bluuebunny/crossref_metadata_2025_split huggingface dataset:
192 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): 12-MONTH TRAJECTORY OF QUALITY OF LIFE IN PEOPLE WITH DEMENTIA
Authors: Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , Power D , O'Shea D , Doyle R , Blake C 
Published: October 2022

Abstract

Background
Research is needed to examine how Quality of Life (QoL) changes as dementia progresses. We explored QoL trajectories over a 12-month period and examined factors that influence QoL in People with Dementia (PwD).

Methods
Fifty-two PwD and their informal caregivers participated in the “CHESS” Study. Data were collected at five time points over 12 months between April 2017 and November 2019. Mixed-model analyses were used to investigate associations of self-rated QoL and caregiver-rated QoL (measured by the DEMQoL and DEMQoL Proxy, respectively) with factors in four domains: 1) Psychological Well-Being (PWB; measures of anxiety and depression); 2) Social Capital and Resources (SCR; incorporating access to community-based health services, education level, occupation and living situation of the PwD, employment status of the caregiver); 3) Physical Fitness and Health (PFH; including the Quantitative Timed Up and Go (QTUG), baseline grip strength, indices of frailty, sensory acuity); and Managing Everyday life with Dementia (MED; incorporating measures of cognition, behavioural disturbances, functional ability, indices of dependence of PwD).

Results
Across all domains, caregivers’ ratings of QoL for PwD decreased over time (p=0.012). In PWB, greater levels of depression (p=0.007) and anxiety in the PwD (p&lt;0.001) predicted lower self-rated QoL, and higher caregiver anxiety levels predicted lower caregiver-rated QoL (p=0.012). In PFH, having a caregiver administer medication (p=0.03) was associated with higher self-rated QoL. Interestingly, caregiver-rated QoL was higher for PwD who took longer to return to sitting during the QTUG (p=0.043). In MED, being independently mobile (p=0.012) predicted higher self-rated QoL. No other factors within the SCR domain reached significance in predicting QoL.

Conclusion
This longitudinal analysis elucidates potential predictors of QoL in PwD. Psychological well-being in PwD and their caregivers was shown to significantly impact on QoL, and so, these factors should be routinely included in future research studies and clinical assessments.
194 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): SMART HEALTH TECHNOLOGY ACCEPTABILITY BY INFORMAL CAREGIVERS OF PEOPLE WITH DEMENTIA
Authors: Blake C , Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , O'Shea D , Doyle R , Power D 
Published: October 2022

Abstract

Background
The prevalence of dementia is increasing worldwide, and innovative strategies are required to meet increasing demands on health services. The Connected HEalth Sustaining home Stay in Dementia (CHESS) Study aimed to provide support to People with Dementia (PwD) and their caregivers in their homes. We aimed to quantitatively assess the acceptance of smart connected health technology by caregivers of PwD through use of standardised questionnaires.

Methods
Fifty-two PwD and their informal caregivers were recruited by convenience sampling to the intervention arm of the CHESS Study. An additional 25 dyads acted as control participants. Questionnaire data were collected following completion of the CHESS study from 27 informal caregivers from the CHESS Technology group and 16 informal caregivers from the Control group. Measures of health technology acceptability included the System Usability Scale (SUS), the eHealth Literacy Scale (eHEALS), the Technology Readiness Index 2.0 (TRI), and the Unified Theory of Acceptance and Use of Technology Scale (UTAUT). Univariate analyses of variance were used to explore differences between groups.

Results
Internal consistency (Cronbach’s alpha) was high for all measures (range 0.68 – 0.96). The SUS score for the technology group was high (M=70.07, SD=17.69), indicating that the CHESS technology had a high level of usability. All participants had a high level of eHealth literacy (M=33.61, SD=10.51). Both groups performed similarly on the TRI and UTAUT, however the control group indicated greater discomfort with health technology and felt less secure in providing their personal information electronically to healthcare professionals than the technology group.

