Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.047
Megan Power Foley, Mohammed Alazzawi, Carolyn Cullinane, Éanna Ryan, Áine O'Neill, Michael Devine, Czara Kennedy, Nicola Raftery, Conor Toale
Background As the population ages, older patients with complex comorbidities are increasingly being admitted to hospitals with surgical pathology. Independent of age and comorbidities, frailty predicts mortality, complications, prolonged length of stay and loss of independence after hospitalisation. Understanding of the impact of frailty on unscheduled surgical care is needed to guide future service provision. This prospective collaborative study aimed to determine the prevalence of frailty amongst emergency general surgery admissions. Methods A multi-centre prospective snapshot audit was performed over a two-month period in eight Irish hospitals. For fourteen consecutive days, all emergency general surgery admissions >60 years was screened for frailty using the Clinical Frailty Score (CFS) by the on-call team. Details on demographics, comorbidities and lab data were recorded from the “Surgical Sign-Out” documents. Discharge summaries were subsequently reviewed, and 30-day outcomes documented. Results Across 112 call sessions in eight hospitals, 277 patients >60 years were admitted. Fifty-one percent were male and the mean age was 75.57 years (+/- SD 8.81). Fifty-two percent (n=135/258) of screened patients had a CFS ≥4. Frail patients had significantly higher rates of CCF (p<0.001), CKD (p=0.009), cognitive impairment (p<0.001), anticoagulation (p<0.001), polypharmacy (p<0.001) and anaemia (p=0.004). Frailty was associated was significantly higher rates of all complications (p<0.001) and cardiac complications (p=0.034). Frail patients required significantly more medical consults (p=0.009), MDT input (p<0.001) and home care package adjustment (p=0.019). At 30 days, frail patients were more likely to still be inpatients (p=0.018) and less likely to be discharged directly to home (p=0.004), with higher rates of inpatient mortality (p=0.033) and 30-day readmissions (p=0.020). Conclusion High levels of frailty were noted amongst emergency surgical admissions across Irish hospitals. Routine frailty screening and proactive specialist geriatric input may lead to improved outcomes in this high-risk cohort.
{"title":"A Multi-Centre Prospective Snapshot Audit of Frailty amongst Emergency General Surgery Admissions","authors":"Megan Power Foley, Mohammed Alazzawi, Carolyn Cullinane, Éanna Ryan, Áine O'Neill, Michael Devine, Czara Kennedy, Nicola Raftery, Conor Toale","doi":"10.1093/ageing/afaf318.047","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.047","url":null,"abstract":"Background As the population ages, older patients with complex comorbidities are increasingly being admitted to hospitals with surgical pathology. Independent of age and comorbidities, frailty predicts mortality, complications, prolonged length of stay and loss of independence after hospitalisation. Understanding of the impact of frailty on unscheduled surgical care is needed to guide future service provision. This prospective collaborative study aimed to determine the prevalence of frailty amongst emergency general surgery admissions. Methods A multi-centre prospective snapshot audit was performed over a two-month period in eight Irish hospitals. For fourteen consecutive days, all emergency general surgery admissions &gt;60 years was screened for frailty using the Clinical Frailty Score (CFS) by the on-call team. Details on demographics, comorbidities and lab data were recorded from the “Surgical Sign-Out” documents. Discharge summaries were subsequently reviewed, and 30-day outcomes documented. Results Across 112 call sessions in eight hospitals, 277 patients &gt;60 years were admitted. Fifty-one percent were male and the mean age was 75.57 years (+/- SD 8.81). Fifty-two percent (n=135/258) of screened patients had a CFS ≥4. Frail patients had significantly higher rates of CCF (p&lt;0.001), CKD (p=0.009), cognitive impairment (p&lt;0.001), anticoagulation (p&lt;0.001), polypharmacy (p&lt;0.001) and anaemia (p=0.004). Frailty was associated was significantly higher rates of all complications (p&lt;0.001) and cardiac complications (p=0.034). Frail patients required significantly more medical consults (p=0.009), MDT input (p&lt;0.001) and home care package adjustment (p=0.019). At 30 days, frail patients were more likely to still be inpatients (p=0.018) and less likely to be discharged directly to home (p=0.004), with higher rates of inpatient mortality (p=0.033) and 30-day readmissions (p=0.020). Conclusion High levels of frailty were noted amongst emergency surgical admissions across Irish hospitals. Routine frailty screening and proactive specialist geriatric input may lead to improved outcomes in this high-risk cohort.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"29 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.004
Robert Briggs, Rose Anne Kenny
Background Falls represent the most frequent reason older people are admitted to hospital, and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. Specialist pathways can prevent falls but currently there is no dedicated falls strategy in Ireland. Using the TILDA Wave 6 data, we have comprehensively delineated the burden of falls amongst older people in Ireland. Methods Population-representative data from Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) were used to estimate the incidence of falls requiring medical attention and ED attendance, fractures and fear of falling amongst participants aged ≥70 years. Additional data detailing falls-risk increasing drugs (FRID) and prior falls at Wave 5 were also analysed. TILDA data was extrapolated to the Central Statistics Office Census 2022 and data on dedicated falls clinics across each regional health area were also aggregated. Results The Wave 6 TILDA data showed that almost 12% of participants – almost 62,000 older people, reported a fall needing medical attention in 2022; over 6% - over 32,000 people, attending ED due to a fall and over 3% sustained a fracture. Almost half were prescribed a falls-risk increasing drugs, and over half had also reported a fall at Wave 5, showing prior falls as a key risk factor. Additionally, 15% of those attending ED for a fall couldn’t access a local dedicated falls clinic. Conclusion The data from the Wave 6 TILDA data has clearly shown that the burden of falls amongst older people is considerable. One in eight people required medical attention for a fall and one in sixteen attended the ED with to fall. Currently, there is no national falls strategy. While this is concerning given the ageing population, the current reconfiguration of Ireland’s health service represents an important opportunity to improve delivery of falls care.
