Pub Date : 2026-02-09DOI: 10.1093/ageing/afaf318.073
Aoife Crowe, Anne Marie Seddon, Joanne Murphy, Eva Marie Elliott, Rachel O'Kelly, Andrew Keegan, Dianaimh Ballantine, Anna Siewierska, Dearbhla Peppard, SKK Lee, Shelina Seebah
Background Older adults with complex care needs should receive a comprehensive geriatric assessment (CGA) in line with the National Clinical Programme for the Older Person recommendations1. The review evaluated integrated multidisciplinary team (MDT) requirements for all admissions, over one year period, on a new Specialist Geriatric Ward (SGW), in a post-acute rehab setting, with frailty screening on admission indicating complexity and MDT input. Methods A retrospective analysis was conducted on all patients admitted onto a SGW in 2024. Outcome measures reviewed included Barthel Index (BI), Functional Independence Measure (FIM) scale in eight activities of daily living, Elderly Mobility Score (EMS) and Functional Oral Intake Scale (FOIS) on admission and discharge. Patients were cohorted by Clinical Frailty Scale (CFS). Referrals to Medical Social Work (MSW), Dietetics and Speech and Language Therapy (SLT) were analysed. Results Medical, nursing, occupational therapy, physiotherapy and pharmacy reviewed all patients (n=217). Mean age was 82.9 years and mean length of stay (LOS) was 45.6 days in 2024. From admission to discharge, the median improvement was 1 point in BI and 4 points in the FIM. The median EMS on admission was 11, improving to 17 on discharge. MSW contributed to 99% (n=215) of CGAs, 174 patients required discharge co-ordination and referral to formal supports. 22 patients required assistance for nursing home application process. Dietetics contributed to 73% (n=159) of CGAs, 23 referrals from a new sarcopenia pathway. SLT contributed to 30% of CGAs (n=64), 35 referred for swallow assessment, 8 referrals for communication assessment, 15 referrals for both and 4 patients requiring Instrumental assessments. Mean FOIS score on admission and discharge was 6. Conclusion CGA on a post-acute SGW was associated with meaningful functional improvements across a spectrum of CFS scores. These findings highlight the value of an integrated MDT in enhancing recovery of older adults.
{"title":"Comprehensive Geriatric Assessment On A New Specialist Geriatric Ward In A Post-Acute Rehabilitation Setting: A Retrospective Review","authors":"Aoife Crowe, Anne Marie Seddon, Joanne Murphy, Eva Marie Elliott, Rachel O'Kelly, Andrew Keegan, Dianaimh Ballantine, Anna Siewierska, Dearbhla Peppard, SKK Lee, Shelina Seebah","doi":"10.1093/ageing/afaf318.073","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.073","url":null,"abstract":"Background Older adults with complex care needs should receive a comprehensive geriatric assessment (CGA) in line with the National Clinical Programme for the Older Person recommendations1. The review evaluated integrated multidisciplinary team (MDT) requirements for all admissions, over one year period, on a new Specialist Geriatric Ward (SGW), in a post-acute rehab setting, with frailty screening on admission indicating complexity and MDT input. Methods A retrospective analysis was conducted on all patients admitted onto a SGW in 2024. Outcome measures reviewed included Barthel Index (BI), Functional Independence Measure (FIM) scale in eight activities of daily living, Elderly Mobility Score (EMS) and Functional Oral Intake Scale (FOIS) on admission and discharge. Patients were cohorted by Clinical Frailty Scale (CFS). Referrals to Medical Social Work (MSW), Dietetics and Speech and Language Therapy (SLT) were analysed. Results Medical, nursing, occupational therapy, physiotherapy and pharmacy reviewed all patients (n=217). Mean age was 82.9 years and mean length of stay (LOS) was 45.6 days in 2024. From admission to discharge, the median improvement was 1 point in BI and 4 points in the FIM. The median EMS on admission was 11, improving to 17 on discharge. MSW contributed to 99% (n=215) of CGAs, 174 patients required discharge co-ordination and referral to formal supports. 22 patients required assistance for nursing home application process. Dietetics contributed to 73% (n=159) of CGAs, 23 referrals from a new sarcopenia pathway. SLT contributed to 30% of CGAs (n=64), 35 referred for swallow assessment, 8 referrals for communication assessment, 15 referrals for both and 4 patients requiring Instrumental assessments. Mean FOIS score on admission and discharge was 6. Conclusion CGA on a post-acute SGW was associated with meaningful functional improvements across a spectrum of CFS scores. These findings highlight the value of an integrated MDT in enhancing recovery of older adults.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"47 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160113","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.027
Aisling Carroll, Donal Fitzpatrick, Finlay Brennan, Kenneth McSherry, Eamon Laird, Leane Hoey, JJ Strain, Anne Molloy, Helene McNulty, Rosaleen Lannon, Conal Cunningham, Kevin McCarroll
