Background Timely diagnosis is essential for effective dementia care, yet Lewy Body Dementia (LBD) may lead to delays in diagnosis compared to Alzheimer’s Disease (AD). LBD accounts for over 20% of the 65,000 people living with dementia in Ireland. Despite this prevalence, fewer than 5% of individuals with LBD receive a diagnosis, leading to delayed care and support. Compared to AD, LBD diagnosis often involves longer timelines and greater healthcare resources. This study compared the diagnostic and post-diagnostic pathways of patients with AD and LBD, examining referral patterns, diagnostic timelines, and follow-up interventions. Methods A retrospective cohort study was conducted using electronic medical records of patients assessed in 2023 at the Memory and Movement Disorder Clinics. Data were extracted for 40 patients diagnosed with Alzheimer’s Disease (AD) and 40 with Lewy Body Dementia (LBD), including Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD). Information collected included reason for referral, time to diagnosis, and healthcare professionals involved in initial assessment and diagnosis. Details of post-diagnostic assessments and interventions were also recorded. Descriptive and comparative analyses were conducted to evaluate differences in diagnostic timelines and referral pathways between AD and LBD patients. Results The findings revealed significant differences in diagnostic timelines and referral pathways between patients with AD and LBD. LBD patients experienced more delays, misdiagnoses, and were more often referred for second opinions compared to AD patients. Furthermore, LBD patients required more healthcare resources before and after diagnosis, including additional diagnostic tests, joint specialist consultations, and multidisciplinary assessments and interventions across various healthcare services. Conclusion The findings of this study indicate that the diagnostic and post-diagnostic pathways for LBD patients are more complex and resource-demanding than AD patients. These results highlight the need for a streamlined, standardised, and integrated care pathway to ensure timely and effective diagnosis and management of LBD.
{"title":"Comparing Diagnostic Timelines And Referral Pathways In Alzheimer’s Disease And Lewy Body Dementia: Insights From A Retrospective Cohort Study","authors":"Loredana Frau, Aoife O` Brien, Suzanne Timmons, Iracema Leroi","doi":"10.1093/ageing/afaf318.072","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.072","url":null,"abstract":"Background Timely diagnosis is essential for effective dementia care, yet Lewy Body Dementia (LBD) may lead to delays in diagnosis compared to Alzheimer’s Disease (AD). LBD accounts for over 20% of the 65,000 people living with dementia in Ireland. Despite this prevalence, fewer than 5% of individuals with LBD receive a diagnosis, leading to delayed care and support. Compared to AD, LBD diagnosis often involves longer timelines and greater healthcare resources. This study compared the diagnostic and post-diagnostic pathways of patients with AD and LBD, examining referral patterns, diagnostic timelines, and follow-up interventions. Methods A retrospective cohort study was conducted using electronic medical records of patients assessed in 2023 at the Memory and Movement Disorder Clinics. Data were extracted for 40 patients diagnosed with Alzheimer’s Disease (AD) and 40 with Lewy Body Dementia (LBD), including Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD). Information collected included reason for referral, time to diagnosis, and healthcare professionals involved in initial assessment and diagnosis. Details of post-diagnostic assessments and interventions were also recorded. Descriptive and comparative analyses were conducted to evaluate differences in diagnostic timelines and referral pathways between AD and LBD patients. Results The findings revealed significant differences in diagnostic timelines and referral pathways between patients with AD and LBD. LBD patients experienced more delays, misdiagnoses, and were more often referred for second opinions compared to AD patients. Furthermore, LBD patients required more healthcare resources before and after diagnosis, including additional diagnostic tests, joint specialist consultations, and multidisciplinary assessments and interventions across various healthcare services. Conclusion The findings of this study indicate that the diagnostic and post-diagnostic pathways for LBD patients are more complex and resource-demanding than AD patients. These results highlight the need for a streamlined, standardised, and integrated care pathway to ensure timely and effective diagnosis and management of LBD.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"26 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.001
Seán Kennelly, Antoinette O'Connor
Background The Alzheimer’s disease (AD) treatment landscape is evolving with new approaches to diagnosis and treatment. Phenotype only diagnosis is incorrect in almost one-third of cases, so biomarker-supported diagnosis is essential for timely and accurate diagnosis of AD. This talk will focus on the application of fluid biomarkers, including cerebrospinal fluid (CSF) analysis and emerging blood-based tests like plasma p-tau217. Biomarkers are essential for confirming the presence of amyloid pathology and guiding treatment options. This presentation will discuss the updated diagnostic criteria for Alzheimer’s disease and how these criteria are incorporated into clinical practice. Methods We will present data from a recent published review on new horizons for diagnostic and therapeutic opportunities in AD clinical practice. We will discuss what the future landscape looks like for biomarker supported diagnosis and prognosis of AD in clinical settings. We will report on the results of real-world clinical validation studies of blood based biomarkers in memory clinical settings. We will report on Irish multidisciplinary consensus guidelines on the application of biomarkers in memory services. Results We will present on clear pathways within the evolving model of care which support the integration of fluid biomarkers in the diagnosis of AD. Blood based biomarkers (plasma p-tau217) demonstrated strong diagnostic performance for AD with an AUC of 0.91, highlighting its potential as a practical diagnostic tool in memory clinic settings. Irish consensus guidelines support the appropriate use of CSF biomarkers in AD diagnosis, and discuss potential structure for roll-out of blood-based biomarkers. Conclusion Timely and accurate AD diagnosis is essential to support individuals to live as well as possible after diagnosis. Advances in fluid biomarkers will ensure diagnostic certainty for patient and clinicians, but will need careful integration into clinical practice.