{"title":"Incidence of Falls Requiring Medical Attention Among Older Adults in Ireland: Findings from Wave 6 of TILDA","authors":"Robert Briggs, Rose Anne Kenny","doi":"10.1093/ageing/afaf318.004","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.004","url":null,"abstract":"Background Falls represent the most frequent reason older people are admitted to hospital, and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. Specialist pathways can prevent falls but currently there is no dedicated falls strategy in Ireland. Using the TILDA Wave 6 data, we have comprehensively delineated the burden of falls amongst older people in Ireland. Methods Population-representative data from Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) were used to estimate the incidence of falls requiring medical attention and ED attendance, fractures and fear of falling amongst participants aged ≥70 years. Additional data detailing falls-risk increasing drugs (FRID) and prior falls at Wave 5 were also analysed. TILDA data was extrapolated to the Central Statistics Office Census 2022 and data on dedicated falls clinics across each regional health area were also aggregated. Results The Wave 6 TILDA data showed that almost 12% of participants – almost 62,000 older people, reported a fall needing medical attention in 2022; over 6% - over 32,000 people, attending ED due to a fall and over 3% sustained a fracture. Almost half were prescribed a falls-risk increasing drugs, and over half had also reported a fall at Wave 5, showing prior falls as a key risk factor. Additionally, 15% of those attending ED for a fall couldn’t access a local dedicated falls clinic. Conclusion The data from the Wave 6 TILDA data has clearly shown that the burden of falls amongst older people is considerable. One in eight people required medical attention for a fall and one in sixteen attended the ED with to fall. Currently, there is no national falls strategy. While this is concerning given the ageing population, the current reconfiguration of Ireland’s health service represents an important opportunity to improve delivery of falls care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.087
Lucy Dooley, Neelam Imitiaz, Orlagh Montague, Melissa Chavira, Ryan Richardson, Shahzaib Naseer, Eimear Dawson, Niamh Daly, Axa James, Jincy Thomas, Chie Wei Fan, Austin Warters, Elizabeth Callaly
Background The IMSA questionnaire is a validated tool which assesses the biopsychosocial complexity of patients across four domains (physical, mental, social, and healthcare). However, the self-assessment format is not always suitable for individuals with cognitive impairment. We aim to evaluate the feasibility of performing a modified IMSA score combining self-assessment and chart review on a frailty rehabilitation ward. Methods We carried out a pilot study with the IMSA (V1.0) questionnaire, utilising a combination of chart review and self-assessment questionnaires. Questionnaires were administered by various members of the multidisciplinary team. Descriptive statistics and Pearson’s correlation were used for our analysis. Results Self-assessment via questionnaire was performed with 15 patients. 5 patients were noted to have difficulty with self-reporting so chart review was used to supplement information on these patients. The assessment took a median time of 20 mins to complete (12-29). The median age in our cohort (n=15) was 87 (67-97), 12 of 15 were female (80%). The median IMSA score was 26 (15-43), with 80% of patients scoring ≥ 20 (indicating a high complexity). IMSA score was positively correlated with length of stay at time of review (r=0.69, p<0.01); this effect was predominantly carried by the social component of the IMSA score (r=0.86, p<0.01). Conclusion This pilot study has demonstrated that our use of a modified IMSA score is feasible. The modified tool demonstrated strong correlation with length of stay, indicating clinical utility. Our results highlight the high prevalence of complexity in this cohort and the adverse effect of social frailty on health outcomes and resource need. Further validation of this modified tool which amalgamates questionnaire with chart review is supported by our preliminary findings. Consideration should be given to interventions to ameliorate social frailty in this vulnerable cohort.
