bluuebunny/crossref_metadata_2025_split huggingface dataset:
115 BARRIERS AND FACILITATORS TO DOCTORS DEPRESCRIBING FALL-RISK INCREASING DRUGS IN OLDER ADULTS
Authors: Kalim R , Ryder S , Cunningham C , McMahon N 
Published: October 2022

Abstract

Background
Some medicines are associated with falls in older adults and have been classified as Fall-Risk Increasing Drugs (FRIDs). Deprescribing FRIDs is one of several possible preventive measures to reduce falls risk [1]. The aim of this qualitative study was to explore the barriers and facilitators to doctors deprescribing FRIDs in hospitals.

Methods
Doctors, who were experienced in caring for older patients, were interviewed individually, directed by an interview guide, at a large teaching hospital. Thematic analysis of transcribed audio recordings was undertaken in NVivo 12.

Results
A total of eighteen doctors participated in the study. Barriers and facilitators were classified into three categories: factors related to the care setting, to doctors and to patients. Incomplete patient medical records, limited time during inpatient stay, poor communication between care providers, and difficulties following up patients after discharge were major barriers to deprescribing in hospital. Doctors’ barriers included concerns about consequences and reluctance changing medications initiated by other prescribers. Acute illness or resistance to change were patient-related barriers to deprescribing. Facilitators included doctors’ awareness of the importance of deprescribing FRIDs, the ability to monitor patients during their inpatient stay, the use of electronic medical records, and support from other healthcare professionals e.g. clinical pharmacists.

Conclusion
Deprescribing FRIDs in older adults is challenging. Interventions based on identified facilitators, such as improved communication between prescribers, enhanced documentation using electronic medical records, and the support of team members with expertise in medication review, might enhance the feasibility of deprescribing.

Reference
1. Seppala LJ et al. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Drugs Aging. 2019; 36(4): 299–307.
117 THE ASSOCIATION BETWEEN SELF-REPORTED SENSORY FUNCTION (VISION AND HEARING) AND COGNITIVE FUNCTION FROM THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: O'Leary E 
Published: October 2022

Abstract

Background
With an aging population worldwide and in Ireland, comes more age-related health problems, including problems with hearing and vision. Ageing is also associated with a gradual decline in some cognitive functions. Sensory impairments (both hearing and vision) have been shown to have an association with cognitive impairment, with a greater cognitive decline seen in those with a combined hearing and vision loss. There is a well-established association between sensory and cognitive impairment, however, no study to date has looked at similar data collected in Ireland. The objective of this study is to analyse data from an Irish sample.

Methods
This study used data collected from Wave 4 of the Irish Longitudinal Study on Ageing (TILDA). Participants with missing data or information were excluded, leaving a complete dataset of 4,612, for analysis. Multiple linear regression analyses were carried out to compare Mini-Mental State Examination (MMSE) scores to self-reported sensory impairment (hearing impairment alone, vision impairment alone and Dual Sensory Impairment (DSI)) while adjusting for several covariates (age, gender, level of education, alcohol consumption, smoking history, depressive symptoms, mobility, loneliness, and physical activity).

Results
Self-reported fair/poor hearing and self-reported fair/poor vision had statistically significant lower MMSE scores than participants with self-reported excellent/very good/good hearing and self-reported excellent/very good/good vision respectively (hearing estimated standard error: –0.055, p value: 3.67e-11; vision estimated standard error: –0.080, p value: 5.14e-15). Self-reported DSI was associated with lower MMSE scores compared to participants without DSI (DSI estimated standard error: –0.13, p value: 5.55e-13).

Conclusion
This cross-sectional study and secondary data analysis demonstrated that in older Irish adults there is an association between hearing impairment, vision impairment and dual sensory impairment and lower cognitive function. These findings contribute to the growing body of research done internationally using other large scale health surveys.
126 CENTRAL ADIPOSITY IS ASSOCIATED WITH INCREASED PREVALENCE OF VERTEBRAL FRACTURES
Authors: Feely O , Laird E , Hoey L , Hughes C , McNulty H , Ward M , Strain JJ , Tracey F , Molloy A , Cunningham C , Fallon N , Lannon R , McCarroll K 
Published: October 2022

Abstract

Background
Increased body weight and obesity are associated with greater bone mineral density (BMD) though effects on fracture risk appear to be site specific. In particular, the relationship between Body Mass Index (BMI), abdominal weight and Vertebral Fractures (VF) is complex. Some studies have found greater incidence of VF's with obesity though results are inconsistent. Recent evidence supports a stronger association between measures of abdominal fat and VF's. We aimed to examine the association between central adiposity and VF's in older Irish adults.

