Pub Date : 2025-12-06DOI: 10.1093/ageing/afaf318.094
Jennifer Allen, Sarah Donnelly, Sinéad Murphy, Sarah Morton
Background Complex physical and mental health comorbidities, including cognitive impairment, can impact upon decision-making capabilities in later life. Therefore, the opportunity to receive timely information, engage actively in decision-making, and express preferences about future care is crucial1. Despite universal recognition of the benefits of engaging older adults and persons living with dementia in advance care planning (ACP), evidence indicates that ACP happens infrequently. This timely study sought to collaboratively explore ACP from the perspective of older persons, their family carers, and inter-disciplinary health care professionals within Older Persons Mental Health Services, considering the commencement of the Assisted Decision-Making (Capacity) Act 2015. Methods This participatory action research study utilised mixed methods with multi-stakeholders; encompassing a local survey (n=19), national survey (n=50), focus groups (n=22), a co-operative inquiry group (n=9), and stakeholder dialogue (n=18), iteratively across three stages. Results The integrated findings of the study identified the importance of timeframe, highlighting the tension between giving individuals time to adjust to a diagnosis, versus ‘a window of opportunity’ for engagement in ACP. Receiving timely information was underscored as facilitating better understanding for older persons and their family carers, and increased capacity to cope later in the illness trajectory. The study identified the need for a multi-pronged life-course policy approach to normalise ACP that would transcend healthcare, and the discourse of death and dying. Furthermore, a life-course approach with associated public campaign(s), may also serve to combat ageism at a societal level, perhaps linking to the National Positive Ageing Strategy. Conclusion A pro-active approach to ACP, including the provision of timely information and engagement, and identifying emotional readiness were highlighted. A life-course policy approach to ACP, with associated public campaign(s) to normalise ACP and combat ageism is recommended. Reference 1. World Health Organisation. Assessing the development of palliative care worldwide: a set of actionable indicators. Geneva: WHO, 2021.
{"title":"Promoting Early Engagement and a Life Course Approach to Advance Care Planning: Findings from a Multi-Stakeholder Participatory Action Research Study","authors":"Jennifer Allen, Sarah Donnelly, Sinéad Murphy, Sarah Morton","doi":"10.1093/ageing/afaf318.094","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.094","url":null,"abstract":"Background Complex physical and mental health comorbidities, including cognitive impairment, can impact upon decision-making capabilities in later life. Therefore, the opportunity to receive timely information, engage actively in decision-making, and express preferences about future care is crucial1. Despite universal recognition of the benefits of engaging older adults and persons living with dementia in advance care planning (ACP), evidence indicates that ACP happens infrequently. This timely study sought to collaboratively explore ACP from the perspective of older persons, their family carers, and inter-disciplinary health care professionals within Older Persons Mental Health Services, considering the commencement of the Assisted Decision-Making (Capacity) Act 2015. Methods This participatory action research study utilised mixed methods with multi-stakeholders; encompassing a local survey (n=19), national survey (n=50), focus groups (n=22), a co-operative inquiry group (n=9), and stakeholder dialogue (n=18), iteratively across three stages. Results The integrated findings of the study identified the importance of timeframe, highlighting the tension between giving individuals time to adjust to a diagnosis, versus ‘a window of opportunity’ for engagement in ACP. Receiving timely information was underscored as facilitating better understanding for older persons and their family carers, and increased capacity to cope later in the illness trajectory. The study identified the need for a multi-pronged life-course policy approach to normalise ACP that would transcend healthcare, and the discourse of death and dying. Furthermore, a life-course approach with associated public campaign(s), may also serve to combat ageism at a societal level, perhaps linking to the National Positive Ageing Strategy. Conclusion A pro-active approach to ACP, including the provision of timely information and engagement, and identifying emotional readiness were highlighted. A life-course policy approach to ACP, with associated public campaign(s) to normalise ACP and combat ageism is recommended. Reference 1. World Health Organisation. Assessing the development of palliative care worldwide: a set of actionable indicators. Geneva: WHO, 2021.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"26 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680160","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 : 2025-12-06DOI: 10.1093/ageing/afaf318.147
Anna Healy, Samaila Shehu, Brendan Sweeney, Ruth McDonagh
Background The End PJ Paralysis campaign is a global movement initiated in the United Kingdom in 2017 that aims to highlight the importance of getting patients dressed and out of bed to reduce the risk of physical deconditioning and promote their independence and improve overall well-being. This audit aims to review the number of patients in a rehabilitation hospital wearing their own clothes and sitting out of their beds during a single evening meal time. Methods We reviewed the clothing attire and location for the evening meal of all patients admitted onto two geriatric medicine rehabilitation wards on a single day. We completed a visual assessment of the patients attire including if they were in pyjamas or normal attire, their footwear and their location during an evening meal. We used a data collection tool to record this information. Results There were n=49 inpatients reviewed over 2 inpatient wards in a rehabilitation hospital. All patients were over the age of 65. N=44 (88%) were wearing normal clothing attire and n=5(12%) were in pyjamas. N=30 (61%) were in soled shoes, n=13 (26%) wore non-slip socks and n=6 (13%) were in normal socks. N=27 (55%) had their evening meal in the communal dining room, n=17 (33%) ate sitting in their chair at the bedside and n=5 (12%) ate dinner in bed. Conclusion This audit found that the majority of patients were appropriately dressed, including proper footwear, and were sitting out of bed for their evening meal. Given the fluctuating clinical status of patients in the hospital, some may not always wear optimal attire. The findings were presented during a departmental teaching session to emphasize the importance of addressing the topic of PJ paralysis and improving patient outcomes.