{"title":"Integrating Pathological Diagnosis And Clinical Staging With Advances In AD Biomarkers","authors":"Seán Kennelly, Antoinette O'Connor","doi":"10.1093/ageing/afaf318.001","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.001","url":null,"abstract":"Background The Alzheimer’s disease (AD) treatment landscape is evolving with new approaches to diagnosis and treatment. Phenotype only diagnosis is incorrect in almost one-third of cases, so biomarker-supported diagnosis is essential for timely and accurate diagnosis of AD. This talk will focus on the application of fluid biomarkers, including cerebrospinal fluid (CSF) analysis and emerging blood-based tests like plasma p-tau217. Biomarkers are essential for confirming the presence of amyloid pathology and guiding treatment options. This presentation will discuss the updated diagnostic criteria for Alzheimer’s disease and how these criteria are incorporated into clinical practice. Methods We will present data from a recent published review on new horizons for diagnostic and therapeutic opportunities in AD clinical practice. We will discuss what the future landscape looks like for biomarker supported diagnosis and prognosis of AD in clinical settings. We will report on the results of real-world clinical validation studies of blood based biomarkers in memory clinical settings. We will report on Irish multidisciplinary consensus guidelines on the application of biomarkers in memory services. Results We will present on clear pathways within the evolving model of care which support the integration of fluid biomarkers in the diagnosis of AD. Blood based biomarkers (plasma p-tau217) demonstrated strong diagnostic performance for AD with an AUC of 0.91, highlighting its potential as a practical diagnostic tool in memory clinic settings. Irish consensus guidelines support the appropriate use of CSF biomarkers in AD diagnosis, and discuss potential structure for roll-out of blood-based biomarkers. Conclusion Timely and accurate AD diagnosis is essential to support individuals to live as well as possible after diagnosis. Advances in fluid biomarkers will ensure diagnostic certainty for patient and clinicians, but will need careful integration into clinical practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"36 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.185
Waseem Rana, Niamh Costelloe, Paul Breen, Christina Donnellan
Background Falls are a leading cause of morbidity and hospitalisation in older adults. The world falls guidelines outline the approach to risk stratification, assessment, prevention and management of falls in this population (1). Comprehensive Geriatric Assessment (CGA) has been introduced to a Frailty at the Front Door (FFD) service in the Emergency Department (ED) of an Irish Model 3 hospital. This study investigates the association between anticholinergic burden, polypharmacy (defined as ≥5 medications), Falls Risk Increasing Drgs (FRIDs) and falls risk in older adults assessed by this service. Methods A retrospective cohort study was conducted on adults aged ≥65 years assessed by the FFD service. The Falls Risk Stratification Algorithm (FRSA) was used to stratified cases into high or low/intermediate falls risk (1). Data collected included: number of medications, anticholinergic burden (ACB) score, number of fall-risk increasing drugs (FRIDs), Clinical Frailty Scale (CFS) score, 4AT and age. Binary logistic regression was used to identify independent predictors of high falls risk. Results A total of 136 patients (103 high risk, 33 low/intermediate risk) were analysed. High-risk patients had a significantly higher mean ACB score (3.12 vs 2.27, p=0.02), were slightly older (mean age: 82.8 vs 81.8 years, p=0.536), and had a higher medication burden (10.1 vs 9.2, p=0.109). The mean number of FRIDs was similar in both groups (3.14 vs. 3.09, p=0.725). The ACB score was a significant predictor of high falls risk (OR=1.36, 95% CI:1.02–1.83; p=0.039). Polypharmacy and FRIDs number were not significant predictors in this cohort. Conclusion High falls risk is prevalent in Older adults attending the ED and the Frailty at the Front Door service plays a vital role in identifying and addressing polypharmacy and anticholinergic burden. Reference 1. Montero-Odasso, M. et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022;51:1–36.
