bluuebunny/crossref_metadata_2025_split huggingface dataset:
242 FALLS-RISK INCREASING DRUGS AND FRAILTY IN OLDER ADULTS EXPERIENCING FALLS: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Randles M , Gannon E , Gallagher P , O'Mahony D 
Published: October 2022

Abstract

Background
Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of falls, a leading cause of injury and injury-related mortality. One of the more prominent extrinsic risk factors for falls in older adults is the use of Falls-Risk Increasing Drugs (FRIDS). This study aims to examine the relationship between measured frailty and FRIDS in older people who have experienced a fall in the previous 12 months.

Methods
A prospective observational study was undertaken. Inclusion criteria were age ≥ 65 years and a history of falling in the preceding 12 months. Exclusion criteria were age &lt;65 years of age, inability to provide informed consent or participation declined. Medical chart and drugs Kardex review was carried out, followed by a short interview with the patient using a standardised data collection proforma. Frailty was measured using the Clinical Frailty Scale (CFS) and the point-prevalence of FRIDS was established using the STOPPFall screening tool.

Results
Results are presented for the first 100 participants: The mean (±standard deviation [SD]) age of study participants was 82.1 (±6.2), 63% were female. The prevalence of frailty measured using the CFS was 60% (CFS ≥5). The median number of falls in the previous 12 months was 3 (IQR 3). 82% of people who had fallen in the previous 12 months had ≥1 STOPPFall FRID. The difference between number of FRIDs in Frail vs Non-Frail people was not statistically significant.

Conclusion
Prescription of FRIDS was detected in over 4 out 5 older fallers. Structured medication review using the STOPPFall screening tool for older adults at risk of falls is one useful and easy way of detecting FRIDS with a view to deprescription. Measured frailty does not appear to increase the prevalence of FRIDS in older fallers.
244 A PILOT STUDY: FRAILTY AND COGNITIVE IMPAIRMENT IN PATIENTS WITH KERATINOCYTE CANCER
Authors: Cino D , Hollywood A , Moloney A , Collins O , Moriarty B , Lally A 
Published: October 2022

Abstract

Background
Incidence of keratinocyte cancer is increasing, and age-related variations in management pose risk of over and under-treatment [1]. Comorbidities and frailty may predict quality of life, mortality and surgical outcomes [2]. This study investigated patient presentations in those with skin cancer aged ≤ 70-years versus &gt;70-years.

Methods
Patients attending dermatology skin cancer clinics were recruited over 8 weeks, June-August 2021. Data including comorbidities, Mini Mental State Exam (MMSE) and Rockwood Clinical Frailty Scale were recorded. Chi-square test for binary characteristics were performed.

Results
107 patients were interviewed, the younger cohort (n=46) had a frailty scale of very fit (81.8%), well (11.4%), managing well (6.8%), whereas the older cohort (n=61) were very fit (14.8%), well (21.3%), managing well (34.4%), vulnerable (14.8%), mildly frail (4.9%), moderately frail (3.2%) and severely frail (6.6%). The older cohort with confirmed skin cancer were significantly more frail (vulnerable, mild, moderate and severely frail) than those in the same cohort without skin cancer (p = 0.01). The older cohort MMSE ranged from; no cognitive impairment (85.2%), mild (6.6%), moderate (4.9%), and severe (3.3%). The older cohort with confirmed skin cancer had significantly more cognitive impairment (moderate and severe) than those in the same cohort without skin cancer (p = 0.04).

Conclusion
Patients with higher frailty score and cognitive impairment were more likely to have skin cancer than their age matched counterparts without. This highlights the importance of the two parameters, and may support clinical guidelines to assist with selecting treatment for older patients with keratinocyte cancer.