{"title":"A Review of the Clothing Attire of Patients Admitted to a Rehabilitation Hospital","authors":"Anna Healy, Samaila Shehu, Brendan Sweeney, Ruth McDonagh","doi":"10.1093/ageing/afaf318.147","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.147","url":null,"abstract":"Background The End PJ Paralysis campaign is a global movement initiated in the United Kingdom in 2017 that aims to highlight the importance of getting patients dressed and out of bed to reduce the risk of physical deconditioning and promote their independence and improve overall well-being. This audit aims to review the number of patients in a rehabilitation hospital wearing their own clothes and sitting out of their beds during a single evening meal time. Methods We reviewed the clothing attire and location for the evening meal of all patients admitted onto two geriatric medicine rehabilitation wards on a single day. We completed a visual assessment of the patients attire including if they were in pyjamas or normal attire, their footwear and their location during an evening meal. We used a data collection tool to record this information. Results There were n=49 inpatients reviewed over 2 inpatient wards in a rehabilitation hospital. All patients were over the age of 65. N=44 (88%) were wearing normal clothing attire and n=5(12%) were in pyjamas. N=30 (61%) were in soled shoes, n=13 (26%) wore non-slip socks and n=6 (13%) were in normal socks. N=27 (55%) had their evening meal in the communal dining room, n=17 (33%) ate sitting in their chair at the bedside and n=5 (12%) ate dinner in bed. Conclusion This audit found that the majority of patients were appropriately dressed, including proper footwear, and were sitting out of bed for their evening meal. Given the fluctuating clinical status of patients in the hospital, some may not always wear optimal attire. The findings were presented during a departmental teaching session to emphasize the importance of addressing the topic of PJ paralysis and improving patient outcomes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"20 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680304","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 : 2025-12-06DOI: 10.1093/ageing/afaf318.014
Aoife O'Brien, Iracema Leroi, Emma O'Shea
Background Despite Lewy Body Dementia (LBD) being prevalent and challenging for families to navigate, models of support for people living with LBD and/or their family caregivers are not always available, accessible or acceptable. Peer support is known to be effective, however models of peer support specific to LBD are not well understood. The aim of this study is to systematically scope the body of existing literature to better understand models of peer support for people living with LBD and their families. Methods We conducted a systematic scoping review of the literature searching six electronic databases for eligible studies; PubMed, Cochrane, EMBASE, SCOPUS, CINAHL and PsycINFO. Two reviewers independently screened and appraised studies and extracted data. Results Five studies were eligible for inclusion. The findings highlighted that existing peer support models for LBD are largely heterogeneous in intervention format, design and characteristics. Interventions include individual and group-based formats, delivered both in-person and online, with duration ranging from 4-16 weeks and frequency from 15-150 minutes. Population sample included both people with LBD and their care partners (n=2) or care partners only (n=3). Interventions varied in facilitator background and training. Some positive themes were identified across the literature; psychoeducational support, informational support and sense of community/shared experiences. Only one standardised peer support intervention for LBD was identified (PERSEVERE). Conclusion Few exemplars of peer support for LBD have been reported in the literature, and those that do exhibit high heterogeneity, presenting challenges for replication and development of the evidence base. Further research is needed to develop and evaluate well-defined models of LBD-specific peer support.