背景：跌倒是老年人发病和住院的主要原因。《世界跌倒指南》概述了这一人群跌倒的风险分层、评估、预防和管理方法(1)。综合老年评估（CGA）已被引入爱尔兰三级医院急诊科（ED）的前门虚弱（FFD）服务。本研究调查了该服务评估的老年人抗胆碱能负担、多种药物（定义为≥5种药物）、增加跌倒风险的药物（frid）和跌倒风险之间的关系。方法采用回顾性队列研究方法，对年龄≥65岁的成年人进行FFD评估。使用瀑布风险分层算法（FRSA）将病例分层为高或低/中等瀑布风险(1)。收集的数据包括：用药数量、抗胆碱能负担（ACB）评分、增加跌倒风险的药物（frid）数量、临床虚弱量表（CFS）评分、4AT和年龄。使用二元逻辑回归来确定高跌倒风险的独立预测因子。结果共分析136例患者，其中高危103例，低/中危33例。高危患者ACB平均评分较高（3.12 vs 2.27, p=0.02），年龄稍大（平均年龄：82.8 vs 81.8岁，p=0.536），用药负担较高（10.1 vs 9.2, p=0.109）。两组患者frid的平均次数相似（3.14 vs. 3.09, p=0.725）。ACB评分是高跌倒风险的显著预测因子（OR=1.36, 95% CI: 1.02-1.83; p=0.039）。在这个队列中，多药和frid数量不是显著的预测因子。结论在急诊科就诊的老年人中存在较高的跌倒风险，“前门虚弱”服务在识别和解决多药和抗胆碱能负担中起着至关重要的作用。引用1。Montero-Odasso， M.等。老年人跌倒预防和管理世界指南：一项全球倡议。老龄化2022；51:1-36。
{"title":"Polypharmacy and Falls Risk in Older Adults Presenting to the Front Door","authors":"Waseem Rana, Niamh Costelloe, Paul Breen, Christina Donnellan","doi":"10.1093/ageing/afaf318.185","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.185","url":null,"abstract":"Background Falls are a leading cause of morbidity and hospitalisation in older adults. The world falls guidelines outline the approach to risk stratification, assessment, prevention and management of falls in this population (1). Comprehensive Geriatric Assessment (CGA) has been introduced to a Frailty at the Front Door (FFD) service in the Emergency Department (ED) of an Irish Model 3 hospital. This study investigates the association between anticholinergic burden, polypharmacy (defined as ≥5 medications), Falls Risk Increasing Drgs (FRIDs) and falls risk in older adults assessed by this service. Methods A retrospective cohort study was conducted on adults aged ≥65 years assessed by the FFD service. The Falls Risk Stratification Algorithm (FRSA) was used to stratified cases into high or low/intermediate falls risk (1). Data collected included: number of medications, anticholinergic burden (ACB) score, number of fall-risk increasing drugs (FRIDs), Clinical Frailty Scale (CFS) score, 4AT and age. Binary logistic regression was used to identify independent predictors of high falls risk. Results A total of 136 patients (103 high risk, 33 low/intermediate risk) were analysed. High-risk patients had a significantly higher mean ACB score (3.12 vs 2.27, p=0.02), were slightly older (mean age: 82.8 vs 81.8 years, p=0.536), and had a higher medication burden (10.1 vs 9.2, p=0.109). The mean number of FRIDs was similar in both groups (3.14 vs. 3.09, p=0.725). The ACB score was a significant predictor of high falls risk (OR=1.36, 95% CI:1.02–1.83; p=0.039). Polypharmacy and FRIDs number were not significant predictors in this cohort. Conclusion High falls risk is prevalent in Older adults attending the ED and the Frailty at the Front Door service plays a vital role in identifying and addressing polypharmacy and anticholinergic burden. Reference 1. Montero-Odasso, M. et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022;51:1–36.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"32 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680370","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}
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder in older adults, affecting up to 50% of octogenarians (von Brevern et al., 2007). It is most often diagnosed using the Hallpike-Dix manoeuvre and treated with repositioning techniques like the Epley manoeuvre (Fife et al., 2008). BPPV significantly raises fall risk (Tinetti & Kumar, 2010). Falls impact the quality of life and independence of older adults; thus, vestibular assessment should be included as part of a comprehensive falls assessment (Montero-Odasso et al., 2022). A 5-year audit was conducted to assess vestibular assessment within a neuro-cardiovascular falls service at a tertiary hospital, focusing on the advantages of multi-canal assessment for improving diagnostic rates. Methods A retrospective audit was conducted of electronic patient records of patients who underwent a nurse-led vestibular assessment over a 5-year period between 2019 and 2024 in a specialist falls service. A total of 632 assessments were identified. Results Two hundred and seventy patients were diagnosed on Dix-Hallpike to have posterior canal BPPV, and 53 patients who proceeded to lateral canal testing following a negative Dix-Hallpike were diagnosed with horizontal canal BPPV, leading to a combined diagnostic yield of 51%. Successful resolution of nystagmus required 2-4 repositioning manoeuvres and a multi-canal diagnostic assessment. The addition of lateral canal testing improved the diagnostic yield by 8.3%, thus supporting its use in patients with negative Dix-Hallpike. Conclusion Given its high prevalence, recurrence, and impact on older adults, BPPV represents a significant public health concern requiring increased awareness and accurate diagnosis. Timely intervention can reduce its effects on mobility, fall risk, and overall well-being in this vulnerable population. Vestibular assessments should incorporate lateral canal testing alongside the Dix-Hallpike manoeuvre to improve diagnostic accuracy; our audit revealed nearly 1 in 10 cases were identified through lateral canal testing alone.
