bluuebunny/crossref_metadata_2025_split huggingface dataset:
24 REVERSING FRAILTY AND ENHANCING RESILIENCE WITH EXERCISE AND DIETARY EDUCATION (REFEREE): A PRIMARY CARE RANDOMISED CONTROLLED TRIAL
Authors: Travers J , Romero-Ortuno R , Langan J , MacNamara F , McCormack D , McDermott C , McEntire J , McKiernan J , Lacey S , Doran P , Power D , Cooney M-T 
Published: October 2022

Abstract

Background
There is a need for effective primary-care interventions that help older people combat frailty and build resilience. This study aims to test the effectiveness of a co-designed exercise and dietary protein intervention.

Methods
This was a multicentre, randomised-controlled, parallel-arm trial in six Irish primary-care practices. We enrolled adults aged 65+ with Clinical Frailty Scale score ≤5 from December 2020 to April 2021. Participants were randomised to intervention or usual care with allocation concealed until enrolment with a GP. Intervention comprised exercises, emphasising strength, and dietary protein guidance. At three-month follow-up, effectiveness was measured by comparing SHARE-Frailty Instrument between groups, on intention-to-treat basis. Secondary outcomes included muscle mass, bone mass and biological age measured by Bioelectrical Impedance Analysis (BIA). Ease of intervention and health difference were measured on Likert scales.

Results
359 adults were assessed for eligibility and 168 enrolled. 156 (92.9%) attended follow-up (mean age 77.1; 67.3% women; 79 intervention, 77 control). At baseline, frailty proportions were 17.7% in the intervention and 16.9% in the control group. At follow-up, they were 6.3% and 18.2%, respectively. The odds ratio (OR) of being frail for the intervention group was 0.23 times that of the control group (95% confidence interval: 0.07-0.72; P=0.011), adjusting for age, gender and site. Absolute risk reduction was 11.9% (CI: 0.8%-22.9%; P=0.018). Number needed to treat was 8.4. BIA parameters improved, bone mass significantly (P=0.040). 66.2% found the intervention easy, 69.0% reported feeling better.

Conclusion
A combination of exercises and dietary protein significantly reduced frailty and improved self-reported health. Frailty was reversed in more than 1 in 9 participants.
27 ASSOCIATIONS BETWEEN ORTHOSTATIC BLOOD PRESSURE BEHAVIOUR AND PROGRESSION OF AGE-RELATED MACULAR DEGENERATION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: Connolly E , Doyle SL , Kenny RA , Romero-Ortuno R 
Published: October 2022

Abstract

Background
Age-Related Macular Degeneration (AMD) is a progressive disease and the leading cause of vision loss in over 50’s in developed countries. Age-related changes in the neuro-cardiovascular system, at times manifesting as exaggerated blood pressure drops on standing (orthostatic hypotension) may be associated with end-organ damage. The aim of this study was to examine if the pattern of recovery of blood pressure upon standing from a supine position (orthostatic blood pressure behaviour), was associated with progression of AMD.

Methods
We utilised data from TILDA participants who had AMD at the wave 1 health assessment and returned for retinal image grading during the wave 3 health assessment, four years later. Beat-to-beat BP data was measured non-invasively by digital photoplethysmography (Finometer® MIDI) during the wave 1 Active Stand (AS) test. Measures recorded during AS included Systolic (SBP) and Diastolic (DBP) blood pressure. Associations between systolic and diastolic orthostatic BP behaviour and AMD progression were examined using generalised linear models (GLM). Baseline characteristics were compared between progression groups with the 2-samples Mann-Whitney U test and the Chi-squared test.

Results
Of the 191 included participants, 46 (24%) were found to have progression of AMD, while 145 (76%) had no change or regression of the disease. GLMs revealed no significant differences in SBP orthostatic behaviour across groups. However, those with AMD progression had lower orthostatic DBP values (tests of between-subjects effects p=0.005), particularly between 30-60 seconds post-stand (AMD progression: 72±10mmHg vs. No AMD progression: 79±12mmHg; p&lt;0.001). Of the baseline participant characteristics considered, only age was associated with AMD progression (AMD progression: 66±8yrs vs. No AMD progression: 62±9yrs; p=0.005).