{"title":"Measuring Case Complexity on a Specialist Geriatric Subacute Frailty ward: A feasibility study of the INTERMED Self-Assessment questionnaire (IMSA)","authors":"Lucy Dooley, Neelam Imitiaz, Orlagh Montague, Melissa Chavira, Ryan Richardson, Shahzaib Naseer, Eimear Dawson, Niamh Daly, Axa James, Jincy Thomas, Chie Wei Fan, Austin Warters, Elizabeth Callaly","doi":"10.1093/ageing/afaf318.087","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.087","url":null,"abstract":"Background The IMSA questionnaire is a validated tool which assesses the biopsychosocial complexity of patients across four domains (physical, mental, social, and healthcare). However, the self-assessment format is not always suitable for individuals with cognitive impairment. We aim to evaluate the feasibility of performing a modified IMSA score combining self-assessment and chart review on a frailty rehabilitation ward. Methods We carried out a pilot study with the IMSA (V1.0) questionnaire, utilising a combination of chart review and self-assessment questionnaires. Questionnaires were administered by various members of the multidisciplinary team. Descriptive statistics and Pearson’s correlation were used for our analysis. Results Self-assessment via questionnaire was performed with 15 patients. 5 patients were noted to have difficulty with self-reporting so chart review was used to supplement information on these patients. The assessment took a median time of 20 mins to complete (12-29). The median age in our cohort (n=15) was 87 (67-97), 12 of 15 were female (80%). The median IMSA score was 26 (15-43), with 80% of patients scoring ≥ 20 (indicating a high complexity). IMSA score was positively correlated with length of stay at time of review (r=0.69, p&lt;0.01); this effect was predominantly carried by the social component of the IMSA score (r=0.86, p&lt;0.01). Conclusion This pilot study has demonstrated that our use of a modified IMSA score is feasible. The modified tool demonstrated strong correlation with length of stay, indicating clinical utility. Our results highlight the high prevalence of complexity in this cohort and the adverse effect of social frailty on health outcomes and resource need. Further validation of this modified tool which amalgamates questionnaire with chart review is supported by our preliminary findings. Consideration should be given to interventions to ameliorate social frailty in this vulnerable cohort.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"161 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.184
Aisling Whelan, Sadbh Moran, Linda Brewer
Background Comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older patients1. Geriatric medicine consultation service is a means of providing CGA. Our aim was to understand local patterns for geriatric medicine consultation requests. Methods Data collected via electronic patient record on all geriatric medicine consults received over a 4-month period January to April 2025. Statistical analysis via Excel. Results There were 252 consultation requests, 21.5% of patients had multiple consultations. Average of 3.7 consults per day. 129 (51.2%) were female. Mean age 81 (standard deviation 8.3). More consults were from medical specialties (N=186, 73.8%) compared to surgical (N=65, 25.8%). Main indications for consultation were long term care (LTC) (N=70, 27.8%), cognition (N=42, 16.7%), general review (N=29, 11.5%), delirium (N=29, 11.5%), capacity (N=18, 7.1%) and discharge planning (N=17, 6.7%). There was a strong correlation between department and consultation reason p-value <0.001. Most frequent medical consultation requests were LTC (31.7%), cognition (16.6%) and capacity assessment (9.1%). Surgical consultation requests were most frequently general review (26.2%) and delirium (24.6%). Mean length of stay was 33.5 days. Mean number of days to consult was 18.4. Mean number of days between consult and discharge was 15.5. Discharge destinations were LTC (N=105, 41.7%), direct home (N=60, 23.8%), respite (N=24, 9.5%) and rehab (N=18, 6.3%). A number of patients were still admitted (N=14, 5.6%) or died (N=19, 7.5%). 91 (36.1%) patients had attended geriatric medicine outpatients within the last year and 33 (13.1%) were newly referred on discharge. Conclusion The geriatric medicine consultation service plays a key role in supporting hospitalised older patients. Further studies are needed to understand the optimal configuration of local geriatric medicine services to better case-find and support our aging population. Reference 1. Ellis, G. et al. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011;343.
{"title":"Understanding Local Demands On The Inpatient Geriatric Medicine Consultation Service","authors":"Aisling Whelan, Sadbh Moran, Linda Brewer","doi":"10.1093/ageing/afaf318.184","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.184","url":null,"abstract":"Background Comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older patients1. Geriatric medicine consultation service is a means of providing CGA. Our aim was to understand local patterns for geriatric medicine consultation requests. Methods Data collected via electronic patient record on all geriatric medicine consults received over a 4-month period January to April 2025. Statistical analysis via Excel. Results There were 252 consultation requests, 21.5% of patients had multiple consultations. Average of 3.7 consults per day. 129 (51.2%) were female. Mean age 81 (standard deviation 8.3). More consults were from medical specialties (N=186, 73.8%) compared to surgical (N=65, 25.8%). Main indications for consultation were long term care (LTC) (N=70, 27.8%), cognition (N=42, 16.7%), general review (N=29, 11.5%), delirium (N=29, 11.5%), capacity (N=18, 7.1%) and discharge planning (N=17, 6.7%). There was a strong correlation between department and consultation reason p-value &lt;0.001. Most frequent medical consultation requests were LTC (31.7%), cognition (16.6%) and capacity assessment (9.1%). Surgical consultation requests were most frequently general review (26.2%) and delirium (24.6%). Mean length of stay was 33.5 days. Mean number of days to consult was 18.4. Mean number of days between consult and discharge was 15.5. Discharge destinations were LTC (N=105, 41.7%), direct home (N=60, 23.8%), respite (N=24, 9.5%) and rehab (N=18, 6.3%). A number of patients were still admitted (N=14, 5.6%) or died (N=19, 7.5%). 