References
1. Garcovich S et al. Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging and Disease. 2017; 8(5):643–61.
2. Valdatta L et al. FRAIL scale as a predictor of complications and mortality in older patients undergoing reconstructive surgery for non-melanoma skin cancer. Oncology Letters. 2019; 17(1):263–9.
248 BENEFITS OF POST-OPERATIVE SPECIALIST GERIATRIC CARE FOR OLDER PATIENTS UNDERGOING ELECTIVE ORTHOPAEDIC SURGERY
Authors: McGarvey C , Larkin J , Costello R , Connor MO 
Published: October 2022

Abstract

Background
The Covid-19 pandemic changed work practices across many different healthcare institutions. The difficulties with cross-site transfers created an opportunity in our institution to provide on-site post-operative rehabilitation for older patients undergoing elective orthopaedic surgery. The aim of this study is to assess the impact of post-operative specialist geriatric care on older patients.

Methods
This is a single-centre, retrospective study that received approval from the local hospital ethics committee. Data were collected on all patients admitted to the on-site specialist rehabilitation unit post-elective orthopaedic surgery between 1st May 2020 and 31st December 2021. Two patients in this group were excluded as they had not attended a pre-operative assessment clinic. Data were collected from hospital Information Technology platform, Bluespiers.

Results
76 patients, 18 males and 58 females, were included in this study. The median age was 80 years. In the specialist rehabilitation unit, evidence of cognitive impairment was established in 40.79% of cases, there were 3 cases of newly diagnosed dementia, a history of falls was identified in 32.89% of patients and 13.16% of patients were found to have sarcopaenia. The median length of stay in the rehabilitation unit was 25 days. 51.32% of patients were discharged home independently, 23.68% of patients went home with a new Home-Care Package (HCP), 15.79% of patients were discharged home with an existing HCP, 6.58% of patients were transferred for further treatment and 2.63% patients were discharged to residential care units.

Conclusion
This data demonstrates a clear role for specialist geriatric care in elective rehabilitation, with a significant proportion of patients being discharged home independently. The benefits of a comprehensive geriatric assessment in the peri-operative setting include increased identification of cognitive impairment allowing appropriate implementation of brain health as well as identification of a history of falls, enabling falls risk assessment and management including bone health assessment.
255 THE ROLE OF GERIATRIC MEDICINE IN CARE OF OLDER ADULTS WITH MAJOR TRAUMA
Authors: Rafferty M , Murphy D , Cloney T , Brent L , Dukelow T , Ahern E 
Published: October 2022

Abstract

Background
In recent Major Trauma Audit Reports the most common cause of major trauma is low falls, 46-49% of injured patients were aged over 65. These are an important group to identify and to prioritise for geriatrician led MDT care. There is currently no specialist geriatric medicine service in Ireland for older adults with major trauma. We aimed to evaluate patients with major trauma currently co-managed by orthopaedic surgery and geriatric medicine, the role of geriatric medicine and the potential role of a major trauma geriatric service.

Methods
We reviewed local data collected for the Irish Hip Fracture Database to examine the incidence of major trauma presenting in older adults and the role of geriatric medicine. We included patients who had injuries in addition to hip fracture including radius, ulna, clavicle, humerus, rib, vertebra, pelvis fracture subdural haemorrhage, diffuse brain injury and traumatic subarachnoid haemorrhage.

Results
In 2020, there were 437 older adults admitted with hip fractures and likely 2185 patients presenting with fragility fractures. We identified 32(7%) patients who sustained other major injuries in addition to hip fracture. Nationally, these patients have a higher in-hospital mortality (11% v 5%). All of these patients had comprehensive geriatric assessment (CGA) and geriatrician-led MDT care. These patients are at high risk for poorer outcomes; delirium, pressure ulcers, hospital acquired infection and disability, prolonged length of stay, delayed transfers of care, premature institutionalisation and death.