{"title":"Models Of Peer Support For LEWY-Body Dementia: A Systematic Scoping Review","authors":"Aoife O'Brien, Iracema Leroi, Emma O'Shea","doi":"10.1093/ageing/afaf318.014","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.014","url":null,"abstract":"Background Despite Lewy Body Dementia (LBD) being prevalent and challenging for families to navigate, models of support for people living with LBD and/or their family caregivers are not always available, accessible or acceptable. Peer support is known to be effective, however models of peer support specific to LBD are not well understood. The aim of this study is to systematically scope the body of existing literature to better understand models of peer support for people living with LBD and their families. Methods We conducted a systematic scoping review of the literature searching six electronic databases for eligible studies; PubMed, Cochrane, EMBASE, SCOPUS, CINAHL and PsycINFO. Two reviewers independently screened and appraised studies and extracted data. Results Five studies were eligible for inclusion. The findings highlighted that existing peer support models for LBD are largely heterogeneous in intervention format, design and characteristics. Interventions include individual and group-based formats, delivered both in-person and online, with duration ranging from 4-16 weeks and frequency from 15-150 minutes. Population sample included both people with LBD and their care partners (n=2) or care partners only (n=3). Interventions varied in facilitator background and training. Some positive themes were identified across the literature; psychoeducational support, informational support and sense of community/shared experiences. Only one standardised peer support intervention for LBD was identified (PERSEVERE). Conclusion Few exemplars of peer support for LBD have been reported in the literature, and those that do exhibit high heterogeneity, presenting challenges for replication and development of the evidence base. Further research is needed to develop and evaluate well-defined models of LBD-specific peer support.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"8 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680305","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}
Background Patients who do not have enough information about their discharge plan, have decreased treatment compliance, decreased patient safety, increased emergency department (ED) re-attendance, and poor satisfaction (DeSai et al. 2021). This project aimed to co-design a discharge information pack that is person centred, for patients referred to the frailty at the front door team. Methods The booklet was developed with a universal design approach and utilised NALA & HSE guidelines. The project was broken down into 3 key phases: In Phase 1, we set the outline of the project, delivered a patient questionnaire and hosted a stakeholder engagement event, which included acute and community Health and Social Care Professional (HSCP) colleagues, local Integrated Care team for Older Persons, local falls service, hospital managers, and patient advocates. An explorative questionnaire was distributed to patients and their family members in the ED, (n=25) to assess their priorities for the information pack. Phase 2 focused on developing the discharge pack content by the multidisciplinary team members. We aimed to provide standardised, evidence based information from each team member, aligned to Healthy Ireland Programmes; key information on living well in the community, positive ageing, and minding your mood, with the overarching aim of promoting patients’ independence at home. Finally, production and piloting of the discharge pack took place in Phase 3. Results We have successfully produced our discharge pack and currently piloting its use among our patient cohort (older adults >70) in our ED. The booklet provides tailored information from each FIT team member on patients’ discharge plan to support them at home, and takes a person centred, holistic approach of the patient’s individual needs. Conclusion We have received successful verbal feedback from patients following receiving the booklet. A pilot of this booklet is in progress, we plan to re-evaluate to complete the PDSA cycle.
对出院计划没有足够信息的患者，治疗依从性降低，患者安全性降低，急诊科（ED）复诊率增加，满意度差（DeSai et al. 2021）。该项目旨在共同设计一个以人为本的出院信息包，用于在前门团队转介的虚弱患者。方法采用通用设计方法，并采用NALA &； HSE指南。该项目分为三个关键阶段：在第一阶段，我们制定了项目大纲，发放了患者问卷，并举办了利益相关者参与活动，参与者包括急性病和社区卫生和社会护理专业人员（HSCP）的同事、当地老年人综合护理团队、当地跌倒服务、医院管理人员和患者倡导者。向急诊科的患者及其家属分发了一份探索性问卷（n=25），以评估他们对信息包的优先级。第二阶段的重点是由多学科团队成员开发放电包内容。我们的目标是为每个团队成员提供标准化的、基于证据的信息，与健康爱尔兰方案保持一致；有关在社区生活良好、积极安度晚年和关注情绪的主要信息，以促进患者在家独立为首要目标。最后，在第三阶段进行了泄放封包的生产和试验。结果：我们已经成功地制作了出院包，目前正在急诊科的患者群体（老年人& gt；70）中试用。小册子提供了每个FIT团队成员关于患者出院计划的量身定制信息，以支持他们在家，并采取以人为本的整体方法来满足患者的个人需求。结论收到宣传册后，我们成功地收到了患者的口头反馈。本手册的试点正在进行中，我们计划重新评估以完成PDSA周期。
{"title":"FIT for Discharge: A Frailty Intervention Team Patient Discharge Information Pack","authors":"Aimee Ocsio, Rachel McLoughlin, Hannah Cronin, Karen Coughlin, Aoife McElligott, Aine Keeshan","doi":"10.1093/ageing/afaf318.067","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.067","url":null,"abstract":"Background Patients who do not have enough information about their discharge plan, have decreased treatment compliance, decreased patient safety, increased emergency department (ED) re-attendance, and poor satisfaction (DeSai et al. 2021). This project aimed to co-design a discharge information pack that is person centred, for patients referred to the frailty at the front door team. Methods The booklet was developed with a universal design approach and utilised NALA & HSE guidelines. The project was broken down into 3 key phases: In Phase 1, we set the outline of the project, delivered a patient questionnaire and hosted a stakeholder engagement event, which included acute and community Health and Social Care Professional (HSCP) colleagues, local Integrated Care