bluuebunny/crossref_metadata_2025_split huggingface dataset:
320 IDENTIFYING OUTCOMES FOR PATIENTS LEAVING REHABILITATION WITHOUT THE MULTI-DISCIPLINARY TEAM (MDT) RECOMMENDED HOME CARE PACKAGE (HCP) HOURS IN PLACE
Authors: Costello R , O'Connor M , McGarvey C 
Published: October 2022

Abstract

Background
Home-Care Packages (HCPs) aim to support older people to remain in their homes. The community care system in Ireland has a small range of services with inconsistent availability. This study aims to identify outcomes for patients leaving rehabilitation without the MDT recommended HCP.

Methods
Demographics of patients discharged from rehab January 2021 to December 2021 were collected. Patients were classified into those with and without recommended HCP at time of discharge. Telephone consultations were held and data collected including; number of falls since discharge and EQ-ED-5L quality of life questionnaires were completed.

Results
Of 30 patients included (aged 66-94), 9 did not have full HCP hours on discharge. The range of Length of Stay (LoS) was 2-120 days in the correct HCP group and 7-59 in the incorrect HCP group. There was 7 readmissions to hospital, 5 from full HCP group. Three patients had a fall since discharge. In the correct HCP group, 42% had a mobility score of 3 or greater and 38% had a self-care score of 3 or greater. This was 11% and 33% respectfully in the incorrect HCP group.

Conclusion
Those who were discharged with full HCP had larger range of LoS. All patients who suffered falls were in the full HCP group. Incorrect HCP group had better scores in mobility and self-care. There were low rates of readmission to hospital in this group of patients discharged following a period of rehabilitation.
321 UNMET NEEDS AFTER STROKE
Authors: Harte G , Keane J , Ryan D , Collins R , Garcia C , Howlin R , Ryan S , Connolly A , Leitch E , Moynan W , Healy S , Keenan M 
Published: October 2022

Abstract

Background
Unmet needs, such as lack of access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services. The UK guidelines on stroke (2016) recommend that all patients should be offered a structured health and social care review at 6 months post-stroke. However, no such clinics exist to date in Ireland. We aimed to explore the extent of unmet needs in the catchment area of a large teaching hospital.

Methods
A random selection of patients 6-months post-stroke were contacted by telephone and unmet needs were assessed using a validated tool, Post-Stroke Checklist. Following analysis of data, the need for a pilot clinic was identified. A separate random selection of patients discharged from acute services 6 months previously were invited to attend a review clinic. Patients were assessed using an adapted version of the Greater Manchester Stroke Assessment Tool. Assessments were conducted jointly by a physiotherapist and a speech and language therapist, and appropriate onward referrals were made.

Results
Telephone clinic: 51 patients completed the checklist. The most prevalent symptoms reported were fatigue (75%), reduced participation in hobbies and activities, decline in cognition (61%) and mobility problems (59%). Review clinic: 21 patients attended. The most prevalent symptoms reported were reduced memory/concentration (71%), low mood (71%), unintentional weight loss/gain (62%), and reduced mobility (43%). Onward referrals were made for in 16/21 (76%) cases; physiotherapy (n=12), occupational therapy (n=7), speech and language therapy (n=7), clinical nutrition (n=5), social work (n=7), psychology (n=5).

Conclusion
Data from this exploratory study supports previous research indicating a high number of stroke survivors with unmet needs. This highlights the importance of establishing post-acute stroke review clinics and pathways in the Irish setting.
325 DISTINCT INTEGRATION OF RAPIDLY PRESENTED AUDIO-VISUAL EVENTS IN OLDER ADULT RECURRENT FALLERS
Authors: O'Dowd AM , Hirst RJ , Setti A , Donoghue OA , Kenny RA , Newell FN 
Published: October 2022

Abstract

Background
The ability to precisely integrate sensory information is critical to everyday functions, including balance/postural control and navigation. Older adults typically integrate sensory information over longer time delays than younger adults, which can reduce the precision of their perceptual judgments. This is particularly evident in older adults with a recent history of falls. However, the extent to which longitudinal patterns of falling or fall risk are associated with the precision of multisensory integration in older adults remains uncertain.

