bluuebunny/crossref_metadata_2025_split huggingface dataset:
35 GERIATRIC EMERGENCY MEDICINE (GEM)’ PEARLS AND PITFALLS’- AN INTERDISCIPLINARY APPROACH TO EDUCATION
Authors: McGettigan L , Abdullahi AS , Loughlin KM , Lyons C , Reddin C , Keane O 
Published: October 2022

Abstract

Background
In recent years we have seen increased awareness of the terms ‘frailty’ and ‘GEM’ in many of our Emergency Departments (ED). A clear understanding of these terms within the context of ED is essential to provide a holistic care and to best meet the needs of older adults. It has been highlighted internationally that current training programmes do not sufficiently address learning needs of trainees to optimise care of this cohort of patients. The European Geriatric Medicine Society and the European Society for Emergency Medicine has attempted to address this gap through the introduction of a core GEM curriculum in 2016, however, at a local level many EDs are not utilising this resource for a number of reasons including lack of awareness and prioritisation of other local learning needs as determined by specialist training. To address the GEM learning needs at a local level an initiative idea was trialled in the form of a GEM teaching wall with dedicated monthly topics chosen from the above curriculum.

Methods
The initiative was led by a Senior Physiotherapist working on the Frailty Intervention Therapy Team and a Senior House Officer (SHO) working in ED with collaboration from other ED members as identified. A brainstorming session took place to identify potential topics. A poster was created by the project leads each month focusing on a core topic including an overview on the subject, national/international guidelines and top tips how to best manage in ED. Relevant team members contributed to different topics. Monthly posters were displayed in the ED.

Results
The project has been successfully running for 4 months with topics including Abdominal pain, Silver trauma Delirium and Falls.

Conclusion
GEM teaching is a cornerstone of successful management of older adults presenting to our EDs. Novel MDT teaching approaches can address the identified learning gap in this area and highlight international recommendations with minimum cost.
36 WHAT DO OLDER ADULTS AND HEALTH CARE PROFESSIONALS LOOK FOR IN A FOOD PRODUCT?
Authors: O'Mahony L , O'Shea E , O'Connor E , Tierney A , Dunne N , Harkin M , Harrington J , Tobin K , Kennelly S , Arendt E , O'Toole P , Timmons S 
Published: October 2022

Abstract

Background
The Mediterranean diet (Medi-diet) has proven benefits for healthy ageing but isn’t the habitual diet of most middle-aged or older adults in Ireland; there can be accessibility and tolerability issues with high amounts of fresh fruit and vegetables. Providing key Medi-diet nutrients in a food product is a novel approach to this challenge. This research aims to explore what ‘younger-old’ adults and healthcare professionals (HCPs) would value in such a novel food product.

Methods
Semi-structured 1:1 interviews and Focus Groups (FGs) were conducted remotely from July 2021 to January 2022. Older adults, defined as over 55’s, were recruited through relevant social, retirement and disease-support groups. Purposive sampling recruited a gender balance and a range of ages and disease profiles. HCPs were recruited through researcher networks and professional associations. Interviews/FGs were recorded, transcribed, and subsequently examined using inductive thematic analysis.

Results
Older adults (n=47; 50% male) were mostly aged 60-69 years (48.9%). Recruited HCPs (n=26) included dieticians (n=8); geriatricians (n=5); therapists (n=4); and nurses, pharmacists, catering managers (community; residential), and meal delivery service coordinators (n=2 each). Participants supported a food product for older adults requiring a nutrient-dense “boost”, or supplementary fibre or protein, but generally preferred a “food-first” approach, as opposed to a “silver bullet” product. Older adults largely associated functional foods with probiotic products “to repair the gut”, something to have “every now and then”. Product texture and portion size should consider changing dentition and appetite, and consider packaging (dexterity) and preparation ease, but should not stigmatize older adults through targeted branding. Participants felt pre-made soups or cake-type bars would be appealing, but not drinks.