team for Older Persons, local falls service, hospital managers, and patient advocates. An explorative questionnaire was distributed to patients and their family members in the ED, (n=25) to assess their priorities for the information pack. Phase 2 focused on developing the discharge pack content by the multidisciplinary team members. We aimed to provide standardised, evidence based information from each team member, aligned to Healthy Ireland Programmes; key information on living well in the community, positive ageing, and minding your mood, with the overarching aim of promoting patients’ independence at home. Finally, production and piloting of the discharge pack took place in Phase 3. Results We have successfully produced our discharge pack and currently piloting its use among our patient cohort (older adults >70) in our ED. The booklet provides tailored information from each FIT team member on patients’ discharge plan to support them at home, and takes a person centred, holistic approach of the patient’s individual needs. Conclusion We have received successful verbal feedback from patients following receiving the booklet. A pilot of this booklet is in progress, we plan to re-evaluate to complete the PDSA cycle.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"350 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680214","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 : 2025-12-06DOI: 10.1093/ageing/afaf318.144
Mary Okon, Roz O'Byrne, Riona Mulcahy, Fizzah Fatima
Background The Assisted Decision-Making Act 2015 (The Act) implemented on April 26, 2023, marked a significant change in Irish healthcare law. It emphasises autonomy and supported decision-making for individuals who may lack capacity. Limited evidence exists regarding Irish medical professionals' awareness and understanding of the Act. We aimed to assess knowledge and awareness among medical professionals in Ireland. Methods A cross-sectional survey was conducted among doctors across four hospitals. It included multiple choice and true/false questions to assess knowledge, awareness, and barriers in implementing the Act. Results 96 (n=96) medical professionals completed the survey. Respondents represented various specialties. 15 (15.62%) Consultants, 81 (84.38%) NCHD’s completed the survey. Years of experience ranged from less than 5 to 20+ years in clinical practice. 81 (84.3%) were aware of the Act and reported basic or moderate grasp of the legislation. 4 (4.17%) reported comprehensive understanding, 18 (18.75%) reported no understanding of the Act. 47 (48.96%) indicated that a multidisciplinary team should be responsible for capacity assessments while 8 (8.33%) felt Geriatricians should perform the assessment. 41 (42.71%) were not confident in applying principles of the Act in practice. 90 (93.75%) identified that a person can appoint a decision-making assistant. 76 (79.17%) identified that The Act abolishes the ward of court. 71 (73.96%) have received no training on The Act. 87 (90.62%) expressed desire for further training, with preferred formats including online modules, workshops, and written guidelines. Common barriers in implementing the Act included lack of awareness (n=50), lack of time (n=32), insufficient training (n=66), and issues with complexity (n=44). Conclusion This audit shows that medical professionals widely recognise the Act, there is notable lack of understanding and confidence in applying its principles. Results highlights need for structured training, multidisciplinary support, and policies to effectively implement the Act in clinical practice.
{"title":"Assessment of Knowledge on the Assisted Decision-Making (capacity) act 2015 among Irish Medical professionals in Ireland","authors":"Mary Okon, Roz O'Byrne, Riona Mulcahy, Fizzah Fatima","doi":"10.1093/ageing/afaf318.144","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.144","url":null,"abstract":"Background The Assisted Decision-Making Act 2015 (The Act) implemented on April 26, 2023, marked a significant change in Irish healthcare law. It emphasises autonomy and supported decision-making for individuals who may lack capacity. Limited evidence exists regarding Irish medical professionals' awareness and understanding of the Act. We aimed to assess knowledge and awareness among medical professionals in Ireland. Methods A cross-sectional survey was conducted among doctors across four hospitals. It included multiple choice and true/false questions to assess knowledge, awareness, and barriers in implementing the Act. Results 96 (n=96) medical professionals completed the survey. Respondents represented various specialties. 15 (15.62%) Consultants, 81 (84.38%) NCHD’s completed the survey. Years of experience ranged from less than 5 to 20+ years in clinical practice. 81 (84.3%) were aware of the Act and reported basic or moderate grasp of the legislation. 4 (4.17%) reported comprehensive understanding, 18 (18.75%) reported no understanding of the Act. 47 (48.96%) indicated that a multidisciplinary team should be responsible for capacity assessments while 8 (8.33%) felt Geriatricians should perform the assessment. 41 (42.71%) were not confident in applying principles of the Act in practice. 90 (93.75%) identified that a person can appoint a decision-making assistant. 76 (79.17%) identified that The Act abolishes the ward of court. 71 (73.96%) have received no training on The Act. 87 (90.62%) expressed desire for further training, with preferred formats including online modules, workshops, and written guidelines. Common barriers in implementing the Act included lack of awareness (n=50), lack of time (n=32), insufficient training (n=66), and issues with complexity (n=44). Conclusion This audit shows that medical professionals widely recognise the Act, there is notable lack of understanding and confidence in applying its principles. Results highlights need for structured training, multidisciplinary support, and policies to effectively implement the Act in clinical practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"132 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680217","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 : 2025-12-06DOI: 10.1093/ageing/afaf318.123