Conclusion
There is a role for expansion of proactive early identification and geriatric medicine input for all older adults with major trauma, in addition to those with hip fractures and other injuries. The increased mortality in these patients has not previously been published. International evidence supports early intervention from a specialist geriatric medicine service, with CGA to provide exceptional, continuous and co-ordinated care.
271 DEVELOPMENT OF AN INNOVATIVE INTER-DISCIPLINARY PARKINSON’S CLINIC IN AN AMBULATORY CARE SETTING
Authors: Kimmage E , Carney C , Conaty S , Cronin A , Digan E , Kennelly SP , McDonagh A , McWilliams O , Nolan E , O'Dwyer A , O'Rourke L , Pierpoint R , Quinn S , Sheridan L , Smith A , Tobin F 
Published: October 2022

Abstract

Background
Ambulatory services provide specialist outpatient care, reducing costs associated with inpatient admissions and enabling the person to remain at home for longer (Report of the National Acute Medicine Programme, 2010). An Older Person’s Ambulatory Care Hub was established in a large teaching hospital. Prior service evaluation demonstrated that approximately one third of patients attending had a diagnosis of Parkinson’s Disease (PD). People with PD should have a collaborative approach between patient, family and healthcare providers to optimally manage their condition (NICE, 2017), therefore, the need was identified to evolve the traditional medical model to an interdisciplinary approach. The aim of this project was to complete a service evaluation and breakdown of Interdisciplinary Team (IDT) referrals.

Methods
An IDT working group including Clinical Nutrition (CN), Medical, Nursing, Occupational Therapy (OT), Physiotherapy (PT), and Speech and Language Therapy (SLT) was established. A comprehensive assessment form was developed and outcome measures were chosen. A short pilot was conducted and necessary amendments were made. A weekly clinic was established which included an IDT assessment, followed by a huddle with the medical team where referrals were generated. Data pertaining to the number of attendees and referrals generated were collected over a 3-month period.

Results
Over the data collection period, 31 patients attended the clinic. Referrals were as follows; Medical: 19, PT: 13, SLT: 10, OT: 7, CN: 6, Medical Social Work: 2. Patients requiring urgent medical review were seen immediately after the IDT huddle.

Conclusion
This project demonstrates a service evaluation of a novel IDT PD Clinic. This clinic highlights the need for an IDT approach to management of people with PD. Future service developments include obtaining patient feedback, pre-clinic calls to patients by a Healthcare Assistant to explain the purpose of the clinic, and adapting the clinic as appropriate.
275 “MOVING ON UP”: FEASIBILITY OF A WARD-BASED THERAPY INITIATIVE TO IMPROVE PATIENT ACTIVITY LEVELS IN NEUROLOGICAL REHABILITATION
Authors: Doran N , Murphy R , Clarke E , Quigley S , Kiernan S , Malone A 
Published: October 2022

Abstract

Background
Patients admitted for neurological rehabilitation are not receiving sufficient dosage of activity to facilitate optimal recovery. Previous research has reported issues with feasibility and patient adherence to intensity programs.

Methods
Mixed methods were employed for this feasibility study. The “Moving On Up” program encompassed “Activitea” structured practice of sit to stands prompted by mealtimes, “Step It Up” a gradual walking program using pedometers and “Weekend Workout” increasing practice of exercise programs. These activities were in addition to daily therapy sessions over a four-week intervention period. Primary feasibility outcomes investigated recruitment, retention, adherence, adverse events, facilitators, barriers and acceptability of the program and preliminarily assessed changes in activity levels using the ActivPAL accelerometer. Functional tests assessed mobility, health-related quality of life and fear of falls. Descriptive statistics were used for analysing quantitative data. Braun and Clarke’s thematic analysis was adopted when reviewing qualitative data.

Results
Ten participants were recruited with zero dropouts. Median age was 72 years and five had a diagnosis of brain tumour excision. Eight participants demonstrated excellent adherence with completion of daily activity logs. There was one participant non-injurious fall, no other adverse events. Clinical outcomes demonstrated improvement in median daily step count, stepping and standing time. The median daily step count for the group increased from 1,375 steps (IQR 2,867, range 82-4,248) to 1,724 steps (IQR 2,914, range 80-8,207). All functional tests improved. Seven participants and three therapists completed semi-structured interviews. Five themes emerged; motivation to move more, empowerment, barriers to increasing activity, weekends long and boring and job satisfaction.