Methods
A sample of 2,321 older adults were grouped into longitudinal trajectories via self-report fall number (decreasing, stable, increasing) and, separately, sensorimotor fall risk via Timed-Up-and-Go (TUG) performance (stable, moderately declining, severely declining). Multisensory integration was measured once with the Sound Induced Flash Illusion, which examines how sound influences vision. A single ‘flash’ and two ‘beeps’ were presented over short (70ms) and longer (150ms and 230ms) temporal delays and older adults were asked to report only the number of ‘flashes’ they perceived. Accuracy on this task was the main outcome measure.

Results
Our results showed that the likelihood of incorrectly perceiving two ‘flashes’ at longer temporal delays increased with age and this was particularly evident for those with an increasing fall number trajectory. Furthermore, the likelihood of incorrectly perceiving two ‘flashes’ at the short temporal delay decreased with age but only for those same recurrent fallers. There was no association between longitudinal TUG trajectories and task performance.

Conclusion
Experiencing increasing incidents of falling over ten years is associated with distinct patterns of audio-visual integration in ageing. In contrast, long-term functional mobility is not. This may reflect links between multisensory integration and perturbed balance function and/or compromised cognitive functions (e.g. inhibitory control). Our findings contribute to our understanding of the mechanisms underpinning brain health in older age.
329 ANTICHOLINERGIC BURDEN IN PEOPLE LIVING WITH DEMENTIA ATTENDING GERIATRIC MEDICINE AND PSYCHIATRY FOR OLDER PERSONS SERVICES
Authors: Burke S , Gibbons O , Ahmed M , Loughlin E , Drumm B , O'Sullivan F , Hickey P , O'Donnell M , Dolan C , McCarthy G , O'Malley G 
Published: October 2022

Abstract

Background
Anticholinergic burden is associated with an increase in cognitive decline, delirium and confusion. We aimed to examine the Anticholinergic Cognitive Burden (ACB) of patients referred to local dementia services, and the prescribing of acetylcholinesterase inhibitors in patients with a significant anticholinergic burden. We also looked at frequency of prescribing of classes of some medications known to increase anticholinergic burden.

Methods
A retrospective chart review was carried out of new referrals attending local Geriatric Medicine and/or Psychiatry For Older Persons outpatient services with a diagnosis of dementia between 2017 and 2018. Medications in use at the time of patient review were obtained. ACB was calculated using ACB score. Results were analysed descriptively.

Results
163 patients over 65 years old were included in this study, 94 (57.6%) were female. 30% (N = 49) had a significant anticholinergic burden (ACB &gt;3). The mean ACB was 1.69 (Range 0 – 8). 38% of all patients (N = 63) were prescribed an acetylcholinesterase inhibitor, and of those, 20% (N = 13) had a significant anticholinergic burden. Polypharmacy (use of 5 medications or more) was evident with 76% (N = 124) patients. Regarding groups of medications known to increase ACB, 35.5% (N = 58) were prescribed antipsychotics and 18.4% (30) were prescribed benzodiazepines.

Conclusion
There is a significant anticholinergic burden among people living with dementia attending the geriatric medicine and psychiatry of later life services. Some patients with a significant anticholinergic burden were being prescribed acetylcholinesterase inhibitors. This suggests acetylcholinesterase inhibitors may be prescribed without also discontinuing inappropriate medications that are contributing to the anticholinergic burden. We should look to further reduce the anticholinergic burden of patients attending the dementia services by avoiding these medications or using alternatives where available.
330 RISK OF MALNUTRITION AND ITS ASSOCIATION WITH FRAILTY-ASSOCIATED FACTORS IN THE OLDER PERSON
Authors: King L , Donnellan C , Pillay I , Sayers K , Ryan S , Maher J 
Published: October 2022

Abstract

Background
The aetiology of malnutrition is multifactorial, with age a facilitating factor. It is associated with poorer physical and mental health and functional ability in frail older persons. Nutritional screening is a key domain in Comprehensive Geriatric Assessment (CGA). This study assessed the relationship between malnutrition risk and other drivers of frailty in the older person by CGA.

Methods
All patients who had a CGA completed by an Integrated Care Team for Older Persons from March 2020 to July 2021 inclusive were studied. Data was entered onto an Excel database by a trained administrator. The variables included were: age, gender, swallow screen, living alone, cognition, loneliness, Clinical Frailty Scale (CFS) score, falls history and risk of malnutrition using the Malnutrition-Screening Tool (MST). Odds ratio (OR), 95% Confidence Intervals (CI) was used to determine if there was an association between malnutrition risk and each variable in the total group.