良性阵发性位置性眩晕（BPPV）是老年人中最常见的外周前庭疾病，影响多达50%的80多岁老人（von Brevern et al., 2007）。最常用的诊断方法是Hallpike-Dix手法，并采用Epley手法等复位技术进行治疗（Fife等，2008）。BPPV显著增加跌倒风险（Tinetti & Kumar, 2010）。跌倒影响老年人的生活质量和独立性；因此，前庭评估应作为综合跌倒评估的一部分（Montero-Odasso et al., 2022）。对一家三级医院的神经-心血管跌倒科进行了为期5年的前庭评估审计，重点关注多管评估在提高诊断率方面的优势。方法对2019年至2024年间在专科跌倒服务中心接受护士领导的前庭评估的患者的电子病历进行回顾性审计。共查明了632项摊款。结果270例患者经Dix-Hallpike检查诊断为后管BPPV， 53例患者经Dix-Hallpike检查阴性后行侧管检查诊断为水平管BPPV，总诊断率为51%。眼球震颤的成功解决需要2-4次重新定位和多管诊断评估。外侧管检测的增加将诊断率提高了8.3%，因此支持其在Dix-Hallpike阴性患者中的应用。鉴于其高患病率、复发率和对老年人的影响，BPPV是一个重要的公共卫生问题，需要提高认识和准确诊断。及时干预可以减少其对这一弱势群体的行动能力、跌倒风险和整体福祉的影响。前庭评估应结合侧管检查和Dix-Hallpike手法，以提高诊断的准确性；我们的审计显示，近十分之一的病例仅通过侧管检测就被发现。
{"title":"Verti-Gone? Auditing the Spin on Hallpike Manoeuvre Documentation in Older Adults","authors":"Lisa Byrne, Dymphna Hade, Lincy Joseph, Deirdre Kelly, Bindu Poulose, Ciara Rice","doi":"10.1093/ageing/afaf318.133","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.133","url":null,"abstract":"Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder in older adults, affecting up to 50% of octogenarians (von Brevern et al., 2007). It is most often diagnosed using the Hallpike-Dix manoeuvre and treated with repositioning techniques like the Epley manoeuvre (Fife et al., 2008). BPPV significantly raises fall risk (Tinetti & Kumar, 2010). Falls impact the quality of life and independence of older adults; thus, vestibular assessment should be included as part of a comprehensive falls assessment (Montero-Odasso et al., 2022). A 5-year audit was conducted to assess vestibular assessment within a neuro-cardiovascular falls service at a tertiary hospital, focusing on the advantages of multi-canal assessment for improving diagnostic rates. Methods A retrospective audit was conducted of electronic patient records of patients who underwent a nurse-led vestibular assessment over a 5-year period between 2019 and 2024 in a specialist falls service. A total of 632 assessments were identified. Results Two hundred and seventy patients were diagnosed on Dix-Hallpike to have posterior canal BPPV, and 53 patients who proceeded to lateral canal testing following a negative Dix-Hallpike were diagnosed with horizontal canal BPPV, leading to a combined diagnostic yield of 51%. Successful resolution of nystagmus required 2-4 repositioning manoeuvres and a multi-canal diagnostic assessment. The addition of lateral canal testing improved the diagnostic yield by 8.3%, thus supporting its use in patients with negative Dix-Hallpike. Conclusion Given its high prevalence, recurrence, and impact on older adults, BPPV represents a significant public health concern requiring increased awareness and accurate diagnosis. Timely intervention can reduce its effects on mobility, fall risk, and overall well-being in this vulnerable population. Vestibular assessments should incorporate lateral canal testing alongside the Dix-Hallpike manoeuvre to improve diagnostic accuracy; our audit revealed nearly 1 in 10 cases were identified through lateral canal testing alone.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"132 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680410","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 Incontinence is a common condition in the older adult that can cause a number of negative effects on a person's life, such as, reduced mobility, skin integrity, increased frailty, reliance on continence wear and an overall decrease in quality of life. The aim of this audit was to assess the use of continence wear in patients aged 65+ years in an inpatient medical cohort within a model 4 teaching hospital against HSE guidelines of continence in adults. Methods Data was collected on patient’s ≥65 years on a number of wards in a model 4 teaching hospital over a month. Pre-admission use of continence wear, current use of continence wear, mobility and patients views of continence wear were recorded. Results N = 76: 39 male (51.3%) and 37 females (48.6%). 12 (15.8%) of 76 patients were incontinent prior to admission to hospital, however, 41 (54%) patients were wearing continence wear at the time of the audit. Of the 64 (84.2%) patients who were not incontinent at admission but using continence wear, 22 (34.4%) felt they needed continence products as an inpatient. Over 50% of patients were not aware of more appropriate continence wear products that were available. Conclusion Throughout the audit, there was an emerging theme of patient’s acceptance of using continence wear during their admission to hospital. Empowering continence confidence in patients is necessary in order to reduce adverse outcomes. Interdisciplinary staff education, a review of assessment documentation and a review of the current continence assessment is recommended in order to ensure appropriate use of continence wear in the hospitalised older adult. Reference 1. Health Service Executive. Guideline for the assessment, promotion and management of continence in adults by registered nurses. Dublin: HSE, 2020, Available at: https://assets.hse.ie/media/documents/ncr/guideline-assessment-promotion-and-management-of-continence-in-adults.pdf [Accessed 13th May 2025].