Niamh O'Donnell, Amy Fowler, Fiona McCleane, James Geoghegan, Robert Murphy, Kevin Kitt, Michelle Canavan, Maria Costello
Background The Integrated Care Programme for Older Persons (ICPOP) is a crucial gateway for general practitioners (GPs) to access multidisciplinary services for older adults with complex care needs. As the future of community care, it is essential that GP trainees are aware of these comprehensive pathways. This study aimed to assess the knowledge and attitudes of GP trainees toward a local ICPOP service. Methods A cross-sectional survey was developed using Google Forms and disseminated via organisational email and local messaging groups to 143 trainees enrolled in the Western GP Training Scheme. The survey assessed trainees’ awareness of ICPOP, understanding of referral criteria, and perceived impact of prior interactions with the service. Results A total of 61 GP trainees completed the survey, yielding a response rate of 42.6%. Most respondents were GP registrars (60.8%, n=37). While 82% (n=50) reported awareness of ICPOP, only 11.5% (n=7) felt confident identifying appropriate referral scenarios, and just 16% (n=10) understood the eligibility criteria. Among the 25 trainees who had previously referred patients to ICPOP, 92% (n=23) reported positive patient outcomes, and 64% (n=16) were highly satisfied with the care provided. Conclusion Despite high levels of general awareness of the service, there is a significant knowledge gap in GP trainees’ understanding of how and when to refer to ICPOP. Notably, those with experience of the service perceived a strong benefit to patient care. These findings highlight the importance of targeted education on ICPOP pathways during GP training. In response, the results of this survey will inform the development of a structured teaching session for trainees, aimed at improving familiarity with referral processes and enhancing integration of geriatric care within general practice.
{"title":"Assessing GP Trainee Awareness and Attitudes Toward an Integrated Care Programme for Older Persons (ICPOP)","authors":"Niamh O'Donnell, Amy Fowler, Fiona McCleane, James Geoghegan, Robert Murphy, Kevin Kitt, Michelle Canavan, Maria Costello","doi":"10.1093/ageing/afaf318.123","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.123","url":null,"abstract":"Background The Integrated Care Programme for Older Persons (ICPOP) is a crucial gateway for general practitioners (GPs) to access multidisciplinary services for older adults with complex care needs. As the future of community care, it is essential that GP trainees are aware of these comprehensive pathways. This study aimed to assess the knowledge and attitudes of GP trainees toward a local ICPOP service. Methods A cross-sectional survey was developed using Google Forms and disseminated via organisational email and local messaging groups to 143 trainees enrolled in the Western GP Training Scheme. The survey assessed trainees’ awareness of ICPOP, understanding of referral criteria, and perceived impact of prior interactions with the service. Results A total of 61 GP trainees completed the survey, yielding a response rate of 42.6%. Most respondents were GP registrars (60.8%, n=37). While 82% (n=50) reported awareness of ICPOP, only 11.5% (n=7) felt confident identifying appropriate referral scenarios, and just 16% (n=10) understood the eligibility criteria. Among the 25 trainees who had previously referred patients to ICPOP, 92% (n=23) reported positive patient outcomes, and 64% (n=16) were highly satisfied with the care provided. Conclusion Despite high levels of general awareness of the service, there is a significant knowledge gap in GP trainees’ understanding of how and when to refer to ICPOP. Notably, those with experience of the service perceived a strong benefit to patient care. These findings highlight the importance of targeted education on ICPOP pathways during GP training. In response, the results of this survey will inform the development of a structured teaching session for trainees, aimed at improving familiarity with referral processes and enhancing integration of geriatric care within general practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"127 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680299","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}
Background Lack of integration between Integrated Care (ICPOP) and Primary Care (PC) Speech and Language Therapy (SLT) services can result in fragmented care, service duplication, and delays in intervention. To address this, a collaborative initiative was developed in the Dublin North West area to streamline triage pathways between ICPOP and PC SLT teams. The primary aim was to improve continuity of care and ensure clients receive coordinated SLT input. A secondary aim was to support caseload management by facilitating timely transfer of suitable clients to ICPOP SLT, thereby alleviating pressure on primary care services. Methods An integrated triage process was introduced. Upon referral to ICPOP SLT, the clinician contacted the corresponding PC SLT for joint case discussion to guide individualized care decisions dependent on client status: This process is now embedded in routine service delivery. Results Between January and April 2025, 65 clients were triaged through this model: Conclusion This collaborative triage model enhanced service integration, reduced duplication, and optimised caseload management. Continued alignment and joint initiatives are recommended to improve outcomes, particularly for clients with progressive neurological conditions commonly identified through ICPOP.
