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}
Pub Date : 2025-12-06DOI: 10.1093/ageing/afaf318.018
Anita Hayes, Mary Jordan, Ailish Houlihan, Olwyn Hanley, David McGrath, Fiona Tuite, Ailbhe Kelly, Caitlin Ui Bhaoill, Marie Alexander
Background Ireland's population of 65 years and over has grown over 40% from 2013 to 2023. 1 in 3 people over 65 fall every year. Creating an age-friendly health service that emphasises preventive care is essential. Evidence shows that falls prevention exercise programmes, of sufficient duration (over 12 weeks), significantly reduce falls risk. The World Guidelines for Falls Prevention and Management (Montero-Odasso et al 2022) recommend falls prevention exercise programmes for all community-dwelling older adults. Primary Care Physiotherapy services do not have capacity to deliver interventions beyond the intermediate care period. Funding secured through HSE Health and Wellbeing, enabled the implementation of a programme designed to meet the recommended duration to effectively reduce falls risk. This pilot project aimed to evaluate the effectiveness of a 26-week Falls Prevention Intervention based on the FaME (Falls Management Exercise) model. Methods This programme was offered to adults over 65 with a history, risk, or fear of falling. It was delivered in 4 community-based locations in the West of Ireland. Each program began with 6-weeks led by a Postural Stability Instructor (PSI)-trained Primary Care Physiotherapist, followed by 20-weeks with a PSI-trained Exercise Instructor. Balance, gait, strength, confidence, and self–reported health were assessed pre-, mid-, and post-intervention. Results 31 participants completed the programme. Objective outcome measures showed statistically significant improvements: 30-seconds chair stand (p < 0.002), Timed Up and Go (p < 0.0004), 4-Stage Balance test (p < 0.0004) and Functional Reach (p < 0.0001). Subjectively participants reported improvements in balance confidence (CONFBal p < 0.002) and self-reported health (EQ VAS P < 0.04) but with smaller effect sizes. The programmes were rated positively by all participants in the Participant Experience Questionnaire. Conclusion This collaborative project between Primary Care Physiotherapy, independent exercise instructors, and HSE Health and Wellbeing yielded positive clinical outcomes and participant feedback, supporting the case for longer interventions.
从2013年到2023年，爱尔兰65岁及以上的人口增长了40%以上。65岁以上的人中，每年有三分之一的人跌倒。建立一种对老年人友好的保健服务，强调预防保健至关重要。有证据表明，持续时间足够（超过12周）的预防跌倒运动规划可显著降低跌倒风险。《世界预防和管理跌倒指南》（Montero-Odasso et al 2022）建议为所有社区居住的老年人制定预防跌倒的运动规划。初级保健物理治疗服务没有能力提供超过中间护理期的干预措施。通过HSE健康与福利获得的资金，使一项旨在满足建议持续时间的方案得以实施，从而有效降低跌倒风险。该试点项目旨在评估基于FaME （Falls Management Exercise）模型的26周预防跌倒干预措施的有效性。方法本方案面向65岁以上有跌倒史、有跌倒风险或有跌倒恐惧的成年人。它在爱尔兰西部的4个社区地点提供。每个项目开始的6周由一位经过姿势稳定指导（PSI）培训的初级保健理疗师领导，随后20周由一位经过PSI培训的运动指导师指导。在干预前、干预中和干预后评估平衡、步态、力量、自信和自我报告的健康状况。结果31名参与者完成了项目。客观结果测量显示了统计学上显著的改善：30秒站立椅（p < 0.002）、Timed Up and Go （p < 0.0004）、4阶段平衡测试（p < 0.0004）和功能延伸（p < 0.0001）。主观上，参与者报告了平衡信心（CONFBal p < 0.002）和自我报告健康（EQ VAS p < 0.04）的改善，但效果较小。在参与者体验问卷中，所有参与者对课程的评价都是积极的。初级保健理疗、独立运动教练和HSE健康与福利之间的合作项目产生了积极的临床结果和参与者反馈，支持长期干预的案例。
{"title":"Improving Falls Prevention Outcomes: Evaluating The Impact Of A 26-Week Collaborative Falls Prevention Pilot Intervention Across 4 Primary Care Areas","authors":"Anita Hayes, Mary Jordan, Ailish Houlihan, Olwyn Hanley, David McGrath, Fiona Tuite, Ailbhe Kelly, Caitlin Ui Bhaoill, Marie Alexander","doi":"10.1093/ageing/afaf318.018","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.018","url":null,"abstract":"Background Ireland's population of 65 years and over has grown over 40% from 2013 to 2023. 