bluuebunny/crossref_metadata_2025_split huggingface dataset:
263 INFORMING INTERVENTION DESIGN IN COGNITIVELY IMPAIRED POPULATIONS: LESSONS LEARNED FROM THE OPTIMIZE DEPRESCRIBING INTERVENTION
Authors: Sheehan OC , Bayliss EA , Green AR , Drace ML , Norton J , Reeve E , Shetterly SS , Gleason Kathy S , Weffald LA , Maciejewski ML , Kraus C , Maiyani M , Wolff J , Boyd CM 
Published: October 2022

Abstract

Background
Polypharmacy is common in older adults with cognitive impairment and multiple chronic conditions increasing their risks of adverse drug events, hospitalization, further cognitive decline and death and leading to higher health care costs. Deprescribing, the process of reducing or stopping potentially inappropriate medications may improve outcomes. The OPTIMIZE trial examined whether educating and activating patients, family and clinicians about deprescribing reduces number of medications for older adults with cognitive impairment and multiple chronic conditions. Acceptability and challenges of intervention delivery in this vulnerable population are not well understood.

Methods
We explored mechanisms of intervention effectiveness through post hoc qualitative interviews and surveys with 15 patients, 7 family caregivers, and 28 clinicians. We assessed accessibility and delivery of materials as well as the ability of the materials to facilitate conversations and influence decisions around deprescribing.

Results
Acceptance of the intervention was affected by contextual factors including cognition and prior knowledge of deprescribing. Positive effects of the intervention included patients scheduling specific appointments to discuss deprescribing and providers being prompted to consider deprescribing. Recollection of intervention materials by patients was inconsistent but highest shortly after intervention delivery. Short clinic visit times remained the largest clinician barrier to deprescribing.

Conclusion
Our work identifies key learnings in intervention roll out which can guide future scaling of our intervention and other pragmatic deprescribing intervention studies in patients with cognitive impairment. We highlight the critical roles of both timing and repetition in intervention delivery to cognitively impaired populations as well as the barrier to deprescribing posed by short clinic consultation time. Our success in activating deprescribing conversations in this population highlights the need to incentivize medical professionals and health systems to incorporate deprescribing into routine clinical practice and expand proven interventions to other vulnerable populations.
266 MINIMALLY-EFFECTIVE PHYSICAL ACTIVITY DOSE FOR DEPRESSION AMONG OLDER ADULTS: PRELIMINARY FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING
Authors: Laird E , Rasmussen CL , Kenny RA , Herring M 
Published: October 2022

Abstract

Background
Among older adults, depression is associated with increased risk of lower physical, social, and cognitive function. Physical Activity (PA) has been associated with lower odds of depression; however, the minimally sufficient dose for protection is unknown. Herein, we quantified the association between different PA doses and depressive symptoms and status among older adults across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods
PA was measured at each wave using the short-form International Physical Activity Questionnaire (IPAQ-SF). Five dose categories (0, 1-&lt;600, 600-&lt;1,200, 1,200-&lt;2,400 and ≥2,400 MET.min.week-1) were examined. At all waves, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale short form (CES-D) and a score of ≥16 was used to define depression. From Waves 2-5, the Composite International Diagnostic Interview quantified diagnosis of a Major Depressive Episode during the past 12 months, or depression status. Poisson regression quantified associations between PA dose and depressive symptoms and status across time, adjusted for age, health/lifestyle variables and antidepressant medication.

Results
Among 4,017 participants, depression status changed from 8.2% at wave 1 to 12.2% at wave 5. The minimal PA dose associated with lower depressive symptoms was 1-&lt;600 MET.min.week-1 (coefficient = –0.06; 95%CI: –0.10, –0.02; p≤0.003). A dose of 600-&lt;1,200 MET.min.week-1 was significantly associated with lower odds of depression status (OR = 0.66; 95%CI: 0.50, 0.87; p≤0.004). Other positive predictors associated with lower odds of depression included greater age, higher education status, and sufficient vitamin D status.