91 (36.1%) patients had attended geriatric medicine outpatients within the last year and 33 (13.1%) were newly referred on discharge. Conclusion The geriatric medicine consultation service plays a key role in supporting hospitalised older patients. Further studies are needed to understand the optimal configuration of local geriatric medicine services to better case-find and support our aging population. Reference 1. Ellis, G. et al. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011;343.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"11 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.107
Amy Lynch, Rose-Anne Kenny, Robert Briggs
Background Older people in Ireland are increasingly presenting to Emergency Departments (ED) for unscheduled care. The aim of this study was to examine the frequency of ED presentation over 12 months in a large sample of older people from a large longitudinal study. Methods A population-representative sample of over 2,300 people aged ≥70 years (mean age 77 years, 55% female) were asked to report the number of ED attendances over the last 12 months. Data was extrapolated to 2022 census figures by the Central Statistics Office to estimate population-based figures. Additional data was collected including health behaviours, chronic disease burden and socioeconomic factors, with logistic regression models assessing the association of these variables with ED attendance. Results Almost one fifth (19% (95% CI 17–21) of older people in Ireland attended the Emergency Department in the last 12 months. This includes 14% (95% CI 12–15) aged 70-74 years; 19% (95% CI 16–23) aged 75-79 years; 20% (95% CI 15–24) aged 80-84 years and 27% (95% CI 22–33) aged ≥85 years. When extrapolated to census data, 99,828 older people reported an ED attendance in the last 12 months, including 22,799 people aged ≥85 years. Factors associated with ED attendance were Age 85+ (Odds Ratio 1.77 (95% CI 1.29 – 2.44); ≥2 Chronic Diseases (Odds Ratio 1.66 (95% CI 1.23 – 2.25) and Heart Disease (Odds Ratio 2.63 (95% CI 1.86 – 3.72), while tertiary education was associated with lower likelihood Ed attendance (Odds Ratio 0.65 (95% CI 0.48 – 0.87)). Conclusion A significant proportion of older people in Ireland attend the ED for unscheduled care, and the number of attendances will likely increase significantly in coming years. Addressing the needs of older people in the ED requires an age-attuned approach, implementing comprehensive geriatric assessment at the hospital front door.
背景：爱尔兰越来越多的老年人到急诊科（ED）接受计划外护理。本研究的目的是在一项大型纵向研究中，在大量老年人样本中检查ED在12个月内出现的频率。方法对2300名年龄≥70岁（平均年龄77岁，55%为女性）的人口代表性样本进行调查，报告过去12个月的急诊科就诊次数。数据是中央统计局根据2022年人口普查数据推算的，以估计人口为基础的数据。收集的其他数据包括健康行为、慢性病负担和社会经济因素，并使用逻辑回归模型评估这些变量与急诊科出勤率的关系。结果爱尔兰近五分之一（19% (95% CI 17-21)）的老年人在过去12个月内就诊于急诊科。其中14% （95% CI 12-15）为70-74岁；年龄在75-79岁的占19% (95% CI 16-23)；20% （95% CI 15-24）为80-84岁，27% （95% CI 22-33）为≥85岁。根据人口普查数据推断，在过去的12个月里，99,828名老年人报告了急诊就诊，其中22,799人年龄≥85岁。与ED出勤率相关的因素有：年龄85岁以上(优势比1.77 (95% CI 1.29 - 2.44)；≥2种慢性疾病(优势比1.66 （95% CI 1.23 - 2.25）和心脏病（优势比2.63 (95% CI 1.86 - 3.72)），而高等教育与较低的Ed出勤率相关（优势比0.65 (95% CI 0.48 - 0.87)）。结论：爱尔兰有相当比例的老年人到急诊科接受计划外护理，而且在未来几年，这一比例可能会显著增加。解决急诊科老年人的需求需要一种与年龄相适应的方法，在医院门口实施全面的老年评估。
{"title":"How Frequently do Older People in Ireland attend the Emergency Department and what Factors influence ED Attendance? A Population-Based Analysis","authors":"Amy Lynch, Rose-Anne Kenny, Robert Briggs","doi":"10.1093/ageing/afaf318.107","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.107","url":null,"abstract":"Background Older people in Ireland are increasingly presenting to Emergency Departments (ED) for unscheduled care. The aim of this study was to examine the frequency of ED presentation over 12 months in a large sample of older people from a large longitudinal study. Methods A population-representative sample of over 2,300 people aged ≥70 years (mean age 77 years, 55% female) were asked to report the number of ED attendances over the last 12 months. Data was extrapolated to 2022 census figures by the Central Statistics Office to estimate population-based figures. Additional data was collected including health behaviours, chronic disease burden and socioeconomic factors, with logistic regression models assessing the association of these variables with ED attendance. Results Almost one fifth (19% (95% CI 17–21) of older people in Ireland attended the Emergency Department in the last 12 months. This includes 14% (95% CI 12–15) aged 70-74 years; 19% (95% CI 16–23) aged 75-79 years; 20% (95% CI 15–24) aged 80-84 years and 27% (95% CI 22–33) aged ≥85 years. When extrapolated to census data, 99,828 older people reported an ED attendance in the last 12 months, including 22,799 people aged ≥85 years. Factors associated with ED attendance were Age 85+ (Odds Ratio 1.77 (95% CI 1.29 – 2.44); ≥2 Chronic Diseases (Odds Ratio 1.66 (95% CI 1.23 – 2.25) and Heart Disease (Odds Ratio 2.63 (95% CI 1.86 – 3.72), while tertiary education was associated with lower likelihood Ed attendance (Odds Ratio 0.65 (95% CI 0.48 – 0.87)). Conclusion A significant proportion of older people in Ireland attend the ED for unscheduled care, and the number of attendances will likely increase significantly in coming years. Addressing the needs of older people in the ED requires an age-attuned approach, implementing comprehensive geriatric assessment at the hospital front door.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"35 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.193
Maryam Al Raisi, Sinead Woulfe, Tiernan Surlis, Claire O’Donovan