Conclusion
The “Moving On Up” program was feasible to implement without additional staffing and was accepted by key stakeholders. Future research is warranted into the program's effectiveness, incorporating a larger sample and randomised pilot trial. Inclusion of a follow-up of participants after discharge would be desirable to investigate long-term effects on activity.
277 The ‘Bermuda Triangle’ of Orthostatic Hypotension, Cognitive Impairment and Reduced Mobility: Associations with Falls and Fractures in Community-dwelling Older People
Authors: Donnell DO , Romero-Ortuno R , Kennelly S , Kenny RA , Lavan A , Neill DO , McElwaine P , Briggs R 
Published: October 2022

Abstract

Background
Orthostatic Hypotension (OH), cognitive impairment and mobility impairment frequently co-occur in older adults who fall. The aim of this study was to examine the clustering of these three geriatric syndromes and ascertain their longitudinal associations with falls and fractures in a large cohort of community-dwelling older people (≥65 years).

Methods
This study utilized data from Waves 1-5 of TILDA. OH was defined as a drop of ≥20 mmHg in systolic blood pressure when measured after standing from a seated position and/or reporting unsteadiness when getting up from a chair. Cognitive impairment was defined as MMSE ≤24 and/or self-reporting memory as fair or poor. Mobility impairment was defined as 'Timed Up and Go' ≥12 seconds. Logistic regression models, including 3-way interactions, were used to assess the longitudinal associations of the three geriatric syndromes with future falls (explained and unexplained) and fractures.

Results
Of those with at least one geriatric syndrome (993/2108, 47%), over two-thirds (644/993) had any one of the three, one-quarter had any two (261/993) and almost 10% (88/993) had all three syndromes. One-fifth of the study sample had an unexplained fall during follow-up (mean 6.6 years), while one-tenth had a fracture. In fully adjusted models, the cluster of OH, cognitive impairment and mobility impairment was associated with a greater than 4-fold likelihood of unexplained fall (Odds Ratio 4.36 (2.61–7.28); p&lt;0.001) and double the likelihood of incident fracture (Odds Ratio 2.51 (1.27–4.96); p=0.008) during follow-up, when compared to other clusters. There was no association with explained falls.

Conclusion
The ‘Bermuda Triangle’ of co-existing OH, cognitive impairment and mobility impairment, was independently associated with increased risk of future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.
280 PERCEIVED NEED FOR A CLINICAL ETHICS SUPPORT SERVICE AT AN IRISH UNIVERSITY HOSPITAL
Authors: O'Donovan M , Crowley P , Flanagan E , McManus C , Moloney E , Favier C , McKiernan M , Cornally N , Campbell L , O’Connor K , O’Caoimh R 
Published: October 2022

Abstract

Background
Ethics are the set of moral principles that guide a person’s behaviour. Ethical issues are a key component of healthcare and frequently arise in the management of hospitalized older patients. To improve decision-making and reduce burden on individual hospital staff, Clinical Ethics Support Services (CESS) have been widely-integrated into care pathways internationally. However, the need for CESS has received little attention in Irish hospitals.

Methods
A cross-sectional analysis of the ethical situation and CESS readiness at a tertiary hospital in Ireland was collected from July-October 2021 and in February 2022 via hard copies and online collection (SurveyMonkey). Both clinical (medicine, nursing other patient care role) and non-clinical (administrative, clerical, ICT, HR, general support staff and management) staff participated. Descriptive statistics were assessed taking the valid percentages, mean 5-item Likert scores and Friedman Test mean rank for ten ranked statements.

Results
In total, 199 people (13% response rate) completed the survey. Staff were largely (76%) clinical and the majority were qualified &gt;10 years (57%). In all, 78% reported that ethical issues arise in the role (83% clinical staff, 59% non-clinical staff). Most (63%) were unsure who to contact about ethical concerns, instead seeking informal advice from colleagues (&gt;90%). The majority of participants were interested in additional ethical training, especially on decision-making capacity (mean interest 4.18 out of 5), strategies for working with challenging patient/family situations (4.07 out of 5) and end-of-life care (4.06 out of 5). Out of ten options assessed, participants preferenced the development of a formal clinical ethics committee over education and training or the provision of educational materials.