1 in 3 people over 65 fall every year. Creating an age-friendly health service that emphasises preventive care is essential. Evidence shows that falls prevention exercise programmes, of sufficient duration (over 12 weeks), significantly reduce falls risk. The World Guidelines for Falls Prevention and Management (Montero-Odasso et al 2022) recommend falls prevention exercise programmes for all community-dwelling older adults. Primary Care Physiotherapy services do not have capacity to deliver interventions beyond the intermediate care period. Funding secured through HSE Health and Wellbeing, enabled the implementation of a programme designed to meet the recommended duration to effectively reduce falls risk. This pilot project aimed to evaluate the effectiveness of a 26-week Falls Prevention Intervention based on the FaME (Falls Management Exercise) model. Methods This programme was offered to adults over 65 with a history, risk, or fear of falling. It was delivered in 4 community-based locations in the West of Ireland. Each program began with 6-weeks led by a Postural Stability Instructor (PSI)-trained Primary Care Physiotherapist, followed by 20-weeks with a PSI-trained Exercise Instructor. Balance, gait, strength, confidence, and self–reported health were assessed pre-, mid-, and post-intervention. Results 31 participants completed the programme. Objective outcome measures showed statistically significant improvements: 30-seconds chair stand (p &lt; 0.002), Timed Up and Go (p &lt; 0.0004), 4-Stage Balance test (p &lt; 0.0004) and Functional Reach (p &lt; 0.0001). Subjectively participants reported improvements in balance confidence (CONFBal p &lt; 0.002) and self-reported health (EQ VAS P &lt; 0.04) but with smaller effect sizes. The programmes were rated positively by all participants in the Participant Experience Questionnaire. Conclusion This collaborative project between Primary Care Physiotherapy, independent exercise instructors, and HSE Health and Wellbeing yielded positive clinical outcomes and participant feedback, supporting the case for longer interventions.","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":"145680300","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/afaf318.054
Sarah O'Loughlin, Agnes Jonsson, Louise Gaffney, Colin Mason
Background Ireland’s national trauma strategy1 advocates for coordinated, specialist-led trauma care within Major Trauma Centres (MTCs) to improve patient outcomes. This audit evaluated the management of traumatic brain injuries (TBIs) at the newly designated National MTC during its first 14 months, benchmarking against national trauma guidelines. Methods A retrospective review of TBI admissions from July 2023 to September 2024 was performed. Data collected included demographics, injury characteristics, care pathways, and outcomes such as length of stay and 30-day mortality. Compliance with national standards for specialist ward admission and neurosurgical referral was assessed. Results Of 203 TBI cases, 147 (72.4%) were male and 107 (52.7%) were aged ≥65 years old. TBIs included 39.0% subdural haematomas, 18.2% subarachnoid haemorrhages, 14.3% intraparenchymal haemorrhages and 22 (10.8%) mixed haemorrhages. Falls from <2 metres accounted for 56% of presentations. Intensive care was required in 29 (14.3%) cases, while 123 (60.6%) were managed on trauma wards. 13.8% (28) required transfer to neurosurgical centre. GCS changes were the only significant predictor of transfer (p = 0.017). Among older patients, 21.5% had dementia, 16.8% were nursing home residents and frailty was common (mean clinical frailty score 4.88). The 30-day mortality was higher (7.4%) compared to younger patients (2%), along with the median length of stay, which was 9 days and 5 days, respectively. Conclusion This audit highlights the diverse patient cohort in trauma care. It highlights adherence to guidelines, with neurosurgical transfer guided by clinical deterioration, not age or other factors. The guidelines advocates for specialist beds; however, due to limited availability, some patients were managed outside dedicated trauma wards. A TBI unit has opened to meet this demand. Cycle two will examine the effects of these changes on 30-mortality and length of stay. Reference 1. Trauma Steering Group. A trauma system for Ireland: report of the trauma steering group. 2018.