Conclusion
In this sample of TILDA participants with AMD, lower orthostatic DBP values were associated with AMD progression over four years. Reduced orthostatic diastolic perfusion may be a novel modifiable risk factor for AMD progression.
32 HOLISTIC PERSON-CENTRED CARE FOR PEOPLE LIVING WITH DEMENTIA AND CO EXISTING MENTAL HEALTH ILLNESSES: A CASE FOR INTEGRATION
Authors: Murphy F , O'Reilly S , Clarke C , Kennelly S 
Published: October 2022

Abstract

Background
65,000 people live with dementia in Ireland, many have co-existing or emerging mental health illnesses and non-cognitive symptoms. During the COVID-19 pandemic there was a need to provide innovative solutions to service provision. As Medicine for the Elderly (MEDEL) and Psychiatry of Later Life (PLL) were established stand-alone services, there was no formalised working relationship, resulting in an overlap of cases and disparity in service provision.

Methods
A description of three cases to illustrate the joint working interface with MEDEL and PLL. These cases highlight their complex care needs and the speciality input required by both services within a shared catchment area. The age range was 78-88 years. All presented with at least two medical co-morbidities, including vascular risk factors and delirium. Each had at least one mental health illness including new onset psychotic and mood disorders. Sharing of resources including diagnostic services, nursing, medical, occupational therapy, physiotherapy and social work facilitated cost effective holistic care.

Results
Given the existing structures of MEDEL and PLL, it was possible to link with community partners attached to each service, allowing domiciliary visits for crisis intervention and best use of expertise from both disciplines. This resulted in the provision of timely patient centred care, reduced polypharmacy through a unified pharmacological approach, enhanced communication, shared learning and cost effectiveness. Care that is in the right place at the right time, in line with Sláinte Care, allowed timely access to diagnostics, improved care outcomes and a cohesive response.

Conclusion
This cohort present with complex care needs. An integrated approach enables patients to receive holistic care without duplication of resources or disparity of treatment and care options. Going forward this should involve a fully integrated memory service, with shared governance.
40 PREVALENCE OF DRUG-DRUG INTERACTIONS IN OLDER COMMUNITY-DWELLERS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Hughes JE , Waldron C , Bennett KE , Cahir C 
Published: October 2022

Abstract

Background
Polypharmacy (regular use of ≥5 medicines) is common in the older population and is an independent risk factor for Drug-Drug Interactions (DDIs). We conducted a systematic review and meta-analysis to summarise the prevalence of DDIs in older (≥65years) community-dwellers.

Methods
An electronic database search was conducted in PubMed and EMBASE. Observational studies published in English between 01/01/2010-10/05/2021 reporting DDI prevalence in community-dwellers aged ≥65years were included. Nursing home and inpatient hospital studies were excluded. Articles were independently double screened for eligibility. Data were independently extracted, 20% extracted in duplicate. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tool. Prevalence estimates and 95% confidence intervals (CI) are presented. All analyses were performed using the metafor package(v3.0.2) in R(v4.1.2). (PROSPERO:CRD42020216686).

Results
5144 unique articles were identified. 33 studies involving 17,011,291 community-dwellers aged ≥65years (age range 65-103) met inclusion criteria. 22 studies measured DDIs broadly classified as (potentially) clinically important. DDI identification methods varied across studies: 5 used Micromedex®; 3 used the 2015 AGS Beers criteria®; 3 used Lexi-Interact®; 2 used drugs.com; 6 used multiple methods; and 14 used a unique method. 31 studies reported DDI prevalence at the study participant level; estimates ranged from 0.8% to 90.6%. 26 studies were qualitatively synthesised and 7 studies were eligible for meta-analyses. In a meta-analysis of 3 studies (n=1122) using Micromedex®, DDI prevalence in older (≥65years) community-dwellers was estimated to be 57.8% (95%CI: 52.2-63.2%; I2 69.6%, p&lt;0.01). In a meta-analysis of 2 studies (n=809,113) using Lexi-Interact®, the estimated prevalence was 30.3% (95%CI: 30.2-30.4%; I2 6.8%). In a meta-analysis of 2 studies (n=947) using the 2015 AGS Beers criteria®, the estimated prevalence was 16.6% (95%CI: 5.6-40.2%; I2 97.5%, p&lt;0.01).