Background Age-Friendly Health Systems are designed to promote evidence-based care that aligns with the individual priorities of older adults. Central to this approach is the 5M’s framework—mind, mobility, medications, multi-complexity, and what matters most—which supports a holistic, person-centered model of care. Methods This audit aimed to assess whether medical admissions at Cork University Hospital aligned with the 5M’s framework for age-friendly healthcare: mind, mobility, medications, multi-complexity, and what matters most. A total of 100 medical admissions in patients over 75 years old were reviewed. Data collected included the grade of admitting doctor, patient age, and documentation of each of the 5M components. Results Among the 100 audited cases, 69% were admitted by a Senior House Officer (SHO). The mean patient age was 83 years. Multi-complexity and medications were documented in 96% and 91% of cases, respectively. Mobility was addressed in 60% of cases, and mind in 40%. What matters most, including any mention of patients’ ideas, concerns, or expectations, was documented in only 7% of admissions. Conclusion While documentation around medications and multi-complexity is well established, a key element of the 5M’s, what matters most, is underrepresented in routine medical admissions. These findings highlighted an opportunity to improve age-friendly practices, by encouraging more comprehensive and patient-centered assessments. A quality improvement initiative was developed involving the use of “What Matters” stickers, designed to prompt clinicians to consider and document patient priorities during medical admissions. The audit findings and the purpose of the stickers were presented to the Senior House Officers (SHOs), as they were responsible for the majority of admissions.
{"title":"The 5M’s Framework: Age-Friendly Medical Admissions in a Model 4 Hospital","authors":"Maryam Al Raisi, Sinead Woulfe, Tiernan Surlis, Claire O’Donovan","doi":"10.1093/ageing/afaf318.193","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.193","url":null,"abstract":"Background Age-Friendly Health Systems are designed to promote evidence-based care that aligns with the individual priorities of older adults. Central to this approach is the 5M’s framework—mind, mobility, medications, multi-complexity, and what matters most—which supports a holistic, person-centered model of care. Methods This audit aimed to assess whether medical admissions at Cork University Hospital aligned with the 5M’s framework for age-friendly healthcare: mind, mobility, medications, multi-complexity, and what matters most. A total of 100 medical admissions in patients over 75 years old were reviewed. Data collected included the grade of admitting doctor, patient age, and documentation of each of the 5M components. Results Among the 100 audited cases, 69% were admitted by a Senior House Officer (SHO). The mean patient age was 83 years. Multi-complexity and medications were documented in 96% and 91% of cases, respectively. Mobility was addressed in 60% of cases, and mind in 40%. What matters most, including any mention of patients’ ideas, concerns, or expectations, was documented in only 7% of admissions. Conclusion While documentation around medications and multi-complexity is well established, a key element of the 5M’s, what matters most, is underrepresented in routine medical admissions. These findings highlighted an opportunity to improve age-friendly practices, by encouraging more comprehensive and patient-centered assessments. A quality improvement initiative was developed involving the use of “What Matters” stickers, designed to prompt clinicians to consider and document patient priorities during medical admissions. The audit findings and the purpose of the stickers were presented to the Senior House Officers (SHOs), as they were responsible for the majority of admissions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"8 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.012
Mary Ni Lochlainn, Wiktoria Milczanowska, Giulia Raffaele, Ruth CE Bowyer, Maria Paz Garcia, Kevin Whelan, Claire J Steves
Background Older people are still not included in many clinical trials resulting in a poor evidence base for older people’s medicine. Remote trial delivery represents a way to improve this. Despite recent advances in technology, there is a lack of research regarding participants’ perspectives on remote research delivery. This study aimed to compare remote physical performance and anthropometric measurements to those taken in-person, and to present participant perspectives on remote trials, utilising findings from the remotely delivered PROMOTe trial. Methods All trial participants (n=72) were invited to complete questionnaire. A subset was invited to attend an in-person visit within 48hours of final video-visit. Bland-Altman plots (95% limits of agreement [LOA]) were employed to compare weight, height, grip strength, and chair-stand time. Results Fifty-eight (81%) participants completed the questionnaire (age mean 73.3 years, SD 5.0). Over half (31/58, 54%) had no preference between remote or in-person participation. Of those who preferred remote participation, a majority (5/7, 71.4%) stated this was to avoid travel. Of those who preferred in-person, a majority stated they liked to talk to staff face-to-face. Sixteen individuals attended in-person validation visits (age mean 75 years, SD 1.7). All (32/32, 100%) measurements of chair stand time, weight, gait-speed and overall short physical performance battery score and 94% (30/32) of measurements of height and grip strength fell within LOA, and there were no statistically significant within person differences between remote and in–person measurements. Conclusion Most participants found remote trial delivery both acceptable and manageable. Remotely measured physical performance was highly comparable to in person, supporting use of remote physical measurements in older adults. It should not be assumed that older people will not be able to manage technology or other aspects of remote trial delivery. Researchers should aim for flexible, responsive study designs ensuring the inclusion of older people.