{"title":"Audit of Traumatic Brain Injury Management at the National Major Trauma Centre","authors":"Sarah O'Loughlin, Agnes Jonsson, Louise Gaffney, Colin Mason","doi":"10.1093/ageing/afaf318.054","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.054","url":null,"abstract":"Background Ireland’s national trauma strategy1 advocates for coordinated, specialist-led trauma care within Major Trauma Centres (MTCs) to improve patient outcomes. This audit evaluated the management of traumatic brain injuries (TBIs) at the newly designated National MTC during its first 14 months, benchmarking against national trauma guidelines. Methods A retrospective review of TBI admissions from July 2023 to September 2024 was performed. Data collected included demographics, injury characteristics, care pathways, and outcomes such as length of stay and 30-day mortality. Compliance with national standards for specialist ward admission and neurosurgical referral was assessed. Results Of 203 TBI cases, 147 (72.4%) were male and 107 (52.7%) were aged ≥65 years old. TBIs included 39.0% subdural haematomas, 18.2% subarachnoid haemorrhages, 14.3% intraparenchymal haemorrhages and 22 (10.8%) mixed haemorrhages. Falls from &lt;2 metres accounted for 56% of presentations. Intensive care was required in 29 (14.3%) cases, while 123 (60.6%) were managed on trauma wards. 13.8% (28) required transfer to neurosurgical centre. GCS changes were the only significant predictor of transfer (p = 0.017). Among older patients, 21.5% had dementia, 16.8% were nursing home residents and frailty was common (mean clinical frailty score 4.88). The 30-day mortality was higher (7.4%) compared to younger patients (2%), along with the median length of stay, which was 9 days and 5 days, respectively. Conclusion This audit highlights the diverse patient cohort in trauma care. It highlights adherence to guidelines, with neurosurgical transfer guided by clinical deterioration, not age or other factors. The guidelines advocates for specialist beds; however, due to limited availability, some patients were managed outside dedicated trauma wards. A TBI unit has opened to meet this demand. Cycle two will examine the effects of these changes on 30-mortality and length of stay. Reference 1. Trauma Steering Group. A trauma system for Ireland: report of the trauma steering group. 2018.","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":"145680301","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/afaf318.146
Edel McDaid, Ciara Ryan, Regina Hennessy, Lucinda Edge
Background The Active Recovery Team (ART) supports older adults to recover following an emergency department (ED) presentation by providing a responsive, next-day therapy intervention at home. The team comprises of a physiotherapist, occupational therapist, and therapy assistant. Older adults are referred to this service by the Frailty Intervention Team in the ED. Methods A retrospective review was conducted of patients discharged home from the ED with ART input between January 2024 and March 2025. Patient data included age, sex, frailty status (measured using the Clinical Frailty Scale), length of stay, and presenting complaint. Functional outcomes were assessed using the Functional Independence Measure (FIM) at initial ART assessment and on discharge from ART. Paired t-tests were used for statistical analysis. ED re-presentation and hospital admission rates were recorded at 72 hours, 7 days, and 30 days. Results A total of 118 patients were discharged from the ED with ART during the study period. All were contacted or had the first home visit on the next working day. The cohort was predominantly female (72%), with a mean age of 81 years. The average duration of ART input was 17 days (range: 3–70). Most patients (90%) had mild to moderate frailty (CFS 4–6); 5% were pre-frail (CFS 1–3), and 5% had severe frailty (CFS 7–9). Falls were the most common reason for ED attendance (72%), and 30% sustained a fracture. FIM scores significantly improved (p<0.001), with a mean increase of 3 points. ED re-presentation rates at 72 hours, 7 days, and 30 days were 1.7%, 2.5%, and 9.3%, respectively. Corresponding hospital admission rates were 1.7%, 1.7%, and 6.8%. Conclusion A responsive, therapy-led home intervention can effectively support older adults living with frailty to recover after an ED presentation. The ART model demonstrated significant functional improvement and low rates of representation and admission.