Conclusion
DDIs are prevalent among older community-dwellers; however, the methodology used to estimate these events varies considerably. A standardised method is needed to allow meaningful measurement of DDI prevalence in this population.
41 PROFILING PHYSICAL ACTIVITY AND SARCOPENIA AMONG OLDER ADULTS ATTENDING A PHYSIOTHERAPY SERVICE DURING THE COVID-19 PANDEMIC: A MIXED METHODS STUDY
Authors: Tague AM , Keating L 
Published: October 2022

Abstract

Background
Reduced physical activity (PA) and increased levels of sarcopenia are possible consequences of the COVID-19 pandemic among older adults. During the pandemic, 26% of people over 70 were inactive. This mixed-methods study aimed to profile PA and sarcopenia levels among older adults attending a primary care physiotherapy service during the pandemic and to explore their experiences of PA.

Methods
Adults over 70 years of age attending a primary care physiotherapy service were invited to participate between September 2021 - January 2022. PA and levels of sarcopenia were captured using the International Physical Activity Questionnaire Short Form and the SARC-F. One-to-one semi-structured telephone interviews were conducted with a sample of the group and analysed using thematic analysis. The Irish College of General Practitioners granted ethical approval.

Results
59 participants (35 females) participated in the cross-sectional study (median age: 79.3; IQR: 12 years). Ninety-one percent of participants (n=54) followed cocooning restrictions. Fifty-six percent (n=33) of participants had low PA levels (95% CI: 43-69%), and 56% (n=33) scored 4 or more on the SARC-F (95% CI: 43-69%), which is predictive of sarcopenia. Ten participants (7 females) completed an interview (median age: 75.4; IQR: 5years). Four themes emerged; 1) a sudden in change in PA levels, 2) the impact of cocooning measures on PA levels, 3) barriers to PA and 4) enablers of PA during the COVID-19 pandemic.

Conclusion
Low PA levels and high levels of sarcopenia were identified among older adults attending a primary care physiotherapy service. Participants were uncertain if they would return to their pre-pandemic PA levels due to slowness of movement and fear of COVID-19. There is a need to address these low PA levels as society enters a new post-pandemic phase.
45 INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE IN FRAIL OLDER PERSONS’ CARE
Authors: McCarthy N , Daly J , Wall O , Wills T , Buckley C ,   HSE/UCC, IPE Development Group Cork, Ireland
Published: October 2022

Abstract

Background
Frail older adults present with complex care needs. Inter-Professional Education (IPE) is a means of creating a practice-ready workforce to improve patient safety and healthcare outcomes. A Steering Group was established comprised of acute and community clinicians, members of the Health Service Executive, service user, students and members of all Schools in the College of Medicine and Health in an Irish University (Medicine, Nursing and Midwifery, Pharmacy, Public Health, Clinical Therapies and Dentistry) to evaluate the effectiveness of IPE. A workshop dedicated to the management of frail older adults occurred for multidisciplinary healthcare students as part of a suite of three IPE workshops.

Methods
The validated ‘Interprofessional Collaborative Competencies Attainment Survey’ (ICCAS) evaluated student views of IPE pre- & post-workshop. This workshop involved a case-based study and facilitated discussion with involvement of frail older adult service users. One service user was in a rehabilitation unit post hospital admission, the other was living well at home. Their participation occurred using an online platform, supported by a consultant geriatrician in the rehabilitation unit and a relative for the home-based service user.

Results
Student scores on the six subscales of the ICCAS (communication, collaboration, roles and responsibilities, collaborative patient-centred approach, conflict management and team functioning) were compared. Scores in all categories achieved statistically significant increases after completion of the IPE workshop. The greatest positive change was observed in collaborative patient-centred approach with pre-workshop scores increasing from a mean of 2.61 to 4.25 (p&lt;0.05).

Conclusion
This initiative explored the inclusion of a frail older adult workshop in the higher education setting. Older adults had an opportunity to share their lived experiences. Evaluation of this IPE initiative will inform future IPE activities to be incorporated into undergraduate education programmes. Similar IPE models can be replicated nationally to enable and enhance team-based working and integrated care.
47 FRAILTY: A QUALITATIVE STUDY EXPLORING THE PERCEPTIONS OF CCCUPATIONAL THERAPISTS IN IRELAND
Authors: Griffin N , O'Sullivan L , Usher R 
Published: October 2022

Abstract

Background
Ireland’s ageing population has resulted in an increasing number of frail older adults presenting to health and social care settings nationwide. Despite growing attention towards older adults’ and health professionals’ perspectives of frailty, the evidence base pertaining to occupational therapists is limited. This study aims to explore occupational therapists’ perceptions of frailty within an Irish context and to investigate whether their perceptions subsequently impact their approach to the assessment and management of frailty.