{"title":"Enhancing Continuity of SLT Care for Older Adults: Integrating ICPOP and Primary Care Services to Reduce Duplication and Improve Outcomes","authors":"Amy Reilly, Ronán Brady, Francesca Keogh, Maeve Keohane","doi":"10.1093/ageing/afaf318.196","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.196","url":null,"abstract":"Background Lack of integration between Integrated Care (ICPOP) and Primary Care (PC) Speech and Language Therapy (SLT) services can result in fragmented care, service duplication, and delays in intervention. To address this, a collaborative initiative was developed in the Dublin North West area to streamline triage pathways between ICPOP and PC SLT teams. The primary aim was to improve continuity of care and ensure clients receive coordinated SLT input. A secondary aim was to support caseload management by facilitating timely transfer of suitable clients to ICPOP SLT, thereby alleviating pressure on primary care services. Methods An integrated triage process was introduced. Upon referral to ICPOP SLT, the clinician contacted the corresponding PC SLT for joint case discussion to guide individualized care decisions dependent on client status: This process is now embedded in routine service delivery. Results Between January and April 2025, 65 clients were triaged through this model: Conclusion This collaborative triage model enhanced service integration, reduced duplication, and optimised caseload management. Continued alignment and joint initiatives are recommended to improve outcomes, particularly for clients with progressive neurological conditions commonly identified through ICPOP.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"28 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680302","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 : 2025-12-06DOI: 10.1093/ageing/afaf318.208
Aoife McFeely, Mary McCarron, Sean Kennelly
Background While adults with Intellectual Disability (ID) are at increased risk of frailty, accurate frailty measurement is challenging in this population. Lifelong functional dependence can be misrepresented as frailty using existing frailty indices (FIs). An ID-specific FI has been developed that omits markers of activities of daily living (ADLs) to limit the bias of pre-existing dependency in frailty measurement. The aim of this study was to examine dependency in ADL ability as an outcome of frailty measured using an ID-specific FI. Methods This cross-sectional study was conducted using the Intellectual Disability Supplement to The Irish Longitudinal Database of Aging (IDS-TILDA). Frailty was measured using the IDS-TILDA FI, a 31-item FI. The IDS-TILDA FI contains no markers of functional dependence. Frailty was measured in 745 adults with ID using data from Wave 1 of IDS-TILDA (2010-2011). Frailty is scored from 0-1 with higher scores indicating higher frailty. The outcomes of interest were personal and instrumental ADLs; Bathing, toileting, shopping and household chores. Pearson correlation was used to examine the relationship between frailty and ADL ability while controlling for age and Level of ID. Statistical analysis was conducted using SPSS Version 29.0.0. Results After controlling for age and level of ID, the IDS-TILDA FI was significantly associated with functional tasks. The strongest correlations were observed for toileting (r = .235, p < .001) and bathing (r = .191, p < .001). Weaker but still significant associations were found for household chores (r = .132, p < .001) and shopping (r = .097, p = .013). Conclusion Frailty appears to have an independent effect on individuals’ ability to perform both personal and instrumental activities of daily living. Stronger associations were observed for personal ADLs over instrumental ADLs, particularly after controlling for Level of ID. These results suggest that frailty can be accurately measured without inclusion of functional ability.
背景：虽然智力残疾（ID）的成年人的衰弱风险增加，但在这一人群中，准确的衰弱测量是具有挑战性的。使用现有的虚弱指数（fi），终身功能依赖可能被错误地表示为虚弱。已经开发了一种id特异性FI，该FI省略了日常生活活动（adl）的标记，以限制虚弱测量中预先存在的依赖性的偏差。本研究的目的是检查ADL能力的依赖性作为虚弱的结果，使用id特异性FI测量。方法采用爱尔兰老龄化纵向数据库智力残疾补充（IDS-TILDA）进行横断面研究。虚弱度测量采用IDS-TILDA FI，一个31项FI。IDS-TILDA FI不含功能依赖标志物。使用IDS-TILDA第1波（2010-2011）的数据，对745名患有ID的成年人进行了脆弱性测量。虚弱程度从0-1分，分数越高，虚弱程度越高。感兴趣的结果是个人adl和工具性adl；洗澡、如厕、购物和做家务。在控制年龄和ID水平的情况下，使用Pearson相关来检验虚弱和ADL能力之间的关系。采用SPSS 29.0.0版本进行统计分析。结果在控制年龄和ID水平后，IDS-TILDA FI与功能任务显著相关。相关性最强的是如厕（r = 0.235, p <）。001)和洗澡（r = .191, p < .001）。家务劳动的相关性较弱，但仍然显著（r = 0.132, p <）。001)和购物（r = 0.097, p = 0.013）。结论：虚弱似乎对个体进行日常生活的个人和工具活动的能力都有独立的影响。观察到个人adl比工具adl有更强的关联，特别是在控制了ID水平之后。这些结果表明，在不包括功能能力的情况下，可以准确地测量脆弱性。