Methods
Participants were from a large cross-sectional study of older Irish adults (aged &gt;60) attending GP or hospital outpatient services. VF diagnosis was based on self-report (ie. clinical vertebral fracture) so we excluded those with a Mini Mental State Examination (MMSE) &lt; 25. BMD was measured with DXA and patients taking antiresorptive or anabolic therapies were excluded. The relationship of waist hip ratio (a surrogate marker of central adiposity) with VF's was explored in regression models.

Results
2055 identified, mean age 69.8 ± 6.3 years (range 60-99), 58.6% female. Vertebral fracture prevalence was 6.3% (n=130). Waist hip ratio was positively associated with presence of a vertebral fracture after adjusting for age, sex, BMI, timed up and go, smoking, serum vitamin D, lumbar spine BMD and steroid use &gt; 3 months (beta: 0.04, P&lt;0.001).

Conclusion
We identified that central adiposity (as measured by waist/hip ratio) was associated with VF presence independent of several factors including BMI and spine BMD. This suggests that body fat distribution and/or altered bone quality may play a role. Visceral body fat (which is correlated with waist hip ratio) is associated with increased production of adipocytokines, altered vertebral geometry and micro-architecture, increased vertebral bone marrow fat and greater loading forces on the spine, all of which may mediate increased VF risk.
127 THE RELATIONSHIP BETWEEN RELIGIOUS INVOLVEMENT AND PSYCHOLOGICAL HEALTH DURING THE COVID-19 PANDEMIC: FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: O'Maoileidigh B , Kenny RA , Ward M , Scarlett S 
Published: October 2022

Abstract

Background
Religious involvement has been shown to be protective against negative mental health outcomes and encourage positive coping behaviour among older adults. During the COVID-19 pandemic and lockdown in Ireland, public health restrictions created a barrier to in person religious participation. It is important to examine the effect this may have had on psychological health in older adults.

Methods
Data were from The Irish Longitudinal Study on Ageing (TILDA). Data from Wave 4 (2016), Wave 5 (2018) and the COVID-19 SCQ (2020) were used for analysis. The final sample was made up of 3,044 community-dwelling adults living in Ireland aged 60 and older. Relationships between religious participation, psychological health and loneliness were modelled using cross-sectional and longitudinal regression analyses.

Results
Religious attendance was positively associated with Purpose in Life [Beta(B)=0.01, 95% CI=-0.00, 0.02, p&lt;0.05], Life Satisfaction [B=0.01, 95% CI= 0.00, 0.02, p&lt;0.001] and Anxiety [Incident Rate Ratio= 1.04, 95% CI=1.01-1.08, p&lt;0.01], during COVID-19. Self-Rated Mental Health significantly decreased between Wave 5 and COVID-19 relative to Religious Attendance reported at Wave 4 [OR= 0.87, 95% CI= 0.75, 0.99, p&lt;0.05]. Loneliness also increased between Wave 5 and COVID-19 relative to Prayer Frequency reported at Wave 4 [OR=0.06, 95% CI= 0.02, 0.10, p&lt;0.01].

Conclusion
These results suggest a complex relationship between psychological health and religious participation and the barriers to it during COVID in the older population. While it there was a protective effect carried into the lockdown, there was also a negative effect regarding some domains of religious participation. Future research should focus on measuring the relationship at later stages of the pandemic and the use of alternative forms of religious practice, such as streaming religious services.
130 CHARACTERISTICS AND OUTCOMES OF OLDER NURSING HOME RESIDENTS ATTENDING AN EMERGENCY DEPARTMENT
Authors: Fallon A , Noonan C , Kennelly S 
Published: October 2022

Abstract

Background
Older nursing home (NH) residents are among the most vulnerable members of society, often with multiple comorbidities and complex care needs. The Emergency Department (ED) is a common point of access to the acute hospital for NH residents. This study aims to review characteristics and outcomes of older NH residents presenting to ED over one year.