{"title":"Remotely Delivered Clinical Trials in Older Adults: The Future of Inclusive Research?","authors":"Mary Ni Lochlainn, Wiktoria Milczanowska, Giulia Raffaele, Ruth CE Bowyer, Maria Paz Garcia, Kevin Whelan, Claire J Steves","doi":"10.1093/ageing/afaf318.012","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.012","url":null,"abstract":"Background Older people are still not included in many clinical trials resulting in a poor evidence base for older people’s medicine. Remote trial delivery represents a way to improve this. Despite recent advances in technology, there is a lack of research regarding participants’ perspectives on remote research delivery. This study aimed to compare remote physical performance and anthropometric measurements to those taken in-person, and to present participant perspectives on remote trials, utilising findings from the remotely delivered PROMOTe trial. Methods All trial participants (n=72) were invited to complete questionnaire. A subset was invited to attend an in-person visit within 48hours of final video-visit. Bland-Altman plots (95% limits of agreement [LOA]) were employed to compare weight, height, grip strength, and chair-stand time. Results Fifty-eight (81%) participants completed the questionnaire (age mean 73.3 years, SD 5.0). Over half (31/58, 54%) had no preference between remote or in-person participation. Of those who preferred remote participation, a majority (5/7, 71.4%) stated this was to avoid travel. Of those who preferred in-person, a majority stated they liked to talk to staff face-to-face. Sixteen individuals attended in-person validation visits (age mean 75 years, SD 1.7). All (32/32, 100%) measurements of chair stand time, weight, gait-speed and overall short physical performance battery score and 94% (30/32) of measurements of height and grip strength fell within LOA, and there were no statistically significant within person differences between remote and in–person measurements. Conclusion Most participants found remote trial delivery both acceptable and manageable. Remotely measured physical performance was highly comparable to in person, supporting use of remote physical measurements in older adults. It should not be assumed that older people will not be able to manage technology or other aspects of remote trial delivery. Researchers should aim for flexible, responsive study designs ensuring the inclusion of older people.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"28 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.078
Dawn Kelly, Ruth Lordan
Background Physical inactivity is recognised as a leading risk factor for obesity, non-communicable diseases and chronic conditions. In Ireland, however, Healthy Ireland data has shown that only 33% of older adults aged 65-74 and 18% of those aged 75+ meet physical activity recommendations. The Physiotherapy Department at Leopardstown Park Hospital created this cycle challenge to increase exercise and to help meet the WHO physical activity guidelines for those > 65 among day centre clients. Methods Each day centre client was asked if they would like to participate in the Ring of Kerry cycle challenge. Individual A3-sized Ring of Kerry maps were used for each client to increase motivation to exercise. The distance cycled each week was marked on the route. Daily, maps were placed on a board with scenic pictures representing key points along the route. Motivation Tools: Visual cues – scenic pictures and individual maps with distance covered in black. Competition between participants. Reminiscence over pictures and memories of times past when they were in Kerry. Chat between day centre clients about the challenge. Results 31 out of approximately 100 clients (31%) agreed to participate in the Ring of Kerry cycle challenge. 4 out of 31 clients attended twice a week, and the remaining 27 (88%) attended once weekly. In addition to the cycle challenge, all participants attended the physio-led exercise class, thus increasing their physical activity levels even further. Youngest: 66, oldest 98, mean age:85 Total Distance: 3850.16km Mean Weekly Distance: 2.4km Total minimum Distance: 11.27km Total maximum Distance: 516.78km Mean Distance: 124.19 Km Time: Minimum =7mins, maximum = 22mins, total time in minutes: 11545 mins Mean time in minutes: 373mins, 7mins per week average Conclusion Inclusion of these motivational tools increased willingness to participate in extra exercise initiatives, as evidenced. The Ring of Kerry cycle challenge created a positive environment for exercising.