{"title":"Frailty and Activities of Daily Living in Adults with Intellectual Disability","authors":"Aoife McFeely, Mary McCarron, Sean Kennelly","doi":"10.1093/ageing/afaf318.208","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.208","url":null,"abstract":"Background While adults with Intellectual Disability (ID) are at increased risk of frailty, accurate frailty measurement is challenging in this population. Lifelong functional dependence can be misrepresented as frailty using existing frailty indices (FIs). An ID-specific FI has been developed that omits markers of activities of daily living (ADLs) to limit the bias of pre-existing dependency in frailty measurement. The aim of this study was to examine dependency in ADL ability as an outcome of frailty measured using an ID-specific FI. Methods This cross-sectional study was conducted using the Intellectual Disability Supplement to The Irish Longitudinal Database of Aging (IDS-TILDA). Frailty was measured using the IDS-TILDA FI, a 31-item FI. The IDS-TILDA FI contains no markers of functional dependence. Frailty was measured in 745 adults with ID using data from Wave 1 of IDS-TILDA (2010-2011). Frailty is scored from 0-1 with higher scores indicating higher frailty. The outcomes of interest were personal and instrumental ADLs; Bathing, toileting, shopping and household chores. Pearson correlation was used to examine the relationship between frailty and ADL ability while controlling for age and Level of ID. Statistical analysis was conducted using SPSS Version 29.0.0. Results After controlling for age and level of ID, the IDS-TILDA FI was significantly associated with functional tasks. The strongest correlations were observed for toileting (r = .235, p &lt; .001) and bathing (r = .191, p &lt; .001). Weaker but still significant associations were found for household chores (r = .132, p &lt; .001) and shopping (r = .097, p = .013). Conclusion Frailty appears to have an independent effect on individuals’ ability to perform both personal and instrumental activities of daily living. Stronger associations were observed for personal ADLs over instrumental ADLs, particularly after controlling for Level of ID. These results suggest that frailty can be accurately measured without inclusion of functional ability.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680303","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 : 2025-12-06DOI: 10.1093/ageing/afaf318.158
Emily Buckley, Aileen Barrett, Deirdre Bennett, Colm O'Tuathaigh, John Cooke
Background The rapidly increasing older adult population necessitates training in gerontological competencies for all hospital doctors regardless of specialty. Simulation-based education (SBE) has been proposed as a potential educational intervention to achieve this. However, research in gerontological simulation is limited. This study aims to explore if SBE fosters transformative learning (TL) and influences clinical behaviour in hospital doctors.. Specifically, we explored if and how SBE facilitates the acquisition of a specific set of gerontological competencies. Methods Incorporating an instructional design approach and Mesirow’s transformative learning theory, we developed a simulation scenario focusing on the management of an older adult with delirium and Parkinson’s disease. A scoping review and national consensus mapping study were conducted to determine learning needs. Doctors within a single hospital site were invited to participate. The learners in each scenario were invited to participate in an individual semi-structured interview two to four weeks post the simulation scenario. The scenario was facilitated utilising minimal resources. Evaluation was conducted via an audio-recorded debrief and semi-structured interview. Questions were guided by the ten phases of Mesirow’s transformative learning theory. Transcripts were analysed using thematic analysis. Results Nine simulation scenarios and debriefs were followed by nine individual semi-structured interviews. Participants included hospital doctors from internal medicine, surgery and obstetrics and gynaecology. Four overarching themes continuously arose contributing to our understanding of TL of gerontological competencies through SBE: 1.)‘Creating a realistic challenge’; 2.)‘SBE as a catalyst for reflection’; 3.)’Looking to the future’ and 4.)'Gerontological simulation: a paradigm shift’. Conclusion Simulation-based education promotes transformative learning of gerontological competencies pertaining to delirium and Parkinson’s disease for hospital doctors. Future research should focus on exploring how SBE can foster the TL of broader gerontological competencies. These findings could subsequently guide the development of dedicated simulation curricula for postgraduate medical training across all hospital specialties.