Background Normal bone undergoes continuous remodelling through resorption and formation. However, an imbalance in this process leads to loss in bone mineral density. Several factors including lifestyle, biophysical and medications influence bone turnover. We aimed to assess the impact of these factors on bone turnover markers (BTMs in older Irish adults. Methods Participants were from the TUDA study of older Irish adults aged>60. Individuals using antiresorptive or anabolic therapies were excluded. BTMswere serum TRAB5b (a resorption marker) and bone alkaline phosphatase (BAP) as a formation marker. The relationship between lifestyle factors (smoking, alcohol consumption), biophysical (age, sex, vitamin D status, timed up and go, body mass index (BMI), diabetes) and medications (steroids, thiazides, statins, ARB’s, PPIs) with BTMswere explored in multinomial regression adjusting for all factors in the model. Results 1764 participants, mean age 70.0 years, 49.0% female. Higher serum TRAP5b was independently predicted by female sex (p<0.001), lower BMI (p<0.001), lower vitamin D (p<0.001) and PPI use (p=0.0005). Conversely, lower TRAB5b was identified in users of thiazides (p<0.001) and ARBs (p=0.003). Predictors of higher BAP were female sex (p<0.001), lower vitamin D (p<0.001), higher PTH (p<0.001) and PPI use (P =0.002) while lower BAP was found in users of thiazides (p<0.001) and steroids (p=0.030). Conclusion As expected lower BMI and lower vitamin D status predicted increased bone resorption. As bone formation is coupled to resorption, lower vitamin D also predicted increased BAP. Of interest, PPI’s were associated with higher bone turnover suggesting a mechanism for increased fracture risk. Conversely, low bone turnover with thiazides may explain their positive association found elsewhere with BMD. ARB’s were selectively associated with lower bone resorption and may be beneficial for bone health. Finally, steroid users had lower bone formation as identified elsewhere as a mechanism for causing bone loss.
{"title":"The Association Of Lifestyle Factors And Medications With Bone Turnover Markers In Older Irish Adults: Results From The TUDA Study","authors":"Aisling Carroll, Donal Fitzpatrick, Finlay Brennan, Kenneth McSherry, Eamon Laird, Leane Hoey, JJ Strain, Anne Molloy, Helene McNulty, Rosaleen Lannon, Conal Cunningham, Kevin McCarroll","doi":"10.1093/ageing/afaf318.027","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.027","url":null,"abstract":"Background Normal bone undergoes continuous remodelling through resorption and formation. However, an imbalance in this process leads to loss in bone mineral density. Several factors including lifestyle, biophysical and medications influence bone turnover. We aimed to assess the impact of these factors on bone turnover markers (BTMs in older Irish adults. Methods Participants were from the TUDA study of older Irish adults aged&gt;60. Individuals using antiresorptive or anabolic therapies were excluded. BTMswere serum TRAB5b (a resorption marker) and bone alkaline phosphatase (BAP) as a formation marker. The relationship between lifestyle factors (smoking, alcohol consumption), biophysical (age, sex, vitamin D status, timed up and go, body mass index (BMI), diabetes) and medications (steroids, thiazides, statins, ARB’s, PPIs) with BTMswere explored in multinomial regression adjusting for all factors in the model. Results 1764 participants, mean age 70.0 years, 49.0% female. Higher serum TRAP5b was independently predicted by female sex (p&lt;0.001), lower BMI (p&lt;0.001), lower vitamin D (p&lt;0.001) and PPI use (p=0.0005). Conversely, lower TRAB5b was identified in users of thiazides (p&lt;0.001) and ARBs (p=0.003). Predictors of higher BAP were female sex (p&lt;0.001), lower vitamin D (p&lt;0.001), higher PTH (p&lt;0.001) and PPI use (P =0.002) while lower BAP was found in users of thiazides (p&lt;0.001) and steroids (p=0.030). Conclusion As expected lower BMI and lower vitamin D status predicted increased bone resorption. As bone formation is coupled to resorption, lower vitamin D also predicted increased BAP. Of interest, PPI’s were associated with higher bone turnover suggesting a mechanism for increased fracture risk. Conversely, low bone turnover with thiazides may explain their positive association found elsewhere with BMD. ARB’s were selectively associated with lower bone resorption and may be beneficial for bone health. Finally, steroid users had lower bone formation as identified elsewhere as a mechanism for causing bone loss.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"303 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160117","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.206
Joshua Ramjohn, Hailey Sledge, Talal Zahid, Ednilson Lang Kim Tao, David O'Loughlin, Tiago Mendes