{"title":"Day Centre Ring of Kerry Cycle Challenge to increase weekly moderate intensity physical activity levels for > 65’s","authors":"Dawn Kelly, Ruth Lordan","doi":"10.1093/ageing/afaf318.078","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.078","url":null,"abstract":"Background Physical inactivity is recognised as a leading risk factor for obesity, non-communicable diseases and chronic conditions. In Ireland, however, Healthy Ireland data has shown that only 33% of older adults aged 65-74 and 18% of those aged 75+ meet physical activity recommendations. The Physiotherapy Department at Leopardstown Park Hospital created this cycle challenge to increase exercise and to help meet the WHO physical activity guidelines for those &gt; 65 among day centre clients. Methods Each day centre client was asked if they would like to participate in the Ring of Kerry cycle challenge. Individual A3-sized Ring of Kerry maps were used for each client to increase motivation to exercise. The distance cycled each week was marked on the route. Daily, maps were placed on a board with scenic pictures representing key points along the route. Motivation Tools: Visual cues – scenic pictures and individual maps with distance covered in black. Competition between participants. Reminiscence over pictures and memories of times past when they were in Kerry. Chat between day centre clients about the challenge. Results 31 out of approximately 100 clients (31%) agreed to participate in the Ring of Kerry cycle challenge. 4 out of 31 clients attended twice a week, and the remaining 27 (88%) attended once weekly. In addition to the cycle challenge, all participants attended the physio-led exercise class, thus increasing their physical activity levels even further. Youngest: 66, oldest 98, mean age:85 Total Distance: 3850.16km Mean Weekly Distance: 2.4km Total minimum Distance: 11.27km Total maximum Distance: 516.78km Mean Distance: 124.19 Km Time: Minimum =7mins, maximum = 22mins, total time in minutes: 11545 mins Mean time in minutes: 373mins, 7mins per week average Conclusion Inclusion of these motivational tools increased willingness to participate in extra exercise initiatives, as evidenced. The Ring of Kerry cycle challenge created a positive environment for exercising.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"127 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.124
Úna Mulligan, Michelle Carville, Sinead Stone, Dominic Hart, David Linehan, Ciara Sankey, Wendelene Latoza, Siobhan O'Neill, Marian Marks
Background Malnutrition, sarcopenia, and frailty are interconnected conditions that can exacerbate one another. They remain under-recognized and under-treated contributing to adverse health outcomes(1). Timely medical, nutritional, and physical interventions can mitigate harm and enhance patient outcomes. While this hospital employed the Malnutrition Universal Screening Tool (MUST), no formal screening tool was used to assess sarcopenia risk. A quality improvement initiative was launched to evaluate malnutrition and sarcopenia risk among patients seen by the Frailty Intervention Team (FIT) in the emergency department (ED) and to strengthen the referral pathway for nutritional intervention. Methods Guided by the Plan-Do-Check-Act framework, the project involved: Results The initial audit revealed poor MUST screening compliance (4%), a high falls history (51%), and low dietetic referral rates (21%). Following implementation, malnutrition screening improved to 85%, with 11% of patients identified as malnourished and 38% at risk. Falls history remained high (57%), and 54% of patients had a SARC-f score ≥4, indicating significant sarcopenia risk. Dietetic referrals increased to 51%. Conclusion This initiative significantly improved screening and referral for malnutrition and sarcopenia among frail older adults in the ED. Given the high sarcopenia risk identified, incorporating hand grip strength assessment may enhance diagnostic accuracy. Ongoing education and monitoring will be crucial to sustaining improvements in clinical practice. Reference 1. Bowler, C. et al. Nutritional Screening, Initial Management and Referral for Older People with Sarcopenia or Frailty-Results from a UK-Wide Survey. Journal of Frailty, Sarcopenia and Falls 2024;9.2:131.