Conclusion
A novel food product could supplement a balanced diet for older adults, providing high-protein content, and high-fibre for gut health, complimenting an overall lifestyle approach to health improvement and disease prevention.
37 RE-AUDIT OF VITAMIN D SUPPLEMENTATION IN FRAIL OLDER ADULTS PRESENTING TO AN IRISH LEVEL 5 EMERGENCY DEPARTMENT
Authors: Pender C , O'Caheny C , Byrne C , Magner S , Carey S , Carrabine N , Mitchell M , Laguna R , Harrington G , Buckley B , Smyth H 
Published: October 2022

Abstract

Background
The Department of Health published new guidance in November 2020 “Vitamin D advice for people aged 65 and older” which recommended that all adults ≥65 years should be supplemented with 15micrograms of Vitamin D daily. 55.5% of adults ≥65 years have insufficient/deficient vitamin D levels in winter (TILDA 2020). The Frailty Intervention Team (FIT) assess frail adults ≥65 years in the Emergency Department using medication review and Comprehensive Geriatric Assessment to identify vitamin D supplementation. The audit aim was to determine if compliance with the new guideline improved since the initial audit in January 2021.

Methods
All patients who had a medicine reconciliation completed by the FIT Pharmacist in January 2022 were included in a retrospective audit. Patients were identified from the pharmacist’s worklist. Data was collected from a Hospital Clinical System using a Microsoft Excel®. The data recorded included: Age, Sex, Rockwood Clinical Frailty Score (CFS) and vitamin D supplementation.

Results
The FIT Pharmacist completed 66 medicine reconciliations in January 2022. The mean age (+/-SD) was 82.4 (+/-7.6) years.The male to female ratio was 1:1.75The median CFS was 5 (mildly/moderately frail) with an IQR of 1.
68% (n=45) were prescribed vitamin D. Of those 89% (n=40) were prescribed a supplement containing at least 15micrograms of vitamin D. 32% (n=21) were not prescribed any vitamin D supplementation. 8% (n=5) were prescribed doses lower than 15micrograms of vitamin D.

Conclusion
Compliance with the new guideline was 61% (n=40) in comparison to 65% (n=39) in the initial audit. The results are reflective of adherence to the new guideline in the community. The policy update and education provided post the initial audit has possibly influenced the prescribing of vitamin D in the acute setting which unless patients are re-presenting will not have been captured in the outcome of this re-audit.
38 IDENTIFICATION OF POTENTIALLY INAPPROPRIATE MEDICATIONS IN FRAIL OLDER ADULTS RESIDING IN LONG-TERM CARE: A RETROSPECTIVE CHART REVIEW STUDY
Authors: Heinrich CH , McHugh S , McCarthy S , Donovan MD 
Published: October 2022

Abstract

Background
Deprescribing is associated with positive health outcomes for older adults in long-term care, however deprescribing is not universally implemented. This study aims to identify the most prevalent Potentially Inappropriate Medication (PIM) used among frail older adults resident in Irish Long-Term Care Facilities (LTCFs), as identified by the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy version 2 (STOPPFrail V2), to form the basis of a deprescribing intervention.

Methods
A retrospective chart review was conducted in two publicly-funded LTCFs in the South/Southwest of Ireland (‘Site 1’ and ‘Site 2’). Eligible participants were those: (i) ≥65 years, (ii) resident in Site 1 or 2, (iii) eligible as per the STOPPFrail v2 criteria by the site’s medical officer, and (iv) receiving regular prescribed medication. Data collected included age, gender, drug, dose, frequency, regular/pro re nata and indication/relevant diagnoses. Descriptive and associative statistics were calculated. STOPPFrail was used to identify PIMs. Polypharmacy (taking ≥ 5 medications) and excessive polypharmacy (taking ≥10 medications) were calculated on the percentage of STOPPFrail eligible patients.

Results
Of the 103 residents screened, 89 were eligible and included in the analysis (86%). The prevalence of frailty for residents aged ≥65 was 93.7% (n=89), polypharmacy 95.5% (n=85) and excessive polypharmacy 64% (n=57). The mean number of regular medications (standard deviation) was 10.8 (±3.8), total medications 17.7 (±5) and diagnoses 5.5 (±2.5). A significant relationship existed between the number of PIMs and the number of medicines prescribed (ρ 0.525, p&lt;0.01). The most common PIMs were those with no clear indication, followed by the antihypertensive medications and ergocalciferol/cholecalciferol.