Conclusion
Caregivers across the technology and control groups had high levels of eHealth literacy and found health technology to be generally acceptable. The CHESS technology in particular was rated as highly usable on the SUS by those who used it. These findings offer support for a Connected Health model of care.
196 AN AUDIT OF PROTON-PUMP INHIBITOR PRESCRIBING IN PATIENTS ATTENDING A RAPID ACCESS FRAILTY ASSESSMENT UNIT
Authors: McDonnell E , Corcoran L , Donnelly T 
Published: October 2022

Abstract

Background
Proton-Pump Inhibitor (PPI) usage has revolutionised gastroenterology practice with clinical indications for conditions such as Gastro-Oesophageal Reflux Disease (GORD), gastric and duodenal ulceration and Barrett's Oesophagus. However, these drugs are inappropriately prescribed, particularly among patients with an already heavy polypharmacy burden. PPI usage has been linked with electrolyte disturbances, most commonly hypomagnesaemia, resulting in higher rates of osteoporosis. It has also been shown to have adverse effects on renal function, an increased correlation with clostridium difficile and most recently, a deleterious impact on cognitive function. The purpose of this audit was to assess the appropriateness and clinical indication of PPI prescribing among patients attending Rapid Access Frailty Assessment Unit (RAFAU) in 2022.

Methods
A database of patients attending RAFAU in an Irish regional hospital was accessed. Records from years 2021-2022 were searched and documents citing patients’ medical history and clinical indication for prescribed medications included hospital discharge letters, outpatient clinic letters and GP referral letters. NICE guidelines from the UK NHS were used as comparison for prescribing guidelines.

Results
120 patients’ records were assessed. 63 (52.5%) patients were found to be prescribed a PPI among this cohort. Of those taking PPIs, only 15 (23.8%) patients were prescribed a PPI with a documented clinical indication in accordance with NICE Guidelines. Although several patients were taking gastro-erosive drugs including antiplatelets, anticoagulants and steroids, only one patient record mentioned PPIs being prescribed for iatrogenic gastritis. No records mentioned deprescribing or cessation of PPIs.

Conclusion
Most patients prescribed PPIs were without documented appropriate clinical indication and without clear duration of use. This is of particular importance among a frailty population where de-prescribing medications associated with significant co-morbidities should be prioritised.
197 IMPROVING THE ASSESSMENT OF VISION IN OLDER ADULTS AT RISKS OF FALLS AT A DAY REHABILITATION CLINIC
Authors: McDowell V , Maxwell K , McLoughlin A 
Published: October 2022

Abstract

Background
Assessment of vision is a key component of multifactorial falls prevention programmes. However, the National Audit of Inpatient Falls (2015) found less than half of older adults had a vision assessment when admitted to hospital. We suspected vision assessment could also be improved for patients attending our outpatient Day Rehabilitation Unit who were falling or at risk of falls.

Methods
21 outpatients were audited initially, with determination of baseline characteristics including age and Rockwood frailty score. We assessed whether past ophthalmological history was documented, whether the patient wore glasses and whether they had had a recent eye test in the community. Finally, documentation regarding visual examination was audited; this comprised range of eye movement, visual fields and visual acuity assessments. We adapted the clinic proforma to include a specific section on ophthalmology history and visual assessment; 14 patients were re-audited following intervention.

Results
Our two groups were relatively similar: mean age of 80 in the initial audit and 78 in the subsequent audit. Both groups had an average Rockwood score of 5. Improvements were noted in documentation regarding previous eye testing (33.3% - 86%), testing of eye movements (71.4% - 100%, and testing of visual fields (66.7% - 93%). There remained no testing of visual acuity following intervention.