Results
In total, 567 patients (325 female, 242 male), mean age 82yrs (SD =19), with median CFS of 6 were studied. Sixty-eight percent (n=384) reported a fall, 37.2% (n=211) had a positive swallow screen, 44% (n=251) lived alone, 35% (n=198) had positive cognitive screening, 14% (n=80) reported loneliness and 31.6% (n=179) were identified as at risk of malnutrition. A positive association was identified between risk of malnutrition and cognitive impairment (OR 1.9, 95%CI 1.2-3.1) and a reported fall (OR 2.2, 95%CI 1.4-3.5). In the population who had a fall and risk of malnutrition, the association remained in those aged ≥80yrs (OR 2.6, 95% CI 1.46 – 4.5) and female (OR 3.6, 95%CI 1.7 – 7.4).

Conclusion
The risk of malnutrition is associated with falls risk and cognitive impairment in frail older persons. Frail older persons identified by integrated care team for older persons with falls risk & cognitive impairment will be targeted for specialist dietetic intervention.
338 APPLYING STOPP/START CRITERIA TO A COHORT OF FALL PATIENTS IN THE COMMUNITY
Authors: Feeney L , Drumm B , O'Malley G , O'Sullivan F , Hickey P , Conlon C 
Published: October 2022

Abstract

Background
Integrated Care Teams for Older Persons (ICTOP) aim to transform care away from hospitals towards multidisciplinary community team care. Seventy percent of injuries requiring acute admission are caused by falls, costing €59 million annually, in addition to the overall morbidity and mortality burden. The Screening Tool of Older Person’s Prescriptions / Screening Tool to Alert Doctors to Right Treatment (STOPP/START) identifies inappropriate prescribing and prescribing omissions, which should reduce falls risk and optimise patient outcomes.

Methods
This prospective study randomly included 20 active ICTOP patients all of whom had fallen in the last 6 months. The STOPP/START Criteria were used to screen patient’s prescriptions at time of referral.

Results
The average age was 83 years old, 60% were male. Overall 45% had 1 fall, 15% had 2 falls, 20% had 3 falls and 20% had more than 5 falls. The most common comorbidities were hypertension (55%), heart disease (45%), and cognitive decline (40%). Regarding polypharmacy, 95% were prescribed more than 5 drugs, 55% were prescribed more than 10 drugs. Overall, 30% had a diagnosis of osteoporosis, 40% were on a bisphosphonate, while 65% were taking vitamin D and Calcium supplements. Of the 35% (7 patients) who had a previous fragility fracture, 1 had a DEXA scan and a further 3 were on the waiting list. Four of these patients were taking bisphosphonates and 6 were taking vitamin D and Calcium. Regarding STOPP criteria, 30% were taking opioids, 45% Proton Pump Inhibitors, 30% Calcium Channel Blockers, 30% Beta-blockers and 15% were taking Alpha-blockers.

Conclusion
The study identifies a need for community teams to consider medications that increase falls risk and medications that should be initiated to optimise bone health. Community teams should have access to professional medical and pharmacy support, in addition to timely access to DEXA scans.
342 THE DISCRIMINATORY VALUE OF ANP-LED CGA ON PATIENT REPORTED SYMPTOMS AND IMPACT ON CARERS: A CROSS-SECTIONAL STUDY
Authors: Mannion E , Murphy R , Robinson S , Waters R , Donnell MO , Walsh T , Geoghegan J , Conry M , Canavan M 
Published: October 2022

Abstract

Background
Comprehensive Geriatric Assessment (CGA) is a cornerstone in geriatric care. Objective findings from CGA may differ to patient and carer reported symptoms. This study compared patient reported symptoms with objective metrics collected during CGA and explored the relationship with carer burnout.

Methods
Cross-sectional study of patients attending an Advanced Nurse Practitioner (ANP)-led integrated care clinic. Patient-reported geriatric syndromes included low mood, memory concerns, incontinence, falls or dizziness. CGA metrics collected included Barthel Index, Lawton IADLs, MOCA scores, Geriatric depression scale scores, Rockwood Clinical Frailty Scale (CFS) scores and presence or absence of carer burnout. Descriptive statistics were used to compare the relationship between these variables and logistic regression explored the magnitude of association with carer burnout.