{"title":"Improving Function in Older Adults with Frailty Following an Emergency Department Presentation","authors":"Edel McDaid, Ciara Ryan, Regina Hennessy, Lucinda Edge","doi":"10.1093/ageing/afaf318.146","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.146","url":null,"abstract":"Background The Active Recovery Team (ART) supports older adults to recover following an emergency department (ED) presentation by providing a responsive, next-day therapy intervention at home. The team comprises of a physiotherapist, occupational therapist, and therapy assistant. Older adults are referred to this service by the Frailty Intervention Team in the ED. Methods A retrospective review was conducted of patients discharged home from the ED with ART input between January 2024 and March 2025. Patient data included age, sex, frailty status (measured using the Clinical Frailty Scale), length of stay, and presenting complaint. Functional outcomes were assessed using the Functional Independence Measure (FIM) at initial ART assessment and on discharge from ART. Paired t-tests were used for statistical analysis. ED re-presentation and hospital admission rates were recorded at 72 hours, 7 days, and 30 days. Results A total of 118 patients were discharged from the ED with ART during the study period. All were contacted or had the first home visit on the next working day. The cohort was predominantly female (72%), with a mean age of 81 years. The average duration of ART input was 17 days (range: 3–70). Most patients (90%) had mild to moderate frailty (CFS 4–6); 5% were pre-frail (CFS 1–3), and 5% had severe frailty (CFS 7–9). Falls were the most common reason for ED attendance (72%), and 30% sustained a fracture. FIM scores significantly improved (p&lt;0.001), with a mean increase of 3 points. ED re-presentation rates at 72 hours, 7 days, and 30 days were 1.7%, 2.5%, and 9.3%, respectively. Corresponding hospital admission rates were 1.7%, 1.7%, and 6.8%. Conclusion A responsive, therapy-led home intervention can effectively support older adults living with frailty to recover after an ED presentation. The ART model demonstrated significant functional improvement and low rates of representation and admission.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"13 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680213","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/afaf318.099
Maeve D'Alton, Maya Baby, Lisa Donaghy, Orla C Sheehan, Eamon Dolan
Background Cognitive impairment is a common consequence of stroke, affecting approximately 40% of survivors, and is associated with adverse outcomes including increased disability and recurrent stroke. Hypertension is the most common risk factor for stroke and is a key target for secondary prevention of further stroke events and progression of background white matter change. Ambulatory blood pressure (ABP) assists in diagnosis and management of hypertension and is better at risk stratifying patients than clinic blood pressure. We examined the relationship between cognition and ABP profile at six months post stroke. Methods This was a prospective study of patients admitted with acute ischaemic or haemorrhagic stroke. Baseline clinical data included stroke type, aetiology, risk factors, demographic and socioeconomic data. Cognition was assessed at baseline and again at six months post stroke using the Montreal Cognitive Assessment (MoCA), with cognitive impairment defined as a score of <24 points. ABP was performed at 6-month follow up. Output variables including day and night mean BP, dipping, and ambulatory arterial stiffness index were correlated with MoCA scores. Statistical analysis was performed using Stata. Results Forty one patients (14 female) with mean age 61.8 years were enrolled. The majority (90%) had ischaemic strokes and 69% were functionally independent (modified Rankin score 0-2) at six months post stroke. Participants with MoCA <24 were older and had higher prevalence of hypertension and more severe white matter change on baseline brain imaging. On ABP, cognitive impairment was associated with nocturnal non-dipping of systolic (4.5% vs 10.7%) and diastolic (7.3% vs 14.2%) BP and higher AASI (0.58 vs 0.46, p= 0.02). Conclusion Cognitive impairment post stroke is associated with non-dipping BP and arterial stiffness, both of which are significant predictors of cardiovascular risk derived from ABP. Hypertension remains a key target for primary and secondary prevention of stroke and cognitive impairment.