{"title":"The Simulation Solution: Empowering Hospital Doctors To Care For Older Adults","authors":"Emily Buckley, Aileen Barrett, Deirdre Bennett, Colm O'Tuathaigh, John Cooke","doi":"10.1093/ageing/afaf318.158","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.158","url":null,"abstract":"Background The rapidly increasing older adult population necessitates training in gerontological competencies for all hospital doctors regardless of specialty. Simulation-based education (SBE) has been proposed as a potential educational intervention to achieve this. However, research in gerontological simulation is limited. This study aims to explore if SBE fosters transformative learning (TL) and influences clinical behaviour in hospital doctors.. Specifically, we explored if and how SBE facilitates the acquisition of a specific set of gerontological competencies. Methods Incorporating an instructional design approach and Mesirow’s transformative learning theory, we developed a simulation scenario focusing on the management of an older adult with delirium and Parkinson’s disease. A scoping review and national consensus mapping study were conducted to determine learning needs. Doctors within a single hospital site were invited to participate. The learners in each scenario were invited to participate in an individual semi-structured interview two to four weeks post the simulation scenario. The scenario was facilitated utilising minimal resources. Evaluation was conducted via an audio-recorded debrief and semi-structured interview. Questions were guided by the ten phases of Mesirow’s transformative learning theory. Transcripts were analysed using thematic analysis. Results Nine simulation scenarios and debriefs were followed by nine individual semi-structured interviews. Participants included hospital doctors from internal medicine, surgery and obstetrics and gynaecology. Four overarching themes continuously arose contributing to our understanding of TL of gerontological competencies through SBE: 1.)‘Creating a realistic challenge’; 2.)‘SBE as a catalyst for reflection’; 3.)’Looking to the future’ and 4.)'Gerontological simulation: a paradigm shift’. Conclusion Simulation-based education promotes transformative learning of gerontological competencies pertaining to delirium and Parkinson’s disease for hospital doctors. Future research should focus on exploring how SBE can foster the TL of broader gerontological competencies. These findings could subsequently guide the development of dedicated simulation curricula for postgraduate medical training across all hospital specialties.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680215","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 : 2025-12-06DOI: 10.1093/ageing/afaf318.028
Patrick Crowley, Mark O'Donovan, Peter Leahy, Evelyn Flanagan, Rónán O'Caoimh
Background Sleep disturbance is an important treatment target in people with cognitive impairment because it is common, leads to negative outcomes, and may contribute to cognitive decline. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to search Medline, CINAHL, PsycINFO and Cochrane CENTRAL, from inception to the 3rd October 2023, for controlled clinical trials of pharmacological and non-pharmacological interventions to improve sleep in people with mild cognitive impairment and dementia. Results In all, 144 trials involving 13,471 participants (median 50 per trial) were included; 95 examined non-pharmacological interventions, 46 examined pharmacological interventions, and three involved both as part of a multi-modal intervention. To measure sleep, 68 trials used subjective measures exclusively, 41 used only objective measures, while 35 used a combination. In total, 287 discreet sleep outcome measures were reported, 205 of which were used in only one of the included trials. No single outcome measure was used in over half of the included trials. Bright light therapy was the most frequently examined non-pharmacological intervention but results were equivocal. Other non-pharmacological interventions (e.g. physical activity, cognitive behavioural therapy for insomnia, music, and continuous positive airway pressure) showed promise but require further evidence. Results for melatonin, the most frequently examined pharmacological intervention, were inconclusive but lower doses may be more effective. Other pharmacological interventions (e.g. trazadone and orexin-receptor antagonists) demonstrated encouraging results in a small number of trials. Conclusion There is insufficient evidence to inform clinical decisions regarding the treatment of sleep disturbance in people with cognitive impairment. Existing research is marked by wide heterogeneity, both in the methods used to measure sleep and in the outcome measures reported, limiting data synthesis. A core outcome set is required to ensure future research produces more coherent and reliable evidence to improve outcomes for people with cognitive impairment.
{"title":"Pharmacological and non-pharmacological interventions to improve sleep in people with cognitive impairment: A systematic review and meta-analysis","authors":"Patrick Crowley, Mark O'Donovan, Peter Leahy, Evelyn Flanagan, Rónán O'Caoimh","doi":"10.1093/ageing/afaf318.028","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.028","url":null,"abstract":"Background Sleep disturbance is an important treatment target in people with cognitive impairment because it is common, leads to negative outcomes, and may contribute to cognitive decline. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to search Medline, CINAHL, PsycINFO and Cochrane CENTRAL, from inception to the 3rd October 2023, for controlled clinical trials of pharmacological and non-pharmacological interventions to improve sleep in people with mild cognitive impairment and dementia. Results In all, 144 trials involving 13,471 participants (median 50 per trial) were included; 95 examined non-pharmacological interventions, 46 examined pharmacological interventions, and three involved both as part of a multi-modal intervention. To measure sleep, 68 trials used subjective measures exclusively, 41 used only objective measures, while 35 used a combination. In total, 287 discreet sleep outcome measures were reported, 205 of which were used in only one of the included trials. No single outcome measure was used in over half of the included trials. Bright light therapy was the most frequently examined non-pharmacological intervention but results were equivocal. Other non-pharmacological interventions (e.g. physical activity, cognitive behavioural therapy for insomnia, music, and continuous positive airway pressure) showed promise but require further evidence. Results for melatonin, the most frequently examined pharmacological intervention, were inconclusive but lower doses may be more effective. Other pharmacological interventions (e.g. trazadone and orexin-receptor antagonists) demonstrated encouraging results in a small number of trials. Conclusion There is insufficient evidence to inform clinical decisions regarding the treatment of sleep disturbance in people with cognitive impairment. Existing research is marked by wide heterogeneity, both in the methods used to measure sleep and in the outcome measures reported, limiting data synthesis. A core outcome set is required to ensure future research produces more coherent and reliable evidence to improve outcomes for people with cognitive impairment.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"4 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680216","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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