Conclusion
A dedicated falls proforma targeting specific risk factors for falls improves identification and assessment of those risks. This enables targeted intervention and referral to be made to improve patient outcomes. For further improvement we would recommend educating the multidisciplinary team on how to test for visual acuity in the outpatient setting.
198 A UNIQUE COMMUNITY POST-DIAGNOSTIC DEMENTIA SUPPORT SERVICE DELIVERED BY THE ADVANCED NURSE PRACTITIONER
Authors: Carey E 
Published: October 2022

Abstract

Background
In Ireland, approximately 67,744 people live with dementia and 63% reside in Irish communities with increasing care cost estimated at €58,550 per person, which is set to rise alongside increasing longevity (HSE, 2020; Department of Health, DOH 2014). Across the Republic of Ireland, care provision predominantly focuses on middle or later stages of the journey, leaving the newly diagnosed and their care partner as somewhat the invisible. Service provision for post diagnostic dementia services is disjointed, with resource allocation at a low level of provision relative to need, leading to inequity with subsequent disparity resulting in significant geographical variation in the provision of services.

Methods
Robust interdisciplinary community care pathways developed underpin this ANP Service. The multi-element pathway structure delivers community clinics for Dementia, NCSD and LivDem programmes alongside support networks for family care partners, amongst others. Support and care provision is demonstrated from point of diagnosis and throughout the dementia journey for the patient and family care partners, which is unique in Irish healthcare. ANP service provision through interdisciplinary collaboration has achieved increased QOL outcomes alongside illuminating KPI's and audit outcomes. Capturing dementia services early optimises outcomes for all involved including health service cost reductions, all in one setting.

Results
Patient satisfaction outcomes range from 71 - 100% with service intervention outcomes favourably indicating the direct impact of the service, which are unmeasurable to the older adult living with dementia, and include increases in: (i) Confidence - 90%; (ii) Mood - 50% and (iii) open to talking through difficulties encountered - 87%. This service contributes to innovations in practice in this complex care area and now achieves 60 attendances each month

Conclusion
Advanced practice drives collaboration and integration across services delivering on hospital avoidance, early supportive discharge and timely access to services. Facilitating early post diagnostic dementia services optimises interdisciplinary collaboration, crucial to achieve aging in place with timely access to services for all older adults.
199 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA
Authors: Myint H , Simmons M , Cruz J , Diaz B , Baldonado G , Edwards B , Kiriyadoss D , Drummond K , Mulkerrin E 
Published: October 2022

Abstract

Background
Pressure Injury (PI) management is challenging for dependent patients in Acute Care Wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition). A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long-Term Care (LTC) wards and thus may improve outcomes.

Methods
The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD.
After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (60 % female; 19/30). All had stage 2-4 PIs (present in 83% on admission to ACW). On transfer to LTC wards, all had severe physical dependency with mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days.

Results
PI improvement by &gt;2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (&lt;21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying.

Conclusion
These results suggest an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation is planned.
202 PATIENTS &gt;65 YEARS ADMITTED WITH AN ACUTE SURGICAL PRESENTATION: REVIEW OF OUTCOME MEASURES FOLLOWING OFF-SITE GERIATRICIAN-LED REHABILITATION
Authors: Treanor C , Smith J , Bhuachalla B Ní , Hoey A , McGreevey S , Faul E 
Published: October 2022

Abstract

Background
The most common causes for surgical admissions in our model 3 hospital are: (1) abdominal pathologies requiring conservative and/or operative management; (2) traumatic injuries leading to rib/sternal fractures; (3) Traumatic Brain Injuries (TBI). With life expectancy increasing, the number of older adults undergoing intra-abdominal surgery and presenting with traumatic injuries is increasing. This cohort often experience high levels of frailty and significant morbidity and mortality due to poor physiological reserves. Further functional decline post-admission causes higher rehabilitation needs with greater risk of requiring long-term care. Care of Older Person Services are under active development in our hospital. An off-site Geriatrician-led specialist rehabilitation unit was initially established for medical patients in 2015. Access was then made available to acute surgical patients in 2021.

Methods
A cross-site review of outcomes achieved by older adults who transferred from the acute surgical ward to specialist inpatient rehab unit was completed.