认知障碍是卒中的常见后果，影响到约40%的幸存者，并与包括残疾增加和复发性卒中在内的不良后果相关。高血压是卒中最常见的危险因素，是进一步卒中事件和背景白质改变进展的二级预防的关键目标。动态血压（ABP）有助于高血压的诊断和管理，并且比临床血压更好地对患者进行风险分层。我们检查了脑卒中后6个月认知与ABP的关系。方法：对急性缺血性或出血性脑卒中患者进行前瞻性研究。基线临床数据包括脑卒中类型、病因、危险因素、人口统计学和社会经济数据。在基线和中风后6个月再次使用蒙特利尔认知评估（MoCA）评估认知能力，认知障碍的定义为得分为&；lt；24分。随访6个月行ABP。输出变量包括昼夜平均血压、血压下沉和动态动脉僵硬指数与MoCA评分相关。采用Stata进行统计分析。结果纳入41例患者，其中女性14例，平均年龄61.8岁。大多数（90%）患有缺血性卒中，69%在卒中后6个月功能独立（修正Rankin评分0-2）。MoCA <；24名患者年龄较大，高血压患病率较高，基线脑成像显示白质改变更严重。在ABP方面，认知障碍与夜间收缩压（4.5% vs 10.7%）和舒张压（7.3% vs 14.2%）不下降和AASI升高（0.58 vs 0.46, p= 0.02）相关。结论脑卒中后认知功能障碍与非降血压和动脉僵硬度相关，两者均是ABP所致心血管危险的重要预测指标，高血压仍是脑卒中及认知功能障碍一级和二级预防的重要目标。
{"title":"Post Stroke Cognitive Impairment and the Relationship with Ambulatory Blood Pressure Indices","authors":"Maeve D'Alton, Maya Baby, Lisa Donaghy, Orla C Sheehan, Eamon Dolan","doi":"10.1093/ageing/afaf318.099","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.099","url":null,"abstract":"Background Cognitive impairment is a common consequence of stroke, affecting approximately 40% of survivors, and is associated with adverse outcomes including increased disability and recurrent stroke. Hypertension is the most common risk factor for stroke and is a key target for secondary prevention of further stroke events and progression of background white matter change. Ambulatory blood pressure (ABP) assists in diagnosis and management of hypertension and is better at risk stratifying patients than clinic blood pressure. We examined the relationship between cognition and ABP profile at six months post stroke. Methods This was a prospective study of patients admitted with acute ischaemic or haemorrhagic stroke. Baseline clinical data included stroke type, aetiology, risk factors, demographic and socioeconomic data. Cognition was assessed at baseline and again at six months post stroke using the Montreal Cognitive Assessment (MoCA), with cognitive impairment defined as a score of &lt;24 points. ABP was performed at 6-month follow up. Output variables including day and night mean BP, dipping, and ambulatory arterial stiffness index were correlated with MoCA scores. Statistical analysis was performed using Stata. Results Forty one patients (14 female) with mean age 61.8 years were enrolled. The majority (90%) had ischaemic strokes and 69% were functionally independent (modified Rankin score 0-2) at six months post stroke. Participants with MoCA &lt;24 were older and had higher prevalence of hypertension and more severe white matter change on baseline brain imaging. On ABP, cognitive impairment was associated with nocturnal non-dipping of systolic (4.5% vs 10.7%) and diastolic (7.3% vs 14.2%) BP and higher AASI (0.58 vs 0.46, p= 0.02). Conclusion Cognitive impairment post stroke is associated with non-dipping BP and arterial stiffness, both of which are significant predictors of cardiovascular risk derived from ABP. Hypertension remains a key target for primary and secondary prevention of stroke and cognitive impairment.","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":"145680220","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/afaf318.040
Patrice Reilly, Adèle de Vries, Emer Ahern, Helen O'Keefe
Background A national survey was co-designed by the office of the NCAGL, Older Persons in collaboration with Your Voice Matters, older adults, ECC ICPOP, ICPOP CST Clinical and Operational Leads. The objectives were: The “Your Voice Matters” framework, the HSE’s national patient engagement and experience tool, was used as a basis for survey development. Methods A mixed-method survey was disseminated across all 30 ICPOP CSTs in Ireland between December 2024 and March 2025. Eligible participants included older adults and carers who attended an ICPOP CST between September 2024 and March 2025. A total of 412 responses were received: 266 from older adults, 96 from carers and 50 joint submissions from older adults and their carer. Data was analysed using SenseMaker® software, which enabled both structured thematic analysis and exploration of personal narratives. Data saturation was achieved, with no new themes emerging prior to survey closure. Results “My experience renewed my faith in the Irish Health System.” [Older adult] 99% of respondents reported an "overall positive or very positive" experience. Feedback highlighted the relational aspects of care are as vital as clinical interventions and contribute significantly to inclusive decision making, improved wellbeing, function, confidence and hopes for the future. “I never knew that a little bit of heaven was so close to my door.” [Older adult] The accessibility and timeliness of the service, especially home visits, were viewed as major strengths. Minor suggestions for improvement included advance notice for appointments, more flexible scheduling, enhanced follow-up and reviews post discharge. Conclusion To build on these insights, the next phase will involve collaborative workshops with older adults and ICPOP CST MDT members to co-design future service improvements.