{"title":"“Strength in Screening”: Improving Malnutrition & Sarcopenia Detection in the Emergency Department","authors":"Úna Mulligan, Michelle Carville, Sinead Stone, Dominic Hart, David Linehan, Ciara Sankey, Wendelene Latoza, Siobhan O'Neill, Marian Marks","doi":"10.1093/ageing/afaf318.124","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.124","url":null,"abstract":"Background Malnutrition, sarcopenia, and frailty are interconnected conditions that can exacerbate one another. They remain under-recognized and under-treated contributing to adverse health outcomes(1). Timely medical, nutritional, and physical interventions can mitigate harm and enhance patient outcomes. While this hospital employed the Malnutrition Universal Screening Tool (MUST), no formal screening tool was used to assess sarcopenia risk. A quality improvement initiative was launched to evaluate malnutrition and sarcopenia risk among patients seen by the Frailty Intervention Team (FIT) in the emergency department (ED) and to strengthen the referral pathway for nutritional intervention. Methods Guided by the Plan-Do-Check-Act framework, the project involved: Results The initial audit revealed poor MUST screening compliance (4%), a high falls history (51%), and low dietetic referral rates (21%). Following implementation, malnutrition screening improved to 85%, with 11% of patients identified as malnourished and 38% at risk. Falls history remained high (57%), and 54% of patients had a SARC-f score ≥4, indicating significant sarcopenia risk. Dietetic referrals increased to 51%. Conclusion This initiative significantly improved screening and referral for malnutrition and sarcopenia among frail older adults in the ED. Given the high sarcopenia risk identified, incorporating hand grip strength assessment may enhance diagnostic accuracy. Ongoing education and monitoring will be crucial to sustaining improvements in clinical practice. Reference 1. Bowler, C. et al. Nutritional Screening, Initial Management and Referral for Older People with Sarcopenia or Frailty-Results from a UK-Wide Survey. Journal of Frailty, Sarcopenia and Falls 2024;9.2:131.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"132 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.093
Kate McCarthy, Neasa Fitzpatrick, Emer Ahern, Alison Holmes, Rose Galvin, Patrice Reilly, Sharon Walsh, Brendan Walsh
Background Facility-based short-stay care (SSC) is increasingly utilised to support older adults transitioning from acute hospital settings. Since 2015 the service has expanded, partly in response to access and discharge issued during the COVID 19 pandemic, however, these access and discharge issues remain. Inconsistencies in terminology, care models, and outcomes challenge both international and national policy and practice, particularly in Ireland where governance, service capability, and outcome monitoring are fragmented. This review aimed to characterise international SSC models, assess their clinical and economic impacts, understand user experiences, and evaluate Ireland’s current SSC framework. Methods A scoping reviewC:UsersamkilgannonDownloadsapplewebdata:6A092C91-6AB4-4024-804F-C187137E9BF7 - _msocom_1 of international literature was conducted alongside a system-level analysis of SSC in Ireland, including public and private sector models. Key data on governance, capacity, interventions, and outcomes were synthesized. Results Internationally, SSC models integrate core components such as multidisciplinary care, comprehensive geriatric assessment, and coordinated discharge planning, yet lack standardised outcome metrics. Older adults have frequently expressed diminished autonomy and increased dependency within this model of care. Evidence on their effectiveness remains mixed. In Ireland, SSC is primarily delivered through private nursing homes under Transitional Care Funding and other schemes, often without adequate regulation or consistent care delivery. Data indicate variable patient outcomes, limited access to allied health services, high rates of readmission, long lengths of stay, and substantial public spending exceeding €120 million annually.C:UsersamkilgannonDownloadsapplewebdata:5921ECC9-86DF-407F-AA22-36BD3808C81E - _msocom_1 C:UsersamkilgannonDownloadsapplewebdata:5921ECC9-86DF-407F-AA22-36BD3808C81E - _msoanchor_1 Conclusion SSC has the potential to play a pivotal role in post-acute care for older adults, but current models in Ireland require major reform. Integrated governance, outcome-based evaluation, service redesign, and robust economic analyses are urgently needed to ensure care quality, safety, and efficiency.
{"title":"Lost In Transition: A Review of Current Facility-Based Short-Stay Care Models for Older Adults in Ireland","authors":"Kate McCarthy, Neasa Fitzpatrick, Emer Ahern, Alison Holmes, Rose Galvin, Patrice Reilly, Sharon Walsh, Brendan Walsh","doi":"10.1093/ageing/afaf318.093","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.093","url":null,"abstract":"Background Facility-based short-stay care (SSC) is increasingly utilised to support older adults transitioning from acute hospital settings. Since 2015 the service has expanded, partly in response to access and discharge issued during the COVID 19 pandemic, however, these access and discharge issues remain. Inconsistencies in terminology, care models, and outcomes challenge both international and national policy and practice, particularly in Ireland where governance, service capability, and outcome monitoring are fragmented. This review aimed to characterise international SSC models, assess their clinical and economic impacts, understand user experiences, and evaluate Ireland’s current SSC framework. Methods A scoping reviewC:UsersamkilgannonDownloadsapplewebdata:6A092C91-6AB4-4024-804F-C187137E9BF7 - _msocom_1 of international literature was conducted alongside a system-level analysis of SSC in Ireland, including public and private sector models. Key data on governance, capacity, interventions, and outcomes were synthesized. Results Internationally, SSC models integrate core components such as multidisciplinary care, comprehensive geriatric assessment, and coordinated discharge planning, yet lack standardised outcome metrics. Older adults have frequently expressed diminished autonomy and increased dependency within this model of care. Evidence on their effectiveness remains mixed. In Ireland, SSC is primarily delivered through private nursing homes under Transitional Care Funding and other schemes, often without adequate regulation or consistent care delivery. Data indicate variable patient outcomes, limited access to allied health services, high rates of readmission, long lengths of stay, and substantial public spending exceeding €120 million annually.C:UsersamkilgannonDownloadsapplewebdata:5921ECC9-86DF-407F-AA22-36BD3808C81E - _msocom_1 C:UsersamkilgannonDownloadsapplewebdata:5921ECC9-86DF-407F-AA22-36BD3808C81E - _msoanchor_1 Conclusion SSC has the potential to play a pivotal role in post-acute care for older adults, but current models in Ireland require major reform. Integrated governance, outcome-based evaluation, service redesign, and robust economic analyses are urgently needed to ensure care quality, safety, and efficiency.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"161 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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