Methods
A qualitative descriptive design was undertaken to explore the perceptions of frailty of occupational therapists working with older adults. Qualitative data was collected from nineteen (n=19) occupational therapists working across Ireland in various clinical settings participating in four online focus groups. Data were analysed using thematic analysis.

Results
Perceptions of occupational therapists were constructed into three main themes; 1) Conceptualising frailty; 2) Management of frailty; 3) Advancing frailty practice. Occupational therapists in Ireland shared similar perceptions of frailty as a multidimensional concept. Findings suggest that although occupational therapists are well-equipped in the provision of care for frail older adults, participants believed that the profession’s scope is not optimised in the assessment and management of frailty.

Conclusion
This study is the first of its kind to be conducted in Ireland, therefore contributing to the growing frailty research field. Development of community services, the enhancement of undergraduate frailty education, and a movement towards a shared understanding of frailty between clinicians and patients are recommended to progress occupational therapy in the context of frailty management.
53 A REVIEW OF THE RAPID ACCESS FRAILTY TEAM (RAFT) IN THE EMERGENCY DEPARTMENT OF A MODEL THREE HOSPITAL
Authors: O'Neill A , Brady A , Donnelly T , McGlynn J , Moore A , Hopper C 
Published: October 2022

Abstract

Background
The Rapid Access Frailty Team (RAFT) in the Emergency Department (ED) has evolved since 2016. The team comprises of 1 senior occupational therapist and 1 senior physiotherapist. The focus of the team is recognition and management of frailty in ED. Patients discharged by RAFT in ED are often followed up in our Rapid Access Frailty Hub. This audit examined the incidence and outcomes of frail older persons presenting to our ED and the impact of intervention from the Rapid Access Frailty team.

Methods
A Variable Indicative of Placement Risk (VIP) positive patient triggers an assessment by RAFTT in ED post triage. Analysis of intervention and discharge destination were used to assess the effectiveness and role of the team.

Results
We compared data over two distinct 6 month periods, between September – February 2019-2020 and 2021-2022. 2723 patients &gt;75 presented to ED in 2019 - 2020. Of these, 1620 were VIP positive patients. 628/1620 patients were seen by RAFFT. 443/628 (70.5%) assessed by RAFT were discharged. In comparison to 2021-2022, we saw an increase with 2818 patients &gt;75, 1657 of which were triaged as frail. 559 patients were assessed by RAFTT and 286/559 (51%) were discharged. We observed 20% reduction in our discharge rate. Most patients received on average five interventions each. 60% of patients received a mobility assessment, 45% received falls prevention intervention and 37% were provided with equipment to facilitate discharge.

Conclusion
Over a two year period we observed an increase in frail patients presenting to our ED. Comprehensive assessment by RAFT in ED is promoting discharge. The follow up through the frailty hub has enhanced our ability to follow up in a timely manner. We hypothesize that the reduction in discharge rates in 2021- 2022 may be due to deconditioning experienced by older adults post pandemic and the increased demand for medical intervention and admission.
54 EMERGENCY PERIOPERATIVE FOR THE OLDER PERSON SERVICE (POPS) IN AN IRISH TERTIARY HOSPITAL: RESULTS OF 16-WEEK COMPREHENSIVE GERIATRIC ASSESSMENT INTERVENTION
Authors: Plant R , Stanely E , Dukelow T , Aherne E 
Published: October 2022

Abstract

Background
Evidence suggests older persons undergoing surgery benefit from Comprehensive Geriatric Assessment (CGA). The Republic of Ireland (ROI) is yet to implement formalised perioperative care services outside of Orthogeriatrics. We present data from an Emergency Perioperative for Older Person Service (POPS) utilising CGA as an intervention in an Irish Tertiary Hospital.