{"title":"Capturing the Experience of Integrated Care: A National Survey of Older Adults and Carers who access ICPOP Community Specialist Teams","authors":"Patrice Reilly, Adèle de Vries, Emer Ahern, Helen O'Keefe","doi":"10.1093/ageing/afaf318.040","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.040","url":null,"abstract":"Background A national survey was co-designed by the office of the NCAGL, Older Persons in collaboration with Your Voice Matters, older adults, ECC ICPOP, ICPOP CST Clinical and Operational Leads. The objectives were: The “Your Voice Matters” framework, the HSE’s national patient engagement and experience tool, was used as a basis for survey development. Methods A mixed-method survey was disseminated across all 30 ICPOP CSTs in Ireland between December 2024 and March 2025. Eligible participants included older adults and carers who attended an ICPOP CST between September 2024 and March 2025. A total of 412 responses were received: 266 from older adults, 96 from carers and 50 joint submissions from older adults and their carer. Data was analysed using SenseMaker® software, which enabled both structured thematic analysis and exploration of personal narratives. Data saturation was achieved, with no new themes emerging prior to survey closure. Results “My experience renewed my faith in the Irish Health System.” [Older adult] 99% of respondents reported an \"overall positive or very positive\" experience. Feedback highlighted the relational aspects of care are as vital as clinical interventions and contribute significantly to inclusive decision making, improved wellbeing, function, confidence and hopes for the future. “I never knew that a little bit of heaven was so close to my door.” [Older adult] The accessibility and timeliness of the service, especially home visits, were viewed as major strengths. Minor suggestions for improvement included advance notice for appointments, more flexible scheduling, enhanced follow-up and reviews post discharge. Conclusion To build on these insights, the next phase will involve collaborative workshops with older adults and ICPOP CST MDT members to co-design future service improvements.","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":"145680365","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/afaf318.066
Patricia Molyneaux, Carina O'Brien, James Shannon
Background Current research indicates that patients aged over 65yrs have a 10% risk of frailty, with this number increasing up to 50% in patients over 85yrs age1. The management of acute pain within this group of patients is challenging owing to the increased risk of delirium if pain or medications to relieve the pain are poorly managed. Given the ageing Irish population and the prospective increased demands on the health care system, we aimed to evaluate if current practice is in keeping with national opioid prescribing recommendations and stewardship. Methods A snapshot audit approach using point prevalence was undertaken in 2024. All patients meeting the inclusion criteria, > 65yrs and able to self-report, were assessed by the Clinical Nurse Specialist in Pain Medicine, using The Pain Assessment Documentation Tool (PADT). Results Forty eight (54%) of inpatients met the inclusion criteria. There was a 35% incidence of severe pain. Furthermore, 23% felt their physical function had declined since admission due to pain and 12.5% reported pain interfered with their sleep. A total of 46% of the patients were prescribed opioids, in line with HSE guidance. However, of this cohort, 33% received no dose of prescribed short acting opioid, despite the high reported rate of severe pain. Thus, highlighting the need to provide further support for clinical staff to ensure the appropriate use of analgesia at ward level. Conclusion This audit identified crucial areas for immediate improvement. Notably, the need for a tailored algorithm for the management of acute pain in patients > 65yrs. This led to the formation of a working group, including Pain Medicine CNS, Pain Consultant and Clinical Pharmacist resulting in the development of two algorithms aimed at addressing both acute and neuropathic pain informed by best practice and an extensive literature review.