Results
We reviewed 99 CGAs over three months. Median age was 81 (IQR 75–86) with 62% female. Cognitive impairment was present in 96% of patients. Self-reported memory trouble was associated with lower MOCA scores (9 vs 23, p &lt; 0.001) and the presence of dizziness was associated with an increased prevalence of falls (89% vs 24%, &lt; 0.001). The presence of incontinence and functional dependency on IADL were both associated with carer strain and a larger magnitude of association with carer strain was seen with increasing frailty (OR 13.7, 95% CI 3.8-58.8 for moderate to severe frailty) than moderate to severe cognitive impairment (OR 8, 95% CI 3.0–24.1)

Conclusion
Older people reported a wide range of symptoms often subtle, some of which are unmasked during CGA. The resultant frailty syndromes often represent increasing degrees of functional impairment impacting on patient and carer quality of life. Striking the balance between patient reported symptoms and objective measurement is important to allow individualised care pathways to be developed as well as highlighting patients at risk of functional and cognitive decline.
345 HOW PREVALENT ARE UNDETECTED DEPRESSIVE SYMPTOMS AMONGST OLDER HOSPITAL INPATIENTS?
Authors: Chambers H , Ahmed R , Cloonan J , May E , Madden R , Briggs R 
Published: October 2022

Abstract

Background
Depression in later life can have a profound effect on quality of life, functional independence, healthcare use and early mortality. For multiple reasons however, depression in later life may often go undetected. The aim of this study is to ascertain the point prevalence of depressive symptoms on a specialist geriatric medicine unit, examining the rate of detection of clinically significant symptoms.

Methods
The study site is a large urban university teaching hospital with a 150-bed specialist geriatric medicine unit, comprising acute medical, rehabilitation and long-stay wards. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale (CES-D) with a score ≥16 indicating significant symptoms. Medical notes were examined for documentation of screening for/assessment of depression since admission. Patients were included if they were aged ≥70 years, a current inpatient and able to give informed consent.

Results
Almost 62% (47/76) of the study sample (Mean age 83 years, 66% female) met criteria for significant depressive symptoms. Almost-half (23/47, 49%) of patients with significant depressive symptoms were screened for depression (either with a structured screening tool, a documented mood assessment or review by psychiatry) while in hospital. The mean length of stay for patients with depressive symptoms who had not yet been screened for depression was 42.7 (23.2 – 62.2) days and over 70% had been in hospital for at least 10 days, with almost two-thirds (15/24, 65%) currently residing on an acute geriatric medicine ward (rather than a rehabilitation or long stay ward).

Conclusion
Our study demonstrates a high burden of depressive symptoms amongst older inpatients, with almost 2 in 3 meeting criteria for clinically significant symptoms. Less than half of those with clinically significant symptoms were screened for depression however, representing an important missed opportunity to identify, and possibly treat, depression.
347 LONELINESS AMONGST OLDER INPATIENTS IN THE CONTEXT OF COVID-RELATED VISITING RESTRICTIONS
Authors: Madden R , Ahmed R , Cloonan J , May E , Chambers H , Briggs R 
Published: October 2022

Abstract

Background
Loneliness can affect people at all stages of life, but appears to be more closely linked to adverse health outcomes such as quality of life and healthcare use amongst older people. There are concerns that restrictions on hospital visits due to infection control policies related to the COVID-19 pandemic may exacerbate loneliness amongst older inpatients. The aim of this study is to quantify the burden of loneliness amongst older inpatients on a specialist geriatric medicine unit.

Methods
The study site is a large urban university teaching hospital with a 150-bed specialist geriatric medicine unit, comprising acute medical, rehabilitation and long-stay wards. The University of California, Los Angeles (UCLA) Scale was used to measure symptoms of loneliness with scores≥43 indicating high levels of loneliness.