Conclusion
Medication and PIM usage was high among LTCF residents, with inappropriate polypharmacy of concern. Potential deprescribing interventions include documenting indications for medications, incorporating routine blood pressure measurements and drug-specific guidelines to support deprescribing PIMs, reducing drug-related morbidity and medication burden.
48 EXPLORING RESIDENTS’ PERCEPTIONS OF SOCIAL AND LEISURE OCCUPATIONAL CHOICE WITHIN NATIONAL NURSING HOME CARE FACILITIES
Authors: Ryan C , Keane J , Usher R 
Published: October 2022

Abstract

Background
National standards state that nursing homes in Ireland must provide residents with a variety of engaging activities that accommodate their needs and preferences. Despite this, residents are at risk of experiencing occupational deprivation as a result of limited choices within these settings. Due to the subjective nature of occupational choice, the objective of this study is to analyse residents’ perceptions of leisure and social occupational choice in nursing homes in Ireland.

Methods
The study adopted a qualitative-descriptive design. Six residents from three different nursing homes participated in two semi-structured interviews that analysed their leisure and social occupational engagement within their nursing home.

Results
The data identified two main themes that were divided into six related sub-themes. Residents' felt their social and leisure occupational choice was influenced by: (1) environmental factors (the cultural, social, physical, and temporal contexts of the nursing home) and (2) personal attributes (residents' health status and personal attitudes).

Conclusion
Residents' leisure and social occupational choices are substantially influenced by the cultural context of the nursing home. This stresses the significant need for person-centred care in nursing homes, in order to promote occupational choice. The findings also highlight the benefits of accessible communal spaces to enable unstructured social interaction. Occupational therapists are essential to support the leisure and social occupational choices of nursing home residents and minimise occupational deprivation, by building residents’ skills, providing staff education and modifying tasks and/or the environment.
50 SERVICE EVALUATION COMPARING ACUTE CARE AT HOME FOR OLDER SEOPLE SERVICE AND CONVENTIONAL ACUTE HOSPITAL CARE OF THE ELDERLY WARD
Authors: Tierney B , Todd S , Melby V 
Published: October 2022

Abstract

Background
Globally, there has been an increased demand for healthcare services caused by population growth and a rise in chronic conditions and an ageing population. Acute Care at Home services offer acute, hospital-level care in a person's own home. Five services have been commissioned across Northern Ireland since 2014 with limited research investigating their feasibility and effectiveness. This study evaluated the impact of a consultant-led Acute Care at Home service in comparison with conventional hospital admission to a care of elderly ward.

Methods
Quantitative design, using service evaluation methodology. A 1-year retrospective chart review was undertaken exploring admission demographics and post-discharge clinical outcomes of patients admitted to a Northern Ireland, Care of the Elderly ward (n = 191) and a consultant-led Acute Care at Home Service (n = 314) between April 2018–March 2019. Data were analysed using descriptive and inferential data analysis methods including frequencies, independent t tests and chi-square analysis. Outcome measurements included length of stay, 30-day, 3-and 6-month readmission and mortality rates, functional ability and residence on discharge. STROBE checklist was used in reporting this study.

Results
Acute Care at Home services are associated with higher readmission and mortality rates at 30 days, 3 and 6 months. Patients admitted to the Acute Care at Home services experience a reduced length of stay and decreased escalation in domiciliary care packages and are less likely to require subacute rehabilitation on discharge. There is no difference in gender, age and early warnings score between the two cohorts.

Conclusion
The Acute Care at Home service is a viable alternative to hospital for older patients. It prevents functional decline and the need for domiciliary care or nursing home placement. Acute Care at Home service has higher mortality and readmissions rates due to treating a higher proportion of dependent, frail older adults.
55 A MOBILITY PROFILE OF STROKE PATIENTS ADMITTED TO A LEVEL 4 ACUTE HOSPITAL OVER A 6-MONTH PERIOD
Authors: Murphy D , Crowley A , Fitzpatrick M 
Published: October 2022

Abstract

Background
In order to best direct physiotherapy stroke resources and further service development it is important to characterise the mobility of stroke patients presenting to an acute hospital.