{"title":"Fit For Purpose: A Continence Wear Clinical Audit","authors":"Amy Elliott Collopy, Caroline Broderick, Nichola Boyle","doi":"10.1093/ageing/afaf318.171","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.171","url":null,"abstract":"Background Incontinence is a common condition in the older adult that can cause a number of negative effects on a person's life, such as, reduced mobility, skin integrity, increased frailty, reliance on continence wear and an overall decrease in quality of life. The aim of this audit was to assess the use of continence wear in patients aged 65+ years in an inpatient medical cohort within a model 4 teaching hospital against HSE guidelines of continence in adults. Methods Data was collected on patient’s ≥65 years on a number of wards in a model 4 teaching hospital over a month. Pre-admission use of continence wear, current use of continence wear, mobility and patients views of continence wear were recorded. Results N = 76: 39 male (51.3%) and 37 females (48.6%). 12 (15.8%) of 76 patients were incontinent prior to admission to hospital, however, 41 (54%) patients were wearing continence wear at the time of the audit. Of the 64 (84.2%) patients who were not incontinent at admission but using continence wear, 22 (34.4%) felt they needed continence products as an inpatient. Over 50% of patients were not aware of more appropriate continence wear products that were available. Conclusion Throughout the audit, there was an emerging theme of patient’s acceptance of using continence wear during their admission to hospital. Empowering continence confidence in patients is necessary in order to reduce adverse outcomes. Interdisciplinary staff education, a review of assessment documentation and a review of the current continence assessment is recommended in order to ensure appropriate use of continence wear in the hospitalised older adult. Reference 1. Health Service Executive. Guideline for the assessment, promotion and management of continence in adults by registered nurses. Dublin: HSE, 2020, Available at: https://assets.hse.ie/media/documents/ncr/guideline-assessment-promotion-and-management-of-continence-in-adults.pdf [Accessed 13th May 2025].","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"127 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.095
Emma Richardson, Claire O'Brien, Damien Gaumont, Paul Ruane, David O'Connor, Nicola Donohue
Background Falls impact approximately 30% of older adults, negatively affecting quality of life (1). The 2022 World Guidelines for falls prevention and management for older adults (WFG) established evidenced-based international recommendations (2). The aim of this audit is to identify existing gaps in our assessment and interventions with patients who have fallen at home, and adopt key recommendations of the WFG into practice. Methods A retrospective analysis of Pathfinder documentation for (1) presentation of a fall (2) did not require hospital admission (3) timeframe August 2023 – January 2024. Sample size: 48. The audit tool was developed comprising of key domains from WFG 2022. Findings from the audit led to quality improvement process, introducing eight practice changes to align with the WFG 2022. The re-audit retrospectively analysed Pathfinder patient’s files who met the original inclusion criteria in the timeframe January- March 2025. Sample size: 15. Results Eight key practice changes aimed for 100% documentation of (1) delirium screen (2) lying/standing blood pressure (3) 12 lead ECG (4) standardised balance & gait screen (5) standardised activities of daily living assessment (6) standardised environmental assessment (7) falls risk stratification (8) 3 key questions. Implementation of these changes increased by 34% on re-audit, improving to 71% on average. The most significant included; 3 key questions increased by 72%, falls risk stratification from 12.5% to 79% and standardised mobility assessment compliance doubling. Conclusion The introduction of the WFG to our practice has enhanced assessment and interventions with patients who have fallen at home. Further quality improvements are now embed in team education and patient information. References (1) Ganz, D.A., Latham, N.K. Prevention of falls in community-dwelling older adults. N Engl J Med 2020;382:734–43. (2) Montero-Odasso, M. et al, World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing 2022; 51: 1–36, https://doi.org/10.1093/ageing/afac205.