Conclusion
Ethical issues commonly arise when caring for older hospitalized patients. This study found a perceived need and widespread interest in additional education as well as formal approaches to develop a hospital-based CESS, centred around a formal committee structure.
285 DEVELOPING A FRAILTY CARE PATHWAY IN A REHABILITATION HOSPITAL: A PILOT STUDY
Authors: Murphy J , Webster C 
Published: October 2022

Abstract

Background
Frailty is a common condition in older adults. The Clinical Frailty Scale (CFS) is a widely used frailty screening-tool within the Irish healthcare system due to its time-efficiency and transferability between settings. The Edmonton Frailty Scale (EFS) is heralded as an effective tool capturing multi-dimensional aspects of frailty. Due to the lack of blanket referral system for some Multi-Disciplinary Team (MDT) members in our Irish rehabilitation hospital, early identification of frailty is key to ensure timely input from all disciplines. To optimise MDT intervention, the EFS was piloted alongside the CFS comparing user-experience and sensitivity.

Methods
Education sessions were held by frailty-group members to familiarise staff with frailty concepts and frailty-tool administration. The EFS and CFS were administered with all patients over 65 years within 72 hours of admission onto two wards of our hospital over a three-month period. Frailty scale completion was co-ordinated by the physiotherapists and occupational therapists who operate a blanket referral system. Detection of frailty triggered an urgent referral to dietician, medical social work and speech and language therapy colleagues who don’t operate a blanket referral system. The target time for MDT input was two days for the severely frail cohort and one week for mild or moderately frail patients.

Results
The EFS was administered for 83 patients (mean age: 84 years). Of those, 6% were severely frail, 23% were moderately frail and 28% were mildly frail. The CFS was found to detect a higher frailty level in 47% of patients screened when compared to the EFS and took an average of ten minutes less to administer.

Conclusion
The CFS will continue to be administered with patients due to its higher sensitivity to frailty and time efficiency for completion. Referrals will continue to be generated to all MDT members to expedite input with frail patients.
290 THE VARIABLE INDICATIVE OF PLACEMENT IN ACUTE HOSPITAL OUTPATIENT CLINICS IDENTIFIES OLDER ADULTS WHO BENEFIT FROM SPECIALIST GERIATRIC ASSESSMENT
Authors: Maher J , McKenna-Barry M , Donnellan C , Pillay I 
Published: October 2022

Abstract

Background
Opportunistic screening of older adults results in early detection of frailty. The Variable Indicative of Placement (VIP) is validated to identify those being admitted to hospital who may benefit from specialist geriatric assessment. VIP screening was gradually introduced throughout hospital-based outpatient clinics in April 2021. The aim of this study was to quantify patient benefit following VIP screening.

Methods
A positive VIP triggered referral for Comprehensive Geriatric Assessment (CGA). Exclusion criteria included prior CGA within a year, nursing home resident or patient declined assessment. Data was prospectively entered onto Excel by a trained administrator. Demographics, Clinical Frailty Score (CFS), modified Barthel Index (mBI) and patient interventions post CGA, between July 2021 and April 2022, were analysed using descriptive statistics.

Results
Of 168 referrals received, 52 were excluded, 53 completed and 63 await review. Thirty-five of those excluded had a prior CGA. Mean (SD) age of patients receiving CGA was 79 (7.6) years. Male:female ratio was 1:1.4. Median (SD) CFS was 6 (0.8) and median (SD) mBI was 16(3.9). There was a mean (SD) of 2.8 (1.6) targeted interventions per patient. Eighty three percent (n=43) required medication changes, 47% (n=25) bone health management, 28% (n=15) dietician, 26% (n=14) occupational therapy, 17% (n=9) public health nursing, 17% (n=9) speech and language therapy, 17% (n=9) memory assessment and 15% (n=8) physiotherapy.

Conclusion
Outpatient clinic VIP screening resulted in identification of frail older adults who benefited from CGA. The VIP should be validated in various outpatient settings.