Methods
A previous audit completed in 2018 in the same organisation established that by using the Berg Balance Scale (BBS) and the Mobility Scale for Acute Stroke (MSAS) as admission outcome measures, a baseline profile could be established while limiting the floor and ceiling effects. A retrospective audit was completed of all patients referred to the stroke physiotherapy service admitted with acute stroke in a 6 month period. An excel spreadsheet was used to record patients’ admission BBS and MSAS. This was recorded along with the mainstay of physiotherapy treatment and discharge destination.

Results
145 stroke patients were assessed by stroke physiotherapy between Oct 2021 and April 2022. Of those patients 30% scored full marks on the MSAS which indicates that they were independently mobile with or without an aid post stroke. 26% of patients scored 3 or less on the BBS which would imply they were unable to sit without help.

Conclusion
This audit provides valuable information on the mobility profile of stroke patients presenting to an acute Level 4 hospital. On admission, patients seem to fall into 3 distinct categories based on their physical function post stroke. One group remained independently mobile post stroke, one group were heavily dependent being unable to sit without assistance and the final cohort requiring some level of supervision or assistance for mobility and balance. This information could be used to facilitate therapy and resource planning.
60 POWER-AGERS: IMPLEMENTING PROGRESSIVE RESISTANCE TRAINING TO MANAGE SARCOPENIA AMONG COMMUNITY DWELLING OLDER ADULTS
Authors: Gilheany Á , Synnott E , McDonnell I , McDaid E , Ross E , Boyle N , Carey G 
Published: October 2022

Abstract

Background
The prevalence of sarcopenia among community dwelling older adults is between 10-40%. Progressive Resistance Training (PRT) improves sarcopenia and functional performance among older-adults. A PRT programme was introduced to a Day Hospital service as part of a sarcopenia management quality improvement initiative.

Methods
The PRT programme was implemented on a phased basis. Phase 1 evaluated the feasibility, safety and participant satisfaction. Phase 2 then collected pre and post outcome measures (gait-speed, grip strength and 5-Times-Sit-to-Stand [5TSTS]), and a patient perception questionnaire. The intervention consisted of a physiotherapist-lead PRT programme (weekly in phase 1 and biweekly in phase 2). Recent community dwelling Day Hospital attendees were recruited by the physiotherapist to participate. The class consisted of a circuit of 4-6 exercises targeting upper and lower limbs, along with an educational component. Exercises were progressively overloaded on an individual basis.

Results
Ten participants attended the PRT programmes (phase 1 [n=5], phase 2 [n=5]). Most were female (n=6), mean age was 84 years. None had prior formal experience of PRT. The phase 1 PRT group was deemed feasible and safe in an outpatient setting. All phase 1 participants (n=5) felt it was beneficial and rated it 5/5. All phase 2 participants had improvements in sarcopenia markers (grip strength [range=1kg-9kg], gait-speed [range=0.04m/s-0.19m/s], and 5TSTS [range=5.1sec-11sec]). All participants reported that the programmes improved their confidence in PRT and that they were interested in continuing PRT in the future.

Conclusion
This supports that PRT a clinical setting with community dwelling older adults is safe, feasible and effective in improving sarcopenia markers. Furthermore, the high rate of satisfaction supports its use with this population. Further research is required to examine the impact of combined nutritional education with strength training as an intervention for older adults with sarcopenia.
64 HIGH-DOSE STEROIDS IN HAEMATOLOGICAL MALIGNANCY: A RED FLAG FOR BONE HEALTH
Authors: Kemple O , Brady S , McHugh J , Desmond R , Meade L , Enright H 
Published: October 2022

Abstract

Background
Bone-protective treatment should always be considered when commencing glucocorticoid therapy in individuals at high risk of fracture, as outlined in recent guidelines (National Osteoporosis Guideline Group, July 2018). Despite this, many patients receive high dose glucocorticoids (&gt;7.5mg/kg/day or equivalent for &gt;3 months) during treatment of haematological malignancy without formal assessment of bone health.

Methods
Twenty-five patients with Non-Hodgkin’s Lymphoma (NHL) on high dose steroid chemotherapy protocols were retrospectively assessed. The inclusion criterion was defined as any patient commenced on a cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) containing protocol from 1/8/2020 to 1/8/21. Data was collected from electronic and written patient records. Information regarding patient age, diagnosis, steroid preparation and dose, presence of risk factors for osteoporosis and calcium and vitamin D prescriptions were collected. Radiological imaging was reviewed to assess for the occurrence of fragility fractures. Each patient had a FRAX® score calculated to assess fracture risk.