Results
Twenty-two patients utilised this pathway but unfortunately only data relating to sixteen individuals was available due to the HSE cyber-attack. 56.25% were male (n=9) and 43.75% (n=7) were female. Most common diagnosis included 31.25% (n=5) new TBI; 18.75% (n=3) post-abdominal surgery and 12.5% (n=2) rib fractures. The average Length of Stay (aLOS) in rehabilitation was 27 days. On average, post-operative patients had a lengthier aLOS (48 days) while new TBI had the shortest (18.5 days). Overall, 94% (n=15) returned home with 60% (n=9) requiring home supports. 100% (n=16) demonstrated improvements in both their Barthel scores and ‘Timed Up and Go’ scores. The average Berg score improved from high falls risk on admission to independent with assistive device. There was one instance of acute readmission post discharge home.

Conclusion
Specialist Geriatrician-led rehabilitation for surgical patients has demonstrated low rates of re-admission, improved function and reduced falls risk with 94% (n=15) of patients returning home.
204 DEDICATED NURSING HOME SERVICE IN A TERTIARY HOSPITAL: EFFECT ON ADMISSION NUMBERS AND LENGTH OF STAY
Authors: Mahon CM , Ryan M , Kennelly SM , Martin R 
Published: October 2022

Abstract

Background
In 2019 a dedicated Nursing Home (NH) in-patient service was established in a tertiary hospital, comprising a Consultant Geriatrician, clinical nurse specialist, NCHD and administrative support. All NH residents over 65 with medical diagnoses were admitted by the NH team who also provide a consult service for NH residents under other specialties.

Methods
Data were sourced from the Hospital Inpatient Enquiry system on length of stay of patients identified as admitted from a nursing home compared to those admitted under the NH team and their average lengths of stay over 2019-2021.

Results
In 2019, 749 NH residents were admitted to hospital with an average length of stay (ALOS) of 7.93 days, the NH inpatient service was established in July 2019 and showed a reduction of ALOS from 9.25 to 6.6 days in the 6 months following its establishment (29% difference.) In 2020, 707 NH residents were admitted with 352 admitted under the NH team. The ALOS of NH residents admitted under the NH team was 5.66 days in 2020 compared to 8.65 overall (35% difference.) In 2021, 765 NH residents were admitted with 402 under the NH team. ALOS of NH residents admitted under the NH team was 5.33 days in 2021 compared to 8.28 overall (36% difference.)

Conclusion
Within six months of its commencement the dedicated NH service had decreased length of stay by 29%. The average length of stay across all services has decreased year on year from 6.6 to 5.3 days from 2019 to 2021. The ALOS in the total cohort (including residents admitted surgically and those under 65) was 29-36% higher. Though difficult to accurately compare these cohorts due to different presenting diagnoses and medical backgrounds in those admitted surgically or those under 65, the overall reduction in length of stay over the three years does highlight the benefit from this dedicated service.
206 IMPROVING FALLS ASSESSMENT AND PREVENTION PRACTICES FOR FRAIL OLDER ADULTS IN AN EMERGENCY DEPARTMENT USING BEST PRACTICE GUIDELINES
Authors: Scannell M , Coakley E 
Published: October 2022

Abstract

Background
NICE guidelines are the current gold standard for the management of falls in older persons. The aim was to benchmark the practice of a Frailty At The Front Door (FATFD) team against NICE guidelines.

Methods
All patients referred to and discharged directly by the FATFD team in the emergency department had demographic data entered prospectively by a trained administrator onto excel. Data gathered included age, diagnosis and CFS score. Patient records were accessed to gather assessment and treatment data. Data was analysed using descriptive statistics.

Results
Between January and March 2022, 443 patients were seen of which 48% (n=213) presented due to a fall. 23% (n= 49) were discharged directly from ED. Full clinical information was available for 35% (n=15). The mean(SD) age of those who presented with falls was 84(8) years with a mean(SD) clinical frailty score of 5.6 (0.9). The male to female ratio was 1.5:1. 53% (n=8) patients had a falls assessment in line with NICE guidelines. Fear of falling, perceived unsteadiness and bone health issues were the most commonly-omitted areas. 7% (n=1) patient received falls prevention education or individualised intervention.