Methods
A prospective cohort study was carried out. NH residents aged 50 years and older attending ED of a university teaching hospital over one year (01/10/2019-30/09/2020) were included. Data on demographics, comorbidities, functional status, frailty and details of ED attendance were collected.

Results
There were a total of 515 ED attendances by 341 NH residents over one year. Mean age was 76.3 years (50-103 years; SD ± 10.9). 50.9% (n=262) were female. Mean Charlson Comorbidity Index (CCI) was 5 (0-12; SD ± 2.1). 46.6% (n=240) had a dementia diagnosis. A mean of 12.6 medications (0-31; SD ± 5.3) were prescribed in the NH. Mean Clinical Frailty Score (CFS) was 6.5 (3-9; SD ± 0.9). Mean Barthel Index (BI) was 8.9 (0-20; SD ± 6.0). 38.3% (n=197) of presentations occurred “in-hours”. Mean Manchester Triage Score (MTS) was 2.54 (1-5; SD ± 0.7) with 92.0% (n=474) scoring 1-3. Delirium was documented in 31.8% (n=164). Mean ED Length of Stay (LOS) was 13.7hours (0-80hours; SD ± 11.0). 14.6% (n=75) were discharged without follow-up. 61.2% (n=315) were admitted to hospital. Mean hospital (LOS) was 9.7days (0-191 days) and 8.7% (n=47) of those admitted died in hospital. 12 months after ED presentation, 40.4% (n=138) of the cohort had died.

Conclusion
NH residents are a frail group, with high levels of multimorbidity, polypharmacy and significant care needs. This complexity is reflected in the numbers requiring urgent review on attendance, rates of delirium, ED LOS and hospital admission rates. Dedicated NH liaison teams may enhance care and improve outcomes for this cohort.
139 A PHARMACIST-LED INTERVENTION TO IMPROVE QUALITY OF CARE AND REDUCE RISK OF RECURRENCE IN HOSPITALISED STROKE PATIENTS
Authors: Coughlan-Siam E , Diskin M , Hannon N 
Published: October 2022

Abstract

Background
Stroke is the leading cause of acquired disability, and the 3rd leading cause of death, in Ireland. This Quality Improvement Project focused on improving the pathway of care provided to stroke inpatients in an acute general hospital admitting up to 60 stroke patients per annum. The care pathway of stroke patients should include specialist input from the wider Multi-Disciplinary Team (MDT), including pharmacists.

Methods
An audit collected data in 2 phases: (A) a retrospective data review looking for broader themes, and (B) a prospective data collection focused on primary drivers of quality care, including patient feedback questionnaires and follow-up phone calls to patients post-discharge. A Pharmacist Screening Tool was applied to individual patient data, and medication changes documented. Key drivers of improvement were identified

Results
Phase A of the audit included 20 patients with confirmed stroke, average age 66 years, all with ischaemic stroke. Phase B included 20 patients, average age 69 years, all with ischaemic stroke. Four primary drivers of quality were identified: (1) Lack of, or delayed, referral to the stroke specialist team; (2) Transcription/prescription errors; (3) Low rate of patient counselling on medications pre-discharge; (4) High rates of interventions and medication changes, with other complexities in medication regimens. Future audit cycles will implement (a) increased education of healthcare professionals about best-practice in stroke and (b) dedicated specialist pharmacist input for stroke inpatients.

Conclusion
Patient feedback highlighted that written information given on discharge was unclear; and errors in medication prescriptions or lack of specialist input were common. A focused, patient-centric approach can improve patient satisfaction, and overall outcomes post-stroke. Pharmacist-led interventions are a key part of the stroke bundle of care.
143 ASSOCIATIONS BETWEEN NTPROBNP AND COGNITION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: O'Halloran A , Fitzpatrick A , Feeney J , De Looze C , Kenny RA 
Published: October 2022

Abstract

Background
Cardiovascular insults increase the risk for future neurological diseases in late life. NT-proB-type Natriuretic Peptide (NTproBNP) is a hormone released in response to pressure changes inside the heart, often related to heart failure and other cardiac problems. We investigated whether levels of this biomarker are related to cognition in older adults from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged 50 years and older living in Ireland.