{"title":"A Clinical Audit Of Current Assessment Of Falls In The Older Adult by the Pathfinder Service","authors":"Emma Richardson, Claire O'Brien, Damien Gaumont, Paul Ruane, David O'Connor, Nicola Donohue","doi":"10.1093/ageing/afaf318.095","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.095","url":null,"abstract":"Background Falls impact approximately 30% of older adults, negatively affecting quality of life (1). The 2022 World Guidelines for falls prevention and management for older adults (WFG) established evidenced-based international recommendations (2). The aim of this audit is to identify existing gaps in our assessment and interventions with patients who have fallen at home, and adopt key recommendations of the WFG into practice. Methods A retrospective analysis of Pathfinder documentation for (1) presentation of a fall (2) did not require hospital admission (3) timeframe August 2023 – January 2024. Sample size: 48. The audit tool was developed comprising of key domains from WFG 2022. Findings from the audit led to quality improvement process, introducing eight practice changes to align with the WFG 2022. The re-audit retrospectively analysed Pathfinder patient’s files who met the original inclusion criteria in the timeframe January- March 2025. Sample size: 15. Results Eight key practice changes aimed for 100% documentation of (1) delirium screen (2) lying/standing blood pressure (3) 12 lead ECG (4) standardised balance & gait screen (5) standardised activities of daily living assessment (6) standardised environmental assessment (7) falls risk stratification (8) 3 key questions. Implementation of these changes increased by 34% on re-audit, improving to 71% on average. The most significant included; 3 key questions increased by 72%, falls risk stratification from 12.5% to 79% and standardised mobility assessment compliance doubling. Conclusion The introduction of the WFG to our practice has enhanced assessment and interventions with patients who have fallen at home. Further quality improvements are now embed in team education and patient information. References (1) Ganz, D.A., Latham, N.K. Prevention of falls in community-dwelling older adults. N Engl J Med 2020;382:734–43. (2) Montero-Odasso, M. et al, World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing 2022; 51: 1–36, https://doi.org/10.1093/ageing/afac205.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"5 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.081
A Graham Cummiskey, Rachael Dooley, Paul O'Brien
Background Target times for intravenous thrombolysis (IVT) is under 4.5 hours as established in the ESO guidelines, however clinical outcomes improve with faster door to needle times (DTN). The Irish National Audit of Stroke (INAS) shows that most patients present to hospital around 3 hours after symptoms onset. INAS target for DTN time is under 60 minutes, and our hospital’s target is under 30 minutes, and CT scan in under 10 minutes. In 2023 we were not meeting our established targets so we performed a quality improvement project to improve our DTN times. Methods With an average of 1000-1200 FAST calls a year, around 10% of strokes received IVT. The average DTN from 2019-2022 was 56 minutes, and average door to CT time of 22.5 minutes. Focusing on system changes, with multidisciplinary involvement, we reorganized the FAST call pathway: radiographers are pre-alerted, patients go directly to ED CT, development of FAST communication proforma, IVT administered in CT room. Results In 2024 there were 1128 FAST calls, with 342 ischaemic strokes. Our average time to CT brain was 12 minutes, down 8 minutes from 2023. Our average DTN time was 37 minutes, down 14 minutes from 2023. We were able to achieve a door to decision time of less than 25 min in 2024, down 8 minutes from 2023. Inpatient FAST calls saw a reduction in time to IVT by 25 minutes. Overall we reduced our door to CT times by 50%, DTN times by 34% and Inpatient FAST times by 25%. Conclusion This quality improvement project demonstrates the efficacy of small changes. By streamlining our FAST pathway for ED and inpatients, we drastically reduced our time to thrombolysis. We are still above target and have planned further improvement projects focused on NCHD teaching and ongoing assessment for areas to improve our FAST calls.
{"title":"Time Matters: Reducing Door to Needle Times in a Major Stroke Centre","authors":"A Graham Cummiskey, Rachael Dooley, Paul O'Brien","doi":"10.1093/ageing/afaf318.081","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.081","url":null,"abstract":"Background Target times for intravenous thrombolysis (IVT) is under 4.5 hours as established in the ESO guidelines, however clinical outcomes improve with faster door to needle times (DTN). The Irish National Audit of Stroke (INAS) shows that most patients present to hospital around 3 hours after symptoms onset. INAS target for DTN time is under 60 minutes, and our hospital’s target is under 30 minutes, and CT scan in under 10 minutes. In 2023 we were not meeting our established targets so we performed a quality improvement project to improve our DTN times. Methods With an average of 1000-1200 FAST calls a year, around 10% of strokes received IVT. The average DTN from 2019-2022 was 56 minutes, and average door to CT time of 22.5 minutes. Focusing on system changes, with multidisciplinary involvement, we reorganized the FAST call pathway: radiographers are pre-alerted, patients go directly to ED CT, development of FAST communication proforma, IVT administered in CT room. Results In 2024 there were 1128 FAST calls, with 342 ischaemic strokes. Our average time to CT brain was 12 minutes, down 8 minutes from 2023. Our average DTN time was 37 minutes, down 14 minutes from 2023. We were able to achieve a door to decision time of less than 25 min in 2024, down 8 minutes from 2023. Inpatient FAST calls saw a reduction in time to IVT by 25 minutes. Overall we reduced our door to CT times by 50%, DTN times by 34% and Inpatient FAST times by 25%. Conclusion This quality improvement project demonstrates the efficacy of small changes. By streamlining our FAST pathway for ED and inpatients, we drastically reduced our time to thrombolysis. We are still above target and have planned further improvement projects focused on NCHD teaching and ongoing assessment for areas to improve our FAST calls.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"53 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.209
Claire Noonan, Cherhasna Rampaul, Josephine Soh
Background Nursing home residents (NHRs) represent the frailest group of healthcare service users with highly complex care needs. It is well accepted that high rates of emergency department (ED) attendances and hospital admissions are common among this group. Ambulatory, community based unscheduled care should be explored as alternative pathways that could provide safe and quality care for NHRs. Methods This retrospective study examined NHRs admitted between June and December 2024, to a University Teaching Hospital. Data on diagnoses, length of stay and readmission rates collected. Results A total of 312 NHRs presented to the ED over the 6 month period. Rate of admission was 63.8% (n=199). Of these, 68.3% (n=136) admitted under the geriatric service. Close to 30% (n=59) of admitted NHRs were discharged within 48 hours. One month re-admission rate of this group was 10.1% (n=6) .The three most common discharge diagnoses were lower respiratory tract infection (n=15), aspiration pneumonia (n=11), and falls (n=10). 16.5% NHR admissions (n=33) occurred outside of normal working hours. Conclusion This study highlights the high admission rate of NHRs, particularly when ED presentations occurred outside of normal working hours. Almost 1 in 3 of admitted NHRs had hospital length of stay of ≤ 48 hours, without higher re-admission rates. The potential of ambulatory care pathways including outreach services to nursing homes to reduce hospital admissions and to avoid associated iatrogenic complications, should be further explored.