Conclusion
The majority of patients received a falls assessment in line with NICE guidelines but 65% of patient data was not available. Data availability is key to service development and a database will be developed for all attendees. A falls education package to address management of visual impairment, home hazard advice, strength and balance training, bone health and individualised patient and family education, including fear of falling, has been developed.
213 EARLY IDENTIFICATION AND NUTRITION INTERVENTION OF FRAIL ADULTS AT RISK OF MALNUTRITION BY AN EMERGENCY DEPARTMENT FRAILTY INTERVENTION TEAM (FIT)
Authors: Pender C , Magner S , Carrabine N , Byrne C , Riches R , Mitchell M , Buckley B , Carey S , Harrington G , Caheny CO , Laguna R 
Published: October 2022

Abstract

Background
Frailty is a nutrition related condition which is potentially reversible if modifiable risk factors including malnutrition are identified at an early stage. National guidance recommends early identification of risk of malnutrition and provision of timely, appropriate oral nutritional support. Over ⅓ of older adults presenting to the Emergency Department (ED) are malnourished/at risk of malnutrition. This study evaluates the early identification and nutrition intervention of frail adults at risk of malnutrition by FIT.

Methods
A retrospective study of frail patients presenting to a level 4 hospital ED over three months was performed. Each patient had a Comprehensive Geriatric Assessment performed. A referral to Dietetics was indicated by: Malnutrition Screening Tool (MST) score ≥2, dysphagia, grade ≥2 pressure ulcer or already prescribed oral nutritional supplements (ONS). Data was collected from a Hospital Clinical System using Excel®. The data recorded included: Clinical Frailty Score (CFS), referral reason, 4AT and admit/discharge location.

Results
117 frail patients were referred to Dietetics by FIT. The median CFS was 5 (mildly/moderately frail) with an IQR of 1. 43%(n=50) had 4AT=0. 75%(n=88) had MST ≥2 identifying risk of malnutrition13.6%(n=16) were already prescribed ONS9.4%(n=11) had dysphagia6.8%(n=8) had a grade ≥2 pressure ulcer
Nutrition support intervention was provided by the Dietitian to 100% (n=117) within 24 hours of referral. 27% (n=32) were discharged from ED and 72% (n=85) were admitted.

Conclusion
FIT have successfully implemented recommendations from the National Clinical Guideline No.22. Early dietetic intervention in ED, for those admitted and discharged, may prevent the onset/progression of malnutrition in frail patients.
216 ENABLING THE DELIRIOUS PATIENT TO REMAIN AT HOME: TWO CASE STUDIES FROM THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE
Authors: Davis AJ , Nally SM , Namara RM 
Published: October 2022

Abstract

Background
The EDITH service brings emergency department care to the older adult thus negating the need for hospital presentation. There is an emerging body of literature regarding optimal treatment for patients with delirium suggesting care takes place in a familiar/ home environment.

Methods
Patient A: an 86 year-old lady with a UTI. She had a CFS:6 and a 4AT:7. She lived with her husband and her daughter who was a nurse lived nearby and provided care. She had a hypoactive delirium presentation. Patient B: an84year old gentleman with a chest infection. He had a CFS:5 and a 4AT:7. He lived with his wife and had a home care package. He had a mixed delirium presentation.

Results
In both cases, the Occupational Therapist (OT) provided education to the family regarding delirium and the recovery process of same. The OT provided advice regarding modifying and optimising the home environment for the delirious patient. The OT provided advice on the therapeutic use of activity and functional engagement. Medical input involved antibiotics and ensuring adequate nutrition and hydration. Safety netting was completed by onwards referrals to community services (PHN, COT, GP etc) and providing additional EDITH in-person reviews and phone-calls during the period of recovery.

Conclusion
Delirium type, level of family support and their understanding of delirium may impact on the success of a delirious patient remaining at home. The OT has a specialised role with regards to the treatment and management of the delirious patient. This is an emerging area of practice that OTs can lead as older adult services evolve and there is a move towards caring for patients with delirium within the familiar home environment.