Methods
NTproBNP levels were measured in 4,963 participants, mean age 62.6 years and 53.4% women, from blood drawn during wave 1 of the study (2009-2011). Cognitive outcomes collected at wave 1 included: memory function (the sum of scores of immediate word recall, delayed recall and prospective memory), a measure of global cognitive function (the Montreal Cognitive Assessment - MoCA), and a measure of semantic fluency (the Animal Naming task). Both NTproBNP and the MoCA scores were log-transformed to correct for skewedness.

Results
Cross-sectional analyses using multivariable linear regression found that NTproBNP was significantly and negatively associated with memory (std coeff. –0.049, std error 0.057, p=.001) and the MoCA (std coeff –0.034, std error .002, p=0.027) after adjusting for age, gender, education, and depressive symptoms. After further adjustment for cardiovascular risk factors (hypertension, high cholesterol, current smoking and problem drinking) and prevalent cardiovascular diseases (heart failure, myocardial infarction, angina pectoris, stroke, and transient ischemic attack), the associations remained for both cognitive measures (memory: std coeff –0.047, std error 0.061, p=.003; MoCA: std coeff. –0.036, std error .002, p=.029). No significant associations were found for the Animal Naming task (full model std coeff. –0.016, std error 0.087, p=0.37).

Conclusion
These results suggest that NTproBNP may be a useful early indicator for declines in some domains of cognitive function in older adults, with and without current cardiovascular diseases. Additional research is needed to evaluate the predictive value of this biomarker.
144 A PILOT STUDY TO BENCHMARK FRAILTY NEEDS IN AN ACUTE OLDER SURGICAL INPATIENTS
Authors: Khan I , Nor MNBMD , Pillay I 
Published: October 2022

Abstract

Background
Evidence to support screening for frailty among acute surgical inpatients is limited. Our aim was to identify surgical inpatients on a general/vascular surgery ward with unmet, frailty-associated needs.

Methods
From 01/03/2022 to 12/04/2022, all inpatients under a vascular/general surgery service in a model 4 hospital were screened for frailty using a modified THINKfrail tool. An abbreviated CGA (‘little g’), to identify what matters to the patient, mobility and functional impairment, mood and mental state and medication review was performed and actions taken on the results.

Results
138 patients were admitted under the surgical teams during the study period. 30% (n=42) were over 70 years. 8% (n=11) screened positive for frailty, all of whom underwent a ‘little g’. The mean (SD) age was 77 (4) years. 45% (n=5) were male. Identified needs were included abnormal 4AT in 50% (n=5), 3 of whom had no prior diagnosis of dementia. 45% had altered ADLs resulting in a reduced ability to dress or mobilise. 80% (N=9) required optimisation of mobility and/or physical function. 45% (n=5) had medication changes made.

Conclusion
A simple modified THINKfrail tool can be implemented by surgical nurses to screen for patients who may need geriatric input. Most have physio and OT needs and 45-50% have undetected cognitive or medication related issues, detected by employing a ‘little g’. Employing a ward-based frailty screen, followed by little g assessment is effective. This approach should be prospectively validated.
148 ORTHOSTATIC HEMODYNAMICS AND ACCELERATED BRAIN AGING
Authors: Shirsath MA , O'Connor J , Boyle R , Newman L , Whelan R , Knight S , Meaney J , Kenny RA 
Published: October 2022

Abstract

Background
Impaired recovery of blood pressure (BP) in response to standing up is a prevalent condition in older individuals. We evaluated the relationship between the recovery of hemodynamic responses to standing and brain health in adults over 50.

Methods
Participants from The Irish Longitudinal Study on Aging (TILDA) (n=418) performed an active stand challenge while BP and heart rate (HR) were continuously monitored. The recovery of these parameters was determined as the difference in measurements taken at 10 s and 20 s after standing, in relation to the baseline value. The difference between biological and chronological brain age was determined using BrainPAD, a novel validated measure of accelerated brain ageing. The data was fitted using linear regression models, using age, sex, weight, height, cardiac disease prevalence, antihypertensive and antidepressant use, smoking status, standing speed and pulse wave velocity as covariates.