Background Clinical handover in geriatric medicine is particularly challenging due to the multifaceted needs of older patients, complex decision-making, and the importance of continuity across care transitions. In many Irish Model Three Hospitals, the current system – where on-call teams facilitate weekend inpatient reviews – introduces further challenges for safe handover. Handwritten weekend review proformas are commonly utilised, though their content may not consistently meet comprehensive handover standards as outlined by the Health Service Executive (HSE). This study audited the content of weekend handover proformas in a Model Three Hospital, against the HSE-recommended handover criteria. Methods A retrospective review of 90 weekend handover proformas was conducted over a two month period, assessing compliance with recognised HSE safe handover standards. Results The mean age of patients listed for weekend review was 74 years. Three patient identifiers were documented in 87% of proformas, while 8% lacked any identifiers. The nature of the requested review was specified in 76% of cases, with combined review of blood results and clinical assessment being the most frequently requested review modality (63%). A proposed management plan was documented in 63% of proformas, and outstanding tasks were noted in 51%. A treatment escalation plan was included in only 25% of entries, and resuscitation status was recorded in 24%. Notably, none of the proformas included triage categorisation, prioritisation, or urgency levels. Conclusion This audit highlights deficits in weekend handover communication within an acute Model Three hospital, particularly impacting older adults. Such deficiencies may contribute to adverse events, suboptimal outcomes and prolonged hospitalisation. We propose implementing a digital, standardised handover tool, incorporating HSE-recommended criteria to support structured, accurate and efficient clinical communication. This aligns with best practice, enhances patient safety and continuity of care through addressing the specific needs of the older inpatient population, while promoting environmental sustainability by reducing reliance on printed proformas.
{"title":"Mind The Weekend Gap: Handover Challenges In Older Patient Care In A Model Three Hospital","authors":"Joshua Ramjohn, Hailey Sledge, Talal Zahid, Ednilson Lang Kim Tao, David O'Loughlin, Tiago Mendes","doi":"10.1093/ageing/afaf318.206","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.206","url":null,"abstract":"Background Clinical handover in geriatric medicine is particularly challenging due to the multifaceted needs of older patients, complex decision-making, and the importance of continuity across care transitions. In many Irish Model Three Hospitals, the current system – where on-call teams facilitate weekend inpatient reviews – introduces further challenges for safe handover. Handwritten weekend review proformas are commonly utilised, though their content may not consistently meet comprehensive handover standards as outlined by the Health Service Executive (HSE). This study audited the content of weekend handover proformas in a Model Three Hospital, against the HSE-recommended handover criteria. Methods A retrospective review of 90 weekend handover proformas was conducted over a two month period, assessing compliance with recognised HSE safe handover standards. Results The mean age of patients listed for weekend review was 74 years. Three patient identifiers were documented in 87% of proformas, while 8% lacked any identifiers. The nature of the requested review was specified in 76% of cases, with combined review of blood results and clinical assessment being the most frequently requested review modality (63%). A proposed management plan was documented in 63% of proformas, and outstanding tasks were noted in 51%. A treatment escalation plan was included in only 25% of entries, and resuscitation status was recorded in 24%. Notably, none of the proformas included triage categorisation, prioritisation, or urgency levels. Conclusion This audit highlights deficits in weekend handover communication within an acute Model Three hospital, particularly impacting older adults. Such deficiencies may contribute to adverse events, suboptimal outcomes and prolonged hospitalisation. We propose implementing a digital, standardised handover tool, incorporating HSE-recommended criteria to support structured, accurate and efficient clinical communication. This aligns with best practice, enhances patient safety and continuity of care through addressing the specific needs of the older inpatient population, while promoting environmental sustainability by reducing reliance on printed proformas.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"91 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160118","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.085
Justyne O'Gara, Amy Reilly