{"title":"Development of an Algorithm for the Management of Acute Pain in Adults 65yrs and Older in an Acute Hospital setting","authors":"Patricia Molyneaux, Carina O'Brien, James Shannon","doi":"10.1093/ageing/afaf318.066","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.066","url":null,"abstract":"Background Current research indicates that patients aged over 65yrs have a 10% risk of frailty, with this number increasing up to 50% in patients over 85yrs age1. The management of acute pain within this group of patients is challenging owing to the increased risk of delirium if pain or medications to relieve the pain are poorly managed. Given the ageing Irish population and the prospective increased demands on the health care system, we aimed to evaluate if current practice is in keeping with national opioid prescribing recommendations and stewardship. Methods A snapshot audit approach using point prevalence was undertaken in 2024. All patients meeting the inclusion criteria, &gt; 65yrs and able to self-report, were assessed by the Clinical Nurse Specialist in Pain Medicine, using The Pain Assessment Documentation Tool (PADT). Results Forty eight (54%) of inpatients met the inclusion criteria. There was a 35% incidence of severe pain. Furthermore, 23% felt their physical function had declined since admission due to pain and 12.5% reported pain interfered with their sleep. A total of 46% of the patients were prescribed opioids, in line with HSE guidance. However, of this cohort, 33% received no dose of prescribed short acting opioid, despite the high reported rate of severe pain. Thus, highlighting the need to provide further support for clinical staff to ensure the appropriate use of analgesia at ward level. Conclusion This audit identified crucial areas for immediate improvement. Notably, the need for a tailored algorithm for the management of acute pain in patients &gt; 65yrs. This led to the formation of a working group, including Pain Medicine CNS, Pain Consultant and Clinical Pharmacist resulting in the development of two algorithms aimed at addressing both acute and neuropathic pain informed by best practice and an extensive literature review.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"161 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680306","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/afaf318.113
Orla Holmes, Mary Enright, Emma Enright, Abdirahman Mohamed, Swarj Singla, Tala Abdulatif, Nouman Niaz, Marwa Mustafa, Margaret O'Connor, Rose Galvin, Mairead Cahill, Catherine Peters, Aoife Leahy, Ahmed Gabr
Background Accurately characterizing patient complexity on admission to rehabilitation is essential for care planning, resource allocation, and outcome prediction. The Rehabilitation Complexity Scale – Extended (RCS-E) (1) offers a framework to quantify clinical, nursing, and therapy needs in this context. This study aims to describe the baseline complexity of patients admitted to inpatient rehabilitation settings using the RCS-E and explore the distribution of complexity domains across the cohort. Methods A prospective cohort study was conducted involving 22 patients admitted to a post-acute care rehabilitation Hospital over a 6 week period. RCS -E scores were collected at admission and analysed across its five domains: “Medical, Nursing, Therapy Disciplines, Therapy Intensity, and Equipment needs.” Data were collected on demographics, clinical characteristics, frailty scores and polypharmacy. Results The mean age of patients included in this study was 79, 11(50%) patients were male and 11(50%) were female. The median total RCS-E score at admission was 11(range: 7-16) indicating moderate rehabilitation complexity. 4.5% were high complexity, 91% moderate and 4.5% low. The therapy disciplines domain was the greatest contributor to higher complexity scoring. Patients with a CFS score(36%) indicating higher levels of frailty, were associated with higher nursing, therapy and medical needs compared to those with lower frailty scores. Polypharmacy, the use of five or more medications, was present in 86% of the study population. Conclusion Understanding complexity patterns amongst patients admitted to rehabilitation can inform care planning and support resource allocation. At present there is an absence of published Irish research using the RCS-E as a tool for evaluating rehabilitation complexity. Implementing a standardised screening tool to assess rehabilitation complexity is critical to ensuring that services are matched to patient needs, facilitating more efficient resource allocation and improving overall care outcomes. Reference 1. The Rehabilitation Complexity Scale: extended (version 13). Available at: https://www.kcl.ac.uk/nmpc/assets/rehab/rcs-e-v13-with-guidelines-score-sheet.pdf.
{"title":"Characterising Baseline Complexity in Rehabilitation Patients Using the Rehabilitation Complexity Scale (RCS-E)","authors":"Orla Holmes, Mary Enright, Emma Enright, Abdirahman Mohamed, Swarj Singla, Tala Abdulatif, Nouman Niaz, Marwa Mustafa, Margaret O'Connor, Rose Galvin, Mairead Cahill, Catherine Peters, Aoife Leahy, Ahmed Gabr","doi":"10.1093/ageing/afaf318.113","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.113","url":null,"abstract":"Background Accurately characterizing patient complexity on admission to rehabilitation is essential for care planning, resource allocation, and outcome prediction. The Rehabilitation Complexity Scale – Extended (RCS-E) (1) offers a framework to quantify clinical, nursing, and therapy needs in this context. This study aims to describe the baseline complexity of patients admitted to inpatient rehabilitation settings using the RCS-E and explore the distribution of complexity domains across the cohort. Methods A prospective cohort study was conducted involving 22 patients admitted to a post-acute care rehabilitation Hospital over a 6 week period. RCS -E scores were collected at admission and analysed across its five domains: “Medical, Nursing, Therapy Disciplines, Therapy Intensity, and Equipment needs.” Data were collected on demographics, clinical characteristics, frailty scores and polypharmacy. Results The mean age of patients included in this study was 79, 11(50%) patients were male and 11(50%) were female. The median total RCS-E score at admission was 11(range: 7-16) indicating moderate rehabilitation complexity. 