{"title":"Evaluating Acute Care Alternatives for Nursing Home Residents","authors":"Claire Noonan, Cherhasna Rampaul, Josephine Soh","doi":"10.1093/ageing/afaf318.209","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.209","url":null,"abstract":"Background Nursing home residents (NHRs) represent the frailest group of healthcare service users with highly complex care needs. It is well accepted that high rates of emergency department (ED) attendances and hospital admissions are common among this group. Ambulatory, community based unscheduled care should be explored as alternative pathways that could provide safe and quality care for NHRs. Methods This retrospective study examined NHRs admitted between June and December 2024, to a University Teaching Hospital. Data on diagnoses, length of stay and readmission rates collected. Results A total of 312 NHRs presented to the ED over the 6 month period. Rate of admission was 63.8% (n=199). Of these, 68.3% (n=136) admitted under the geriatric service. Close to 30% (n=59) of admitted NHRs were discharged within 48 hours. One month re-admission rate of this group was 10.1% (n=6) .The three most common discharge diagnoses were lower respiratory tract infection (n=15), aspiration pneumonia (n=11), and falls (n=10). 16.5% NHR admissions (n=33) occurred outside of normal working hours. Conclusion This study highlights the high admission rate of NHRs, particularly when ED presentations occurred outside of normal working hours. Almost 1 in 3 of admitted NHRs had hospital length of stay of ≤ 48 hours, without higher re-admission rates. The potential of ambulatory care pathways including outreach services to nursing homes to reduce hospital admissions and to avoid associated iatrogenic complications, should be further explored.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.068
Agnes Jonsson, Sarah O'Loughlin, Louise Gaffney, Colin Mason
Background Frailty is recognised as a predictor of poor outcomes following trauma, including traumatic brain injuries (TBI). Despite this, frailty assessment is not always integrated into acute trauma pathways. This study evaluates the prevalence of frailty and its association with clinical outcomes in older patients admitted with TBI during the first year of a Geriatric Trauma Service at a National Trauma Centre without on-site neurosurgical capabilities. Methods A retrospective review was conducted of patients aged ≥65 admitted with TBI over a 14-month period. Frailty was assessed using the Clinical Frailty Scale (CFS) when recorded during initial evaluation as part of assessment by the Frailty Intervention Team (FIT) in the Emergency Department. Outcomes included 30-day mortality and length of stay (LOS). Minitab was used for statistical analysis. Results Of 107 patients over 65 admitted with TBI, 42% (n=45) had a documented CFS. The mean age was 82 years, and 58% (n=26) were male. The mean CFS was 4.8 (median: 5), with 58% (n=26) classified as frail (CFS ≥5). Higher frailty scores were associated with 30-day mortality (OR 2.4; 95% CI 0.94–6.16; p=0.06). No difference in LOS was observed between frail and non-frail groups, with a median LOS of 6.5 in the non-frail group, and 6 days in the frail group. Conclusion Frailty is common among older patients with TBI and may be associated with increased mortality. These findings underscore the importance of early frailty identification and the integration of geriatric expertise in trauma care.