Results
Adjusting for age and sex only, each additional year of BrainPAD was associated with a –0.35 mmHg (95% CI: –0.54 – –0.16, P&lt;.001) change in orthostatic systolic BP recovery. In a fully adjusted model, the regression coefficient was estimated at –0.29 mmHg (95% CI: –0.48 – –0.10, P&lt;.01). Similarly, a year increase in BrainPAD was associated with –0.21 mmHg (95% CI: –0.32– –0.10, P&lt;0.001) and –0.14 mmHg (95% CI: –0.25– –0.04, P&lt;.01) change in orthostatic diastolic BP recovery, for minimally and fully adjusted models respectively. HR recovery was not significantly associated with BrainPAD.

Conclusion
These results demonstrate that impaired systolic and diastolic BP recovery after standing is associated with accelerated brain aging in older individuals. This suggests that the BP response to standing, measured using beat-to-beat monitoring, has potential to be used as a marker of accelerated brain aging, relying on a simple procedure and devices that are easily accessible for clinical use.
150 ESTABLISHING A PFO PATHWAY FOR ACUTE STROKE PATIENTS WITH A POSITIVE BUBBLE STUDY
Authors: Donaghy L , Saiva L , Guilfoyle P , Sheehan O , Dolan E 
Published: October 2022

Abstract

Background
A bubble study is performed routinely on patients under the age of 65 years of age with a confirmed diagnosis of either acute ischaemic stroke or TIA in order to assist with the presence of a Patent Foramen Ovale(PFO)/Atrial Septal Defect(ASD) as an aetiology for the stroke event. Historically, a referral letter would be written to a hospital who specialises in cardiac structural surgeries, requesting a review of a patient with a positive bubble study and acute stroke. Closure would typically exceed 9 months.

Methods
The Stroke RANP led out on the project as she performs all bubble studies in stroke survivors. A designated Cardiologist, who also works in a hospital where PFO closures takes place, is notified by the RANP or team about a positive bubble study and the images are reviewed. It is then decided if the patients requires a TOE or not. A 2-page PFO referral form was created which contains all relevant information.

Results
Stroke RANP performed 92 bubble studies between January 2021 and May 2022. There were 18 positive studies (20% positivity rate): 7 positive studies from January to August 2021 (pre-pathway) and 11 positive studies from September 2021 to May 2022 (post-pathway). 72% (5/7) of patients had a TOE performed following a positive bubble study result pre-pathway, whereas only 1 TOE was performed out of 11 cases (9%) post-pathway. The time from positive bubble study to closure time reduced from 9months on average to 3 months.

Conclusion
There was a 63% reduction in the number of TOEs being performed for patients with a positive bubble study with the introduction of this PFO pathway. Additionally, there was a 6-month reduction time from the positive bubble study result to closure. This pathway has improved patient outcomes for this young group of stroke survivors and assists with the reduction of further stroke events in the future.
156 A SIGN IN TIME…; WHAT IMPACT DOES THE INTRODUCTION OF SIGNAGE HAVE FOR DEMENTIA PATIENTS? – A STAFF PERSPECTIVE
Authors: Doyle C , Davis A , McNally S 
Published: October 2022

Abstract

Background
Dementia is often seen as a presenting or existing medical condition for older adults attending hospital services. There are over 64,000 people in Ireland living with dementia. A hospital-wide environmental audit of an acute Irish hospital was completed using the Irish National Audit of Dementia tool. A priority action from this audit was the introduction of new dementia-friendly signage in key patient areas across the hospital, including nurses’ stations, toilets and bedrooms.

Methods
Random selection was used to distribute staff questionnaires, gathering their perceptions on the effectiveness of this signage. These questionnaires were multiple-choice based.

Results
Forty-six questionnaires were completed across 11 wards and from at least 4 different disciplines. Over 70% of staff members noticed the signage prior to survey completion. Twenty-eight percent of staff members felt that patients required less prompting to topographically orientate themselves. Over 75% of staff felt signage helped improve overall orientation by either a small, moderate or significant amount. Over 40% of staff feel their ward is dementia-friendly.

Conclusion
The implementation of dementia-friendly signage has had a positive impact on in-patients with dementia, by improving orientation and by promoting independence levels with this group. Dementia-friendliness of the hospital has improved but further exploration in this area is required.