Results
Over 84% of patients were lonely at some time while in hospital, with over one-third (24/76) reporting high levels of loneliness. The mean number of days since last visit from a relative or friend for patients reporting high degrees of loneliness was 11.4 (1.2 – 21.6) days, compared to 5.2 (3.2 – 7.1) days for those with reporting lower levels or no loneliness, though confidence intervals overlapped (p = 0.108). Similarly, patients with higher levels of loneliness had a longer length of stay (68.2 (49.4 – 87.1) compared to 47.9 (33.1 – 62.6) but again findings did not reach significance (p = 0.098). Linear regression models, controlling for competing covariates, found that depressive symptoms, were independently associated with burden of loneliness with a β-Coefficient = 10.69 (5.00 – 16.39).

Conclusion
Loneliness is particularly prevalent amongst older inpatients, with a trend towards higher levels of loneliness in those with less frequent visits. Interventions to help older people stay in touch with family and friends, and maintain social connectedness while in hospital, allowing for COVID-related restrictions, would be welcome, particularly for those with longer lengths of stay.
348 WHAT IS THE OLDER PATIENT’S VIEW ON RECEIVING DETAILED MEDICAL LETTERS?
Authors: Butler E , Walsh JE , Grogan S , Lyons C , Whalley D , Fitzpatrick J , Gallagher L , Dockery F 
Published: October 2022

Abstract

Background
Sending copies of clinic letters to patients involves additional work for medical staff in formatting letters, administrative staff in printing and posting and is an added cost to the healthcare service. Though seen largely as good practice in some specialities, it is not done routinely in Geriatric medical services. We introduced this practice as standard in our service and wished to evaluate whether from the patient perspective, it is worthwhile.

Methods
We sent a questionnaire to n=80 older patients who were evaluated in the home setting (by the Integrated Care Team for Older People – ICTOP) or recently attended CGA (Comprehensive Geriatric Assessment) clinic or FLS (Fracture Liaison Service) clinic. We asked their opinion on the detailed medical letter sent to their General Practitioner (GP), which they received a copy of. The questionnaire could be completed by patient/carer/relative, and returned anonymously.

Results
N=30/80 were returned. Two said they found the letter difficult to understand; 1/30 said the letter caused them to worry but all said they still preferred that they had received it. N= 2 said they would like to have contributed to the letter for accuracy. All said they felt they should receive copies of all their medical correspondence. Free text comments showed overwhelming support for the process, in allowing them to self-manage their health, enhance communication with other healthcare professionals and was a useful document to refer back to when they are trying to process information during short consultations.

Conclusion
Though a small survey and limited by low response rate, older people expressed high levels of satisfaction in receiving copies of medical letters about their health. It supports the ongoing practice and should be adopted widely.
349 THE IMPACT OF INTER-HOSPITAL TRANSFER TO ENDOVASCULAR THROMBECTOMY (EVT) CENTRES ON THE INCIDENCE OF TENOUS THROMBOEMBOLISM (VTE) IN STROKE PATIENTS
Authors: Kinane J , Murtagh N , O'Malley T 
Published: October 2022

Abstract

Background
The risk of VTE is increased following an ischaemic stroke with pulmonary emboli accounting for up to 25% of early deaths after stroke. Patients suitable for EVT have a higher NIHSS (average 16 in Ireland, 2020) and are more likely to have hemiplegia, potentiating the risk of VTE. Many VTE prophylaxis interventions that are provided to in-hospital stroke patients are not provided to those during the journey to thrombectomy centres. Our objective was to assess the incidence of VTE in acute ischaemic stroke patients transferred from a peripheral hospital to an EVT centre and estimate the potential national impact.

Methods
We reviewed the files of patients (n=35) transferred from a peripheral hospital to an EVT centre from January 1st 2019 until December 31st 2021 and included those who had a VTE confirmed on imaging during their admission. We calculated the incidence of VTE in these patients and the potential national figure. The sample size in this review is small, however 458 patents were transported to EVT centres from other hospitals in Ireland in 2020.

Results
VTE was confirmed in 8.57%(n=3/35) ; 1 out of 15, in 2019, 2 out of 10 in 2020, 0 out of 10 in 2021. The potential national rate using figures from 2020 equates to 39 VTEs.

Conclusion
We report a substantial risk of VTE risk in stroke patients during transit to EVT centres. Agreed national thrombectomy guidelines do not address the prevention of VTE in transit. A national audit of VTE in patients transferred from peripheral hospitals is needed with special focus on the role of mechanical preventative devices(pneumatic compression) in this preventable complication of stroke.