharge from ED. The main themes identified from open ended questions included thorough assessment, patient centred care and satisfaction with early intervention and discharge.

Conclusion
A Frailty Intervention Team is a cost effective and patient centred way of avoiding unnecessary admissions for older people presenting to the ED.
307 THE FEASIBILITY OF USING AN INCLINOMETER TO PROVIDE OLDER HOSPITALISED PATIENTS WITH FEEDBACK ON THEIR ACTIVITY LEVELS
Authors: O'Keeffe E , Landers S , Kehoe B , Davey N , Cooke J 
Published: October 2022

Abstract

Background
Low levels of physical activity in older adults are well documented and have been associated with functional decline, acute sarcopenia, prolonged length of stay and higher readmission rates. Interventions to modify behaviour in hospitalised older adults include providing feedback on performance. Commercially available activity trackers and pedometers which rely on step count, are often unable to detect steps at the walking speeds found in older hospitalised patients. This study investigated the feasibility of using an inclinometer to measure the time spent by older hospitalised adults in lying and sitting versus standing and walking, and to provide feedback to patients on their active versus sedentary levels.

Methods
This was a feasibility study using a cross-sectional single centre design. Twelve inpatients over 70 years of age were fitted with an ActivPAL accelerometer on their thigh, which was worn continuously for 3 days. A graphic display of sedentary versus active time was provided to the participants each morning. Acceptability of wearing the device and receiving feedback was determined using a modified technology acceptance questionnaire.

Results
Twelve hospitalised older adults (7 female, 5 male) were included in the study, median age 74 (66-84). A modified technology questionnaire showed that 83% of participants found the ActivPAL device comfortable to wear, 100% reported that the feedback from the device was clear and understandable and 92% reported that the information enhanced their motivation for physical activity and that they would wear the device again.

Conclusion
This feasibility study shows that the ActivPAL is a device that can be worn in the hospital setting to provide older adults with feedback on their activity levels in order to modify behaviour and increase their levels of physical activity while in hospital.
310 A COMPARATIVE ANALYSIS OF THE IRISH POST-GRADUATE GERIATRIC TRAINING SCHEME WITH THE EUROPEAN POST-GRADUATE CURRICULUM IN GERIATRIC MEDICINE
Authors: Murphy R , McCarthy C , Reddin C , Canavan M , O’Dwyer C , Mulroy M , O'Donnell M 
Published: October 2022

Abstract

Background
Minimum training recommendations to become a specialist geriatrician in the EU have been published. In this study we sought to evaluate the curriculum of the higher specialist training scheme in Geriatric Medicine in Ireland and examine how it compares with the knowledge recommendations from the European post-graduate curriculum in Geriatric medicine, which is endorsed by both the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA).

Methods
In this study we examined the content of didactic study-day lectures given over a five-year rolling period which is the minimum duration of the higher specialist training programme in Geriatric medicine in Ireland. We also examined the published Irish curriculum and compared how both the Irish curriculum and content of the study-days matches up with the 36 items that are identified as the core knowledge content in the European post-graduate curriculum.

Results
There were 24 study days delivered over a five-year time period. The Irish geriatric medicine curriculum formally outlined that 30 of the 36 knowledge areas proposed in the European curriculum should be formally covered during post-graduate geriatric training in Ireland. The European curriculum recommended formal teaching in sarcopenia, sleep disorders, tissue viability, iatrogenic care delivered disorders, sexuality in older adults and geron-technology/e-health, none of which were referred to in the Irish curriculum. However, despite this discrepancy, formal teaching was delivered on 92% (n = 33) of proposed areas. Pain assessment, sleep disorders and tissue viability were areas not covered in Irish didactic study-days. 24 of 36 topics were covered at least twice.

Conclusion
There was high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine. Benchmarking against European training standards is an opportunity to ensure that parity of education and training is achieved across the EU.
311 FROM ONE FRONT DOOR TO ANOTHER: OUTCOMES OF PATIENTS DIRECTLY DISCHARGED FROM THE FRAILTY AT THE FRONT DOOR SERVICE
Authors: Griffith V , Murphy R , Sheil O , Roche E , Devaney T , Geoghegan J , Robinson S , Waters R , O'Donnell M , Canavan M 
Published: October 2022

Abstract

Background
The Frailty at the Front Door service is a novel service that provides comprehensive geriatric assessment in the emergency department for older adults who have an unplanned emergency presentation to hospital. It is important to monitor outcomes of patients discharged by the service to ensure appropriate patient selection.

Methods
Patients over the age of 75 with a Manchester Triage Score of between three and five and a possible frailty syndrome are eligible for review by the service. After initial review patients are either discharged directly or recommended for admission. We reviewed the outcomes of patients who were discharged directly after Emergency Department (ED) assessment by the service.

Results
Discharge disposition was available for review in 413 (95%) of patients since initiation of the service in October 2021. 30% (n= 122) of patients were discharged directly after initial ED review. Elevated 4AT score (p = 0.002) but not frailty (p = 0.80) was associated with decreased chances of direct discharge. Of patients discharged directly from ED 13% were reviewed post discharge by the community integrated care team (GICOP), with 43% of these reviews taking place within 30 days. Overall, 16% of patients discharged directly represented to ED within 30 days. There was a trend towards lower rates of representation to ED among patients who were seen by GICOP after discharge from ED (p = 0.12).