虚弱被认为是创伤后不良预后的预测因素，包括创伤性脑损伤（TBI）。尽管如此，虚弱评估并不总是整合到急性创伤途径。本研究评估了在国家创伤中心老年创伤服务中心没有现场神经外科手术能力的老年TBI患者入院第一年的虚弱患病率及其与临床结果的关系。方法回顾性分析年龄≥65岁收治的14个月TBI患者。在最初的评估中，作为急诊科虚弱干预小组（FIT）评估的一部分，使用临床虚弱量表（CFS）进行虚弱评估。结果包括30天死亡率和住院时间（LOS）。采用Minitab进行统计分析。结果在107例65岁以上的TBI患者中，42% （n=45）有CFS记录。平均年龄82岁，58% （n=26）为男性。平均CFS为4.8（中位数：5），其中58% （n=26）被分类为虚弱（CFS≥5）。较高的虚弱评分与30天死亡率相关（OR 2.4; 95% CI 0.94-6.16; p=0.06）。体弱多病组和非体弱多病组之间的LOS无差异，非体弱多病组的LOS中位数为6.5，体弱多病组为6天。结论衰弱在老年TBI患者中很常见，并可能与死亡率增加有关。这些发现强调了早期虚弱识别和创伤护理中老年专业知识整合的重要性。
{"title":"Frailty Amongst Older Adults Presenting with Traumatic Brain Injuries","authors":"Agnes Jonsson, Sarah O'Loughlin, Louise Gaffney, Colin Mason","doi":"10.1093/ageing/afaf318.068","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.068","url":null,"abstract":"Background Frailty is recognised as a predictor of poor outcomes following trauma, including traumatic brain injuries (TBI). Despite this, frailty assessment is not always integrated into acute trauma pathways. This study evaluates the prevalence of frailty and its association with clinical outcomes in older patients admitted with TBI during the first year of a Geriatric Trauma Service at a National Trauma Centre without on-site neurosurgical capabilities. Methods A retrospective review was conducted of patients aged ≥65 admitted with TBI over a 14-month period. Frailty was assessed using the Clinical Frailty Scale (CFS) when recorded during initial evaluation as part of assessment by the Frailty Intervention Team (FIT) in the Emergency Department. Outcomes included 30-day mortality and length of stay (LOS). Minitab was used for statistical analysis. Results Of 107 patients over 65 admitted with TBI, 42% (n=45) had a documented CFS. The mean age was 82 years, and 58% (n=26) were male. The mean CFS was 4.8 (median: 5), with 58% (n=26) classified as frail (CFS ≥5). Higher frailty scores were associated with 30-day mortality (OR 2.4; 95% CI 0.94–6.16; p=0.06). No difference in LOS was observed between frail and non-frail groups, with a median LOS of 6.5 in the non-frail group, and 6 days in the frail group. Conclusion Frailty is common among older patients with TBI and may be associated with increased mortality. These findings underscore the importance of early frailty identification and the integration of geriatric expertise in trauma care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"33 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.180
Amy Lynch, Robert Briggs, Rose-Anne Kenny, Joseph Harbison
Background Recognition and investigation of stroke is important in determining aetiology and treating underlying risk factors to prevent reoccurrence. We propose the theory that there is a significant minority of older people with stroke that do not present to hospital or seek medical assessment. We examined stroke incidence data from a large longitudinal study to assess the likely number of older people with acute stroke that do not present to hospital. Methods Data was from a large population-representative longitudinal study was analysed, specifically for self-reported stroke or transient ischemic attack (TIA) in the past 2 years. Stroke/TIA incidence was compared to data on presentation to an emergency department (ED) and admission to hospital. Results 281 participants of 4,321 aged 50+ reported a history of stroke/TIA (6.5% of the cohort), with 36 (.08%) new or incident strokes and 61 (1.4%) new or incident TIAs reported in the last 2 years. Of the 36 older people with incident stroke, only 15 had an ED attendance and 12 reported they were admitted to hospital within the last 12 months. Of the 61 people with incident TIA only 30 reported an ED attendance and 25 reported they were admitted to hospital within the last 12 months. Conclusion Assuming a constant incidence of stroke/TIA over a 2-year period, it is possible that 17% of older people with acute stroke did not present to hospital after they developed stroke symptoms. These patients are potentially missing out on hyperacute stroke treatment and comprehensive workup of stroke aetiology with appropriate secondary prevention. A comprehensive strategy including public education would be useful in increasing public awareness of stroke symptoms and the need to present promptly to the ED.
{"title":"Estimating the Incidence of Stroke where Older People do not present to Hospital using a Large population-Representative Dataset","authors":"Amy Lynch, Robert Briggs, Rose-Anne Kenny, Joseph Harbison","doi":"10.1093/ageing/afaf318.180","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.180","url":null,"abstract":"Background Recognition and investigation of stroke is important in determining aetiology and treating underlying risk factors to prevent reoccurrence. We propose the theory that there is a significant minority of older people with stroke that do not present to hospital or seek medical assessment. We examined stroke incidence data from a large longitudinal study to assess the likely number of older people with acute stroke that do not present to hospital. Methods Data was from a large population-representative longitudinal study was analysed, specifically for self-reported stroke or transient ischemic attack (TIA) in the past 2 years. Stroke/TIA incidence was compared to data on presentation to an emergency department (ED) and admission to hospital. Results 281 participants of 4,321 aged 50+ reported a history of stroke/TIA (6.5% of the cohort), with 36 (.08%) new or incident strokes and 61 (1.4%) new or incident TIAs reported in the last 2 years. Of the 36 older people with incident stroke, only 15 had an ED attendance and 12 reported they were admitted to hospital within the last 12 months. Of the 61 people with incident TIA only 30 reported an ED attendance and 25 reported they were admitted to hospital within the last 12 months. Conclusion Assuming a constant incidence of stroke/TIA over a 2-year period, it is possible that 17% of older people with acute stroke did not present to hospital after they developed stroke symptoms. These patients are potentially missing out on hyperacute stroke treatment and comprehensive workup of stroke aetiology with appropriate secondary prevention. A comprehensive strategy including public education would be useful in increasing public awareness of stroke symptoms and the need to present promptly to the ED.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"18 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673636","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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