Background The Integrated Care Programme for Older Persons (ICPOP) provides specialist community-based multidisciplinary intervention for older people with complex needs, shifting care from hospitals toward communities. In 2025, 28 of 30 planned ICPOP teams are established nationwide. The Irish Association for Speech and Language Therapists' (IASLT, 2022) recommend SLTs be included on all frailty intervention teams across Ireland. Currently 10 of 28 ICPOP teams have SLT. The specific contribution of ICPOP SLTs remains unexplored. Gaining an understanding of the dynamic role of SLTs within ICPOP is vital for informing professional clinical guidelines. Methods A non-experimental, cross-sectional survey design was used, incorporating principles from the Tailored Design Method to enhance response rates. The survey was developed in Microsoft Word and distributed via email. The survey was non-anonymous, with identifying information collected to follow-up where necessary. SLTs working on ICPOP teams across rural and urban settings, including community and hospital-based teams, were invited to participate. Data was gathered from ten participants with 100% response rate. Results Findings highlight roles and responsibilities of SLTs within ICPOP teams across Ireland. While commonalities were observed, variations existed based on team configurations and geographical locations. Of ten SLTs surveyed, nine are employed at 0.5 Whole Time Equivalent, a predominant part-time workforce within these specialist roles, with the majority expected to participate in non-SLT-specific activities such as referral triaging and Comprehensive Geriatric Assessments. SLTs face challenges related to care coordination upon discharge due to primary care vacancies. Significant variation exists in accessing specialist interventions such as Videofluoroscopy Swallow Study, Fiberoptic Endoscopic Evaluation of Swallowing and Voice/Digital Stroboscopy Clinics. Conclusion Understanding challenges faced by SLTs in different geographical and organisational contexts can support policymakers to meet the diverse needs of older individuals. Further research is needed to explore how increasing SLT resources could improve outcomes for older adults receiving integrated care.
{"title":"The Expanding Role of Speech and Language Therapists within ICPOP Specialist Community Teams: A National Perspective","authors":"Justyne O'Gara, Amy Reilly","doi":"10.1093/ageing/afaf318.085","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.085","url":null,"abstract":"Background The Integrated Care Programme for Older Persons (ICPOP) provides specialist community-based multidisciplinary intervention for older people with complex needs, shifting care from hospitals toward communities. In 2025, 28 of 30 planned ICPOP teams are established nationwide. The Irish Association for Speech and Language Therapists' (IASLT, 2022) recommend SLTs be included on all frailty intervention teams across Ireland. Currently 10 of 28 ICPOP teams have SLT. The specific contribution of ICPOP SLTs remains unexplored. Gaining an understanding of the dynamic role of SLTs within ICPOP is vital for informing professional clinical guidelines. Methods A non-experimental, cross-sectional survey design was used, incorporating principles from the Tailored Design Method to enhance response rates. The survey was developed in Microsoft Word and distributed via email. The survey was non-anonymous, with identifying information collected to follow-up where necessary. SLTs working on ICPOP teams across rural and urban settings, including community and hospital-based teams, were invited to participate. Data was gathered from ten participants with 100% response rate. Results Findings highlight roles and responsibilities of SLTs within ICPOP teams across Ireland. While commonalities were observed, variations existed based on team configurations and geographical locations. Of ten SLTs surveyed, nine are employed at 0.5 Whole Time Equivalent, a predominant part-time workforce within these specialist roles, with the majority expected to participate in non-SLT-specific activities such as referral triaging and Comprehensive Geriatric Assessments. SLTs face challenges related to care coordination upon discharge due to primary care vacancies. Significant variation exists in accessing specialist interventions such as Videofluoroscopy Swallow Study, Fiberoptic Endoscopic Evaluation of Swallowing and Voice/Digital Stroboscopy Clinics. Conclusion Understanding challenges faced by SLTs in different geographical and organisational contexts can support policymakers to meet the diverse needs of older individuals. Further research is needed to explore how increasing SLT resources could improve outcomes for older adults receiving integrated care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"14 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160210","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.116
Aidan O'Beirne, Emily Crowley, Brian Magennis, Colm Byrne, Lorraine Kyne
Background Delirium is one of the most common complications of hospitalisation in older people. A 2020 review estimated an inpatient rate of 23%. In