Results
The mean age of patients studied was 67 years and equally distributed between males and females. All patients had NHL. 32% (n=25) of patients were identified to be at high risk for fracture (FRAX® score &gt;20% ten-year probability of major osteoporotic fracture). 16% had already established fragility fractures prior to commencing steroid treatment. 28% of patients were females over the age of 70 years. Only 12% of patients received vitamin D and calcium supplementation. No patient commenced bone protection therapy.

Conclusion
Omission of bone health assessment prior to high dose glucocorticoid treatment is prevalent in haematological malignancy and places patients at risk of significant morbidity. Patients are not routinely considered for protective measures including calcium and vitamin D supplementation and bone protection therapy. A simple risk-assessment tool and education to staff and patients prior to glucocorticoid therapy could significantly improve practice in this area. It is now planned to introduce routine risk assessment for this cohort of patients, with re-audit following implementation.
69 BUILDING TOWARDS COMPREHENSIVE GERIATRIC ASSESSMENT (C.G.A.) – A STEP-BY-STEP CPD PROGRAM
Authors: O'Connor S 
Published: October 2022

Abstract

Background
The National Clinical Programme for the Older Person (2016) advises Comprehensive Geriatric Assessment (CGA) as the gold standard for the management of frailty in older people. Over the past three years the Medicine for the Elderly (MedEl) OT service have introduced a number of key quality initiatives as part of a wider Continuous Professional Development (CPD) program to support adherence to the CGA guidelines. These initiatives have focused on implementing staff development and training, and clinical processes to provide OTs with the necessary knowledge, skills and structures to carry out CGA

Methods
An audit of OT initial assessments was completed in which data pertinent to CGA was collected, this identified poor compliance and led to the re-design of the OT MedEl Staff Grade competencies in line with CGA guidelines. The team In-services and staff grade peer support were also re-designed into cycles based on the key performance domains within CGA such as upper limb and cognition. It was hoped that a more coordinated approach to CPD, beginning with the structures in place would result in improved knowledge and skills to carry out CGA.

Results
An audit of OT initial assessments was completed in which data pertinent to CGA was collected pre and post in-service cycles. This demonstrated an average increase of 21% across the 9 performance domains. Staff also self-rated their knowledge, skills and confidence in relation to the key performance domains within CGA which demonstrated an average improvement of 12.5%.

Conclusion
As part of an ongoing iterative testing cycle, a further re-audit of the OT Initial Assessment tool will be completed in the next quarter to ascertain the long-term impact of a coordinated, cohesive CPD program to support sustained implementation of CGA within our service.
71 A MOBILITY PROFILE OF THE PATIENTS ADMITTED TO AN ESD SERVICE IN IRELAND
Authors: Crowley A , Dhochartaigh DN , Murphy A , Gough D , Fitzpatrick M 
Published: October 2022

Abstract

Background
Early Supported Discharge (ESD) allows patients to receive multidisciplinary stroke rehabilitation in their own home upon discharge from the acute hospital setting. ESD is recognised as international best practice for patients with mild to moderate impairments post stroke. An ESD team was set up in September 2020 from an acute hospital. A retrospective audit was carried out to profile the mobility of patients referred to the physiotherapy ESD service.

Methods
A retrospective chart audit was carried out on 42 patients referred to physiotherapy during the first six months of the ESD service. Data was collected on admission and discharge from hospital, for those patients being referred to ESD on the following: age, mobility, Berg Balance Scale score and length of stay.

Results
The mean age of the patient group was 70 (range 41 – 80 years). On discharge to ESD, 80 % of patients were independently mobile with or without an aid . Supervision or assistance of one person was required by 20% of patients. Thirty percent of patients were off their baseline mobility on discharge to the ESD service. The average Berg Balance Scale score was 51. The mean length of inpatient stay for ESD patients was 12 days compared to 33 days for those awaiting offsite rehabilitation.

Conclusion
This data demonstrates that the majority of patients admitted to ESD were independent with mobility. This patient cohort most likely required higher level physiotherapy interventions such as exercise tolerance progression, community integration and upper limb rehabilitation. Further research should evaluate the range of interventions provided within this ESD physiotherapy service.