Methods
A geriatric medicine registrar performed CGA on patients over 75 admitted for unscheduled General or Vascular Surgery. Senior decision-makers could refer patients under 75 whom they considered frail. Data collected: demographics; clinical frailty score (CFS); identified delirium; length of stay (LOS); mortality during admission; 90-day mortality; 30-day readmission; new Acute Kidney Injury (AKI) during admission. We compared this data to the corresponding cohort of patients admitted in 2019 (Pre-COVID19 pandemic).

Results
104 patients underwent CGA over 16 weeks. 50.5% (48/104) were female. Average age was 82. 34.6% (36/104) CFS ≥5. 24.2% (23/104) had delirium on admission. 31.7% (33/104) had identifiable delirium throughout their admission. Pre-COVID19 data (n=92) vs POPS data (n=104): Average LOS: 14.6 days vs 13.3 days; AKI new/worse during admission 29% (28/92) vs 15% (16/104); Mortality during admission 8.6% (8/96) vs 7.7% (8/103); 30 day readmission 19.3% (17/88) vs 17.7% (17/96). 90 day mortality 14.1% (13/92) vs 16% (13/80 to date).

Conclusion
Our data is, to our knowledge, the first in the ROI to capture CGA intervention in an Emergency Surgical Ward. Early data demonstrate positive trends. We believe the implementation of perioperative CGA would benefit older patients undergoing emergency surgery in Ireland.
56 SARCOPENIA SCREENING FOR INDEPENDENTLY MOBILE STROKE PATIENTS IN AN ACUTE HOSPITAL SETTING
Authors: Murphy D , Crowley A , Fitzpatrick M 
Published: October 2022

Abstract

Background
Sarcopenia appears to be under-assessed and under-treated in the stroke population. It has been suggested by EWGSOP2 criteria, that if there is a clinical suspicion of sarcopenia, an intervention for this is appropriate. In order to establish the need for this in the independent stroke population an audit of the clinical prevalence of sarcopenia in independently mobile stroke patients was completed.

Methods
An excel spreadsheet was compiled of a convenient sample of stroke patients who were independently mobile post stroke. Their grip strength and five times sit to stand was audited along with the patient’s age and sex. This information was then used to assess for sarcopenia risk as per the EWGSOP2 guidelines.

Results
Fifteen patients were assessed, all of whom were independently mobile with or without an aid post admission for a primary diagnosis of acute stroke. Their age ranged from 64 to 86. Of these patients 93% were deemed likely to have sarcopenia based on their clinical assessment. This was based on grip strength measurements and time taken to complete five sit to stands. These clinical signs indicate low muscle strength and likely sarcopenia.

Conclusion
Currently no intervention is provided for these patients in relation to sarcopenia from the physiotherapy department. This audit indicates that this is currently an unmet need and these patients may benefit from an intervention to address this significant issue.
59 IMPROVING DELIRIUM AWARENESS AMONGST JUNIOR DOCTORS IN A REGIONAL HOSPITAL
Authors: Condon C , Connaughton R , Keady N , Martin M 
Published: October 2022

Abstract

Background
Delirium is a common medical emergency which is well known to be associated with adverse outcomes but often remains under recognised and inappropriately managed in the acute care setting. This audit aimed to assess Non-Consultant Hospital Doctors (NCHDs) approach to diagnosing, managing and prescribing in patients with delirium.

Methods
Data was collected via an anonymous questionnaire and distributed to NCHDs in April 2021 and repeated again in March 2022 following several education sessions on delirium and the inclusion of the 4AT screening tool in the medical admission pro-forma. A point prevalence survey on 20 randomised patient charts was completed in April 2022 to establish if a 4AT score was documented by NCHDs in the medical admission pro-forma.

Results
Two audits were completed over a one-year period between April 2021 and March 2022 including NCHDs, n=25 and n=26 respectively. The results showed that 56% vs 70% considered delirium as a medical emergency, 40% vs 77% stated that they used the 4AT tool when assessing cognition in patients aged over 65 years of age and 72% vs 76% stated that they did not use any guideline when prescribing a medication for a patient with delirium. However, on review of 20 medical charts, 0% of patients had a documented 4AT score completed on admission in April 2022.

Conclusion
Although there was a positive improvement in NCHD’s knowledge of delirium diagnosis and management on paper, it was evident that this did not transpire into clinical practice. We will address this by delivering further education sessions on delirium, with a plan to re-audit. We have also made the National Delirium Algorithms visible in the emergency department and on the wards to act as visual prompts for our NCHDs.