Conclusion
There was a high rate of direct discharge after review by the service, with low rates of representation to hospital. While limited by low numbers there was a trend towards lower representation rates in patients reviewed post-discharge by the integrated care team. Future quality improvement initiatives will aim to improve the integration between the services and highlighting patients who would benefit from more timely reviews.
317 PREVALENCE OF MOTORIC COGNITIVE RISK SYNDROME IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT ATTENDING A MEMORY CLINIC
Authors: Harte G , Kennelly S , Dukelow T 
Published: October 2022

Abstract

Background
Mild Cognitive Impairment (MCI) alone is not predictive of progression to dementia. However, previous research has found that the combination of MCI and slow gait speed, termed Motoric Cognitive Risk syndrome (MCR), is associated with a three-fold increased risk for the development of dementia. This study aimed to identify the prevalence of MCR among patients with MCI attending a memory clinic at a large teaching hospital.

Methods: Participants
Participants were recruited from the memory clinic at the study site. All participants matching the inclusion criteria were invited to participate in the study. Inclusion criteria: Age &gt; 55 years, independently mobile &gt; 50m unaided, diagnosis of MCI. All participants gave informed consent prior to testing.

Procedure
Gait speed (in cm/s) during normal pace walking was measured using a 5-metre computerised walkway with embedded sensors (GaitRite).

Data Analysis
Gait speed data was dichotomised into “normal” or “low” using previously defined gait speed cut-offs derived from age-based norms. Data was analysed using descriptive statistics on Microsoft Excel.

Results
31 participants completed testing (Males: 12; Females: 19). Mean age was 73.65 (range 63-84). Median score on the Montreal Cognitive Assessment (MoCA) was 20 (range 4-28). N = 2 (6.45%) reached criteria for MCR.

Conclusion
Although this study had small numbers, prevalence of MCR was similar to that previously reported among similar populations. This approach to identifying those at high risk for dementia may allow clinicians to target and prioritise further investigations and preventative interventions.
318 CARER STRESS REVIEW IN COMPLEX CASES REQUIRING INTERVENTION BY A COMMUNITY-BASED OLDER PERSONS TEAM
Authors: Bradley E , Byrne A , Ramalingam K , Mills D , Spencer M , Wheelan M , Nee R 
Published: October 2022

Abstract

Background
Complex cases of older adults suffering from multimorbidity are continuing to increase in number. The integrated care team, overseen by a consultant geriatrician, aims to facilitate the management of stable complex cases in the community. Patient care is largely affected by their support system at home; therefore, it is of great importance to ensure that the patient’s primary carer is receiving the support they require to facilitate the older patients’ management in the community. Our aim is to assess carer stress levels before and after Multi-Disciplinary Team (MDT) integrated care intervention.

Methods
Study Population were carers of patients identified as complex cases by the integrated care team. Caregiver stress index was administered during the initial assessment and on the closing of active cases. The maximum score on this index is 13 with high stress classified as &gt;7. Scores were added to a spreadsheet. This spreadsheet was reviewed, and relevant data was collated. One year assessed March 2021- March 2022.

Results
Carer stress information was collected on 62 of 112 identified complex cases (55%). Of these 55 of 96 individual patients were represented (57%). Average age 82 years old. 65% female and 35%, male. Range of carer stress scores observed 0- to 12. Of the 62 cases, 85% (53 cases) had a reduction in carer stress post-intervention(p&lt;0.01). Of these 65% had a reduction below 7 (p&lt;0.01). Mean score improvement 7. No carer stress indices disimproved post-treatment.

Conclusion
Multidisciplinary, patient-centred community care has a clear positive impact on the patient carer. Improvements in carer stress scores could be further evaluated as to the benefits of specific interventions in time. In future, a more large-scale collection and interpretation of data would need to occur for a more conclusive positive impact of the community based integrated care team to be confirmed.
319 CAN INDEX BARTHEL SCORE AT EMERGENCY DEPARTMENT PRESENTATION PREDICT ADVERSE OUTCOMES AMONG OLDER ADULTS AT 30 DAYS AND 6 MONTHS?
Authors: Corey G , Leahy A , Carroll I , Barry L , Galvin R 
Published: October 2022

Abstract

Background
Frailty is acknowledged as a significant syndrome particularly in the older population. Monitoring frailty in late life aetiology and recognising the value of frailty as a marker of risk for adverse health outcomes is vital and ensures the identification of opportunities for intervention with this cohort in clinical practice. The aim of this prospective cohort study is to examine if an index Barthel Score at Emergency Department presentation predicts adverse outcomes among older adults at 30 days and 6 months.

Methods
Six-hundred and fifty older adults (≥65 years) attending a university model 4 hospital ED were recruited. Baseline evaluation included the Barthel Index. Adverse outcomes (hospital readmission or death) were recorded by a research nurse at 30 days and 6 months, blinded to Barthel score. Descriptive statistics were used to profile the population and report the incidence of adverse outcomes.

Results
At 30 days, 61 older adults had either being admitted to hospital (n=28) or died (n=33) and at 180 days a further 72 had been admitted (n=43) or died (n=29). A total of 29% (n=189) of the population had a Barthel score of ≤15 indicating moderate dependency. Of this cohort, 70% had an adverse outcome-readmitted or died within 180 days.

Conclusion
It may be worth looking at introducing the Barthel Index as a routine measure of activity for older adults presenting to the ED. This tool demonstrates an increased risk of adverse outcomes among older adults who present with moderate dependency. Early intervention either in the hospital or community setting with this ‘at risk’ cohort may serve to reduce adverse outcomes among this group.