4.5% were high complexity, 91% moderate and 4.5% low. The therapy disciplines domain was the greatest contributor to higher complexity scoring. Patients with a CFS score(36%) indicating higher levels of frailty, were associated with higher nursing, therapy and medical needs compared to those with lower frailty scores. Polypharmacy, the use of five or more medications, was present in 86% of the study population. Conclusion Understanding complexity patterns amongst patients admitted to rehabilitation can inform care planning and support resource allocation. At present there is an absence of published Irish research using the RCS-E as a tool for evaluating rehabilitation complexity. Implementing a standardised screening tool to assess rehabilitation complexity is critical to ensuring that services are matched to patient needs, facilitating more efficient resource allocation and improving overall care outcomes. Reference 1. The Rehabilitation Complexity Scale: extended (version 13). Available at: https://www.kcl.ac.uk/nmpc/assets/rehab/rcs-e-v13-with-guidelines-score-sheet.pdf.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"25 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680308","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/afaf318.003
Anne-Marie Miller, Iracema Leroi
Background As Alzheimer’s disease (AD) enters a new treatment era, clinical trials are vital for patient access and aligning Ireland with global innovation. Dementia Trials Ireland (DTI), an Health Research Board (HRB) Clinical Trials Network (CTN), is building national trial capacity across pharmaceutical and non-pharmacological interventions including key studies of diverse intervention type such as EVOKE, EVOKE+ (anti-amyloid therapies), and DIAN studies (preventive approaches in genetically at-risk individuals). Despite progress, challenges persist which include our small patient population, limited specialist sites, regulatory complexity, and significant resource demands. Addressing these issues requires coordinated infrastructure development and workforce upskilling. Methods DTI’s ‘trial ready’ initiative, developed through working groups and harnessing PPI, aims to expand national dementia trial capacity and attract sponsors. Core components include a) pre-consented subtype-specific ‘trial ready’ cohorts; b) centralised feasibility support; c) an early career development programme; and d) simulation-based workforce training. DTI also engages with key national and international stakeholders and policymakers to reduce regulatory barriers and strengthen our potential for impact through international collaboration. Results Conclusion Ireland’s meaningful participation in the evolving AD research landscape depends on sustained investment in infrastructure, workforce development, and regulatory reform. DTI’s initiatives are laying the foundation for a nationally coordinated ‘trial ready’ platform. This ensures that Irish patients will benefit from early access to innovative therapies and that the country contributes to advancing global dementia care.
{"title":"Clinical Trials For New Therapeutics In Alzheimer’s Disease – Ensuring Ireland Is Research-Ready","authors":"Anne-Marie Miller, Iracema Leroi","doi":"10.1093/ageing/afaf318.003","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.003","url":null,"abstract":"Background As Alzheimer’s disease (AD) enters a new treatment era, clinical trials are vital for patient access and aligning Ireland with global innovation. Dementia Trials Ireland (DTI), an Health Research Board (HRB) Clinical Trials Network (CTN), is building national trial capacity across pharmaceutical and non-pharmacological interventions including key studies of diverse intervention type such as EVOKE, EVOKE+ (anti-amyloid therapies), and DIAN studies (preventive approaches in genetically at-risk individuals). Despite progress, challenges persist which include our small patient population, limited specialist sites, regulatory complexity, and significant resource demands. Addressing these issues requires coordinated infrastructure development and workforce upskilling. Methods DTI’s ‘trial ready’ initiative, developed through working groups and harnessing PPI, aims to expand national dementia trial capacity and attract sponsors. Core components include a) pre-consented subtype-specific ‘trial ready’ cohorts; b) centralised feasibility support; c) an early career development programme; and d) simulation-based workforce training. DTI also engages with key national and international stakeholders and policymakers to reduce regulatory barriers and strengthen our potential for impact through international collaboration. Results Conclusion Ireland’s meaningful participation in the evolving AD research landscape depends on sustained investment in infrastructure, workforce development, and regulatory reform. DTI’s initiatives are laying the foundation for a nationally coordinated ‘trial ready’ platform. This ensures that Irish patients will benefit from early access to innovative therapies and that the country contributes to advancing global dementia care.","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":"145680364","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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