Conclusion
Present findings suggest that even low physical activity doses appear protective against depressive symptoms among older adults. Moderate PA dose, consistent with WHO recommendations, was protective against major depression over a 10-year period among older adults. However, individuals with chronic conditions may have different PA dose requirements, which should be further investigated.
269 PHARMACIST INTERVENTIONS WITHIN A MULTIDISCIPLINARY CARE TEAM FOR FRAIL OLDER ADULTS PRESENTING TO A LEVEL 4 EMERGENCY DEPARTMENT
Authors: O'Caheny C , Dillon L , Smyth H , Riches R , Laguna R , Magner S , Pender C , Carrabine N , Buckley B , Carey S , Harrington G , Mitchell M , Brown J , Callaly E , Purcell R , Ramiah V , Byrne C 
Published: October 2022

Abstract

Background
Inappropriate polypharmacy and ‘Potentially Inappropriate Prescriptions’ (PIP) are associated with increased morbidity and hospitalisation, in particular among frail older persons. A structured medication review, in conjunction with a Comprehensive Geriatric Assessment (CGA), can address PIP. The aim of the study was to review Frail Intervention Team (FIT) pharmacist interventions for frail, older adults presenting to the Emergency Department (ED) and experiencing medication compliance difficulties, polypharmacy and PIP.

Methods
Patients identified for medication review included those experiencing polypharmacy or medication compliance issues, presenting with a fall, delirium and/or frailty syndromes or complex comorbidities. The medication review process involved completion of medicines reconciliation and medication appropriateness review in accordance with the 7-Steps Medication Review Model (Scottish Government Polypharmacy Model of Care Group, 2018). Pharmacist optimisation recommendations were reviewed by a Consultant Geriatrician or Registrar and discussed with the patient prior to implementation.

Results
The FIT Pharmacist completed medication reviews for 765 patients between May 2021 and April 2022. The mean age (+/-SD) was 83.1 (+/-7.0) years with a median Clinical Frailty Score (CFS) of 5 (mildly/moderately frail). Medication Optimisation recommendations were actioned in 63% (n=483) of patients reviewed. The most commonly encountered PIP’s included: excessive anti-hypertensive/diuretic therapy, long-term acid-suppression therapy, anticholinergics and long-term prophylactic antimicrobials. Prescribing opportunities identified included: bone protection, laxatives and pain management.

Conclusion
FIT pharmacist review, in conjunction with the CGA, led to medication optimisation interventions in the frail older adult cohort presenting to the ED. Future studies should examine the impact of medication review on patient outcomes post-discharge.
273 ‘HOME ON TIME’: MULTIDISCIPLINARY INTERVENTION REDUCES LENGTH OF STAY AND DELAYS IN CARE TRANSFERS ON AN ACUTE GERIATRIC MEDICINE WARD
Authors: Mealy B , Nevin A , Lavan A , Jariol AL , Roll V , Connor SO , Donnell DO , Cummiskey AG , McNulty J , Malley MO , Briggs R 
Published: October 2022

Abstract

Background
Unnecessarily prolonged hospital admission can have a profound effect on a frail, older person’s confidence, mood, functional status and cognition.This study examined whether a structured multidisciplinary intervention, embedded within an acute geriatric medicine ward, could reduce unnecessary days in hospital for acutely unwell older patients.

Methods
The study site is a 28-bed acute geriatric medicine ward in a large urban teaching hospital; data was collected from 1/1/22 to 11/4/22. Patients aged ≥70 years and admitted to the ward were randomly allocated to the Home On Time (HOT) Pathway (n=50) or usual care (n=100). All patients were cared for by a specialist geriatric team. The HOT Pathway involved daily multidisciplinary team (physiotherapy, nursing, occupational therapy, social work and medical) huddles focusing on enhanced communication, early discharge planning and identification of barriers to discharge home. Huddles typically lasted for &lt;15 minutes.

Results
Almost two-thirds (92/150) of the study sample (mean age 83 years, 60% female) were discharged directly from the ward while one-fifth (29/150) were transferred for rehabilitation and one-tenth ultimately to long term care (16/150). The average acute ward Length-of-Stay (LOS) for HOT pathway patients was 10.4 days, compared to 14.4 days for usual care. The average LOS for HOT pathway patients discharged directly home (i.e. not via rehabilitation or to long-term care) was 8.0 days, compared to 10.2 days for usual care. One-fifth (10/50) of HOT pathway patients were discharged home within 48 hours of admission compared to one tenth (10/100) of usual care patients.

Conclusion
A structured, multidisciplinary intervention focusing on enhanced communication and early discharge planning within a geriatric medicine ward can reduce length of inpatient stay, delays in transitions of care and increase the rate of discharge home within 48 hours, potentially averting complications related to prolonged hospital admission.
276 SENSORY DEPRIVATION IN OLDER MEDICAL INPATIENTS: ARE WE AWARE ENOUGH?
Authors: McCreery A , Leahy A , Geraghty T , Boyle N 
Published: October 2022

Abstract

Background
Visual and hearing impairment is common amongst older adults admitted to the acute hospital setting. Sensory deprivation can contribute to falls and incidence of delirium, particularly in those who have underlying cognitive impairment. Interventions which reduce sensory deprivation have been recommended to avoid these complication [1].

Methods
Patients over 75 admitted to 11 medical wards in a University Teaching Hospital were assessed. Baseline demographics were collected. Documentation regarding hearing and visual impairment, delirium, completion of 4 AT, and underlying cognitive impairment was reviewed. Inpatient falls were documented.

Results
100 older adults were included in the audit. (Mean age: 83.5 years). 73% of patients had a visual impairment and 23% had a hearing impairment. 67% had access to their glasses and only 27% of patients had access to their hearing aids. Documentation of sensory disability in either medical or nursing notes was 19%. 29% of patients had documented delirium during their inpatient stay. 4AT was performed on 76% of admitted older adults in the selected wards.

Conclusion
Visual and hearing impairment is common amongst older admitted medical inpatients. Despite this, there can be a lack of access to glasses and hearing aids. There is a paucity of documentation regarding sensory deprivation, therefore interventions targeting this risk factor for delirium may not be allocated to the cohort most at risk. We recommend strategies highlighting awareness of sensory deprivation in older adults admitted to hospital.

Reference
1. Surkan MJ and Gibson W. Interventions to mobilize elderly patients and reduce length of hospital stay. Canadian Journal of Cardiology. 2018 34(7), pp. 881–888.
281 PREVALENCE OF STOPPFALL FALLS-RISK-INCREASING DRUGS (FRIDS) IN PATIENTS PRESENTING TO HOSPITAL WITH A FALL
Authors: O'Donnell D , Zainal T , Malomo K , Neasa F , Briggs R , Cunningham C , Romero-Ortuno R , Rice C , Kenny RA , Lavan AH 
Published: October 2022

Abstract

Background
Falls cause presentation and admission to hospital. Falls-Risk-Increasing-Drugs (FRIDs) are a modifiable risk factor. STOPPFalls criteria was developed, using an expert Delphi panel, to achieve consensus on a comprehensive list of FRIDs. The aim of this study was to identify the prevalence of STOPPFall PRIDs in patients presenting to hospital with falls and identify whether review by a specialist Falls and Syncope Service (FASS) reduces FRIDs.

Methods
This was a retrospective observational study. Patients ≥65 years reviewed by the hospital FASS in the emergency department (over 6-months) and in house (over 2-months), were included. Medication appropriateness at admission and discharge were assessed using STOPPFall criteria. Ethical approval was received from the local research and innovation office (ref7013).

Results
Of 156 patients, 87(55.8%) were ≥65 years; 46% female, mean age 78.1(SD7.5) years. The mean number of conditions was 4(SD4.4); the mean number of regular medications was 6.9(SD4.5). Reasons for referral to FASS included falls (34.5%), dizziness/near fall (35.6%), and transient loss of consciousness (29.9%). For 21.8% there was an associated injury; 11.5% a fracture. Thirty-seven (42.5%) had experienced at least one fall in the previous 12-months.
Sixty-four (73.6%) were on ≥1 STOPPFall FRID. The most common STOPPFall FRID prescribed to older adults were diuretics (24.1%), anti-depressants (20.7%) and benzodiazepines/benzodiazepine-related drugs (13.8%). At least 1 STOPPFall FRID was stopped in 31.3%. The most commonly deprescribed STOPPFall FRIDs were diuretics (20%), alpha blockers (6%) and benzodiazepines/benzodiazepine-related drugs (4.7%). Adults &lt;65years (n=69) were more likely to be prescribed a STOPPFall FRID at admission than older adults (≥65years); 88.4% vs 73.6%, p=0.021.

Conclusion
STOPPFall FRIDs are prevalent in fallers of all ages. Even one review by a specialist FASS leads to medication optimization. The effectiveness of STOPPFalls criteria in the prevention of falls should be evaluated further in intervention studies.
283 AN EXPLORATION OF THE IRISH NATIONAL FRAILTY EDUCATION PROGRAMME ON PRACTICE: A FRAILTY FACILITATOR'S PERSPECTIVE
Authors: Munro F , Murphy C 
Published: October 2022

Abstract

Background
Frailty is associated with a range of adverse outcomes in older adults requiring prevention, early detection and management. Interprofessional collaboration in education and practice can facilitate integrated care for older people in the management of frailty. In Ireland, an interprofessional National Frailty Education Programme (NFEP) is delivered in partnership between the National Clinical Programme for Older People (NCPOP) and The Irish Longitudinal Study on Ageing (TILDA). On completion of the NFEP, Frailty Facilitators return to their regional/local frailty networks to deliver the programme to healthcare professionals across disciplines and settings. The aim of this study is to explore the impact of the National Frailty Education Programme on practice.

Methods
A qualitative exploratory approach was adopted to elicit the perspectives of Frailty Facilitators on the impact of the NFEP on practice. Purposive sampling was employed across frailty networks nationwide. Focus groups were conducted, and data were analysed using thematic analysis.

Results
Twenty-four participants from five frailty networks took part in five focus groups across Ulster, Leinster and Connaught. Frailty Facilitators collaborated to deliver education on frailty in their local networks following the NFEP. Management support particularly that provided by the Centres for Midwifery and Nurse Education was deemed a significant enabler of frailty education. Strong interprofessional alliances were developed that enhanced communication between primary and secondary care settings in the care of older people. The medical profession were noted to have low participation in the frailty networks. The results revealed widespread use of frailty instruments for assessment and a shared understanding and language on frailty.

Conclusion
The NFEP had a clear impact on Frailty Facilitator’s practice. Conceptualisation and reflection on frailty related practice was in evidence across the frailty networks thus enabling multidisciplinary teams to manage the care of an older person with frailty in an integrated way.
284 DO MEDICATIONS GET OPTIMISED DURING AN ACUTE ADMISSION TO HOSPITAL?
Authors: MokGatla O , Haupfear I , Cafferty J , Campbell E , Lavan AH 
Published: October 2022

Abstract

Background
Potentially Inappropriate Prescriptions (PIPs) and Potential Prescribing Omissions (PPOs) are common in hospitalised older adults and associated with poor outcomes. The aim of this study was to assess whether PIPs and PPOs are reduced during an acute hospital admission.

Methods
All inpatients on 5 gerontological wards (1 acute, 1 subacute, 2 rehabilitation, 1 long-stay) on October 31st 2021 were eligible for inclusion. Medical records were retrospectively reviewed. Medication appropriateness was assessed by two assessors at admission and discharge using STOPP/START version 2. Records were consecutively reviewed according to discharge date. Ethical approval was received from the local research and innovation office (ref6275)

Results
Of 144 eligible patients, 41 were included; mean age 82.1 (SD6.8) years; 48.8% female, 95.1% under the care of geriatricians. The median length of stay was 24 (IQR10-67.5) days. Mean number of conditions was 5.6 (SD2.9) with dementia present in 22.5%. The mean number of medications increased during admission from 7.2 (SD3.2) to 9 (SD3.1); p=0.006
The number of patients prescribed at least 1 STOPP-PIP reduced by 20.6%; 82.9% (admission) vs 65.9% (discharge), p&lt;0.001. The most common PIPs at were (i) drugs without a clear indication, 34.1% (admission) vs 14.6% (discharge), (ii) high dose proton pump inhibitors, 34.1% (admission) vs 34.1% (discharge) and (iii) Z-drugs in fallers; 17.1% (admission) vs 12.2% (discharge). Of 41 patients, 35 could have START criteria applied. START PPOs were reduced by 53%; 47.2% (admission) vs 22.2% (discharge), p=0.001. The largest improvement was seen in bone absorptive therapy (11.4% (admission) vs 2.9% (discharge) and vitamin d in those experiencing falls/osteopenia; 5.57% (admission) vs 2.9% (discharge). Of the 134 STOPP/START criteria listed, 36 (19.4%) were identified in this cohort.

Conclusion
Although the average number of medications increased, PIPs reduced significantly. Only 19.4% of STOPP/START criteria were identified, suggesting that focusing on a number of key PIPs going forward could improve prescribing practices.
299 OLDER PERSONS’ EXPERIENCES AND PERSPECTIVES OF COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Leahy A , O’Shaughnessy I , Barry L , Gabr A , Shanahan E , O'Connor M , Galvin R , Robinson K 
Published: October 2022

Abstract

Background
There is an abundance of evidence to demonstrate the positive impacts of Comprehensive Geriatric Assessment (CGA) on clinical and process outcomes for older adults across settings of care. However, it is unclear how older adults themselves view CGA and their experiences of the care process. The aim of this qualitative evidence synthesis is to explore the experiences and perspectives of older adults of CGA.

Methods
A comprehensive literature search was completed across MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Social Sciences Full Text. Qualitative or mixed methods studies that included qualitative data on the perspectives and experiences of older adults of CGA were included. The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Findings were synthesised using thematic analysis

Results
Nine studies were included in the synthesis, including studies where CGA was completed in hospital, outpatient assessment unit and home settings. Divergent experiences of CGA were reported. Older adults reported experiences of being respected and listened to during CGA and attention paid to all their issues and priorities. Good communication by healthcare providers was central to these positive experiences (theme 1). In contrast, experiences of being unclear about the aim of CGA or perceived benefits of CGA, feeling that the outcome of CGA did not align with their priorities (theme 2) and not feeling involved in decision making during CGA (theme 3) were also commonly reported.

Conclusion
Findings indicate that CGA is a process by which older adults can felt respected and paid attention to. However, scope exists to further improve older adults’ experiences of CGA. Enhanced healthcare provider communication and facilitation of older adult involvement in decision-making are priority areas for improvement. Further research should focus on exploring other stakeholder groups experiences of CGA including caregivers and healthcare professionals.
302 MONITORING FALLS RISK IN THE COMMUNITY USING AN IMPLANTABLE CARDIAC MONITOR WITH EMBEDDED ACCELEROMETER
Authors: Bourke R , Perez S , Mogollo AZ , Finucane C , Leenders M , Roberts F , Morren G , Maree A , De Melis M , Kenny RA , Foran T 
Published: October 2022

Abstract

Background
Falls are the most common cause of injury amongst older adults. Falls can lead to hospitalisation, functional decline and are associated with increased morbidity and mortality. The holy grail for clinicians would be to predict increased likelihood of falls occurring and intervene before the event. Understanding underlying dynamic biophysiological changes may therefore inform novel predictor models and falls prevention. This study examines activity and cardiac data acquired from an implanted Medtronic Reveal LINQ™ Insertable Cardiac Monitor (ICM) with an embedded tri-axial accelerometer.

Methods
Thirty participants with at least one unexplained fall in the previous two years were prospectively recruited. All met criteria for ICM insertion following comprehensive assessment. Participants were followed for one year and attended every three-months for cardiac and gait assessment. Information pertaining to activity levels, posture changes and cardiac parameters were collected daily from the device. Summary metrics and trends were collected for inclusion in a continual assessment of falls risk.

Results
Mean age of participants was 68.0 years (±9.3). 19/30 (63.3%) were female. 22/30 (73.3%) had at least one cardiovascular condition documented in their medical history. There was seasonal variation in activity levels. Twelve participants had falls and cardiovascular, gait and activity variables were examined at the time of a fall to determine any trends in biophysiological changes.

Conclusion
Causes of falls are usually multifactorial. A holistic approach is necessary to manage and minimise risk factors. The use of an ICM with an embedded tri-axial accelerometer allows clinicians to formulate an algorithm to determine if a person is at an increased risk of falling based on biophysiological changes. This may create an opportunity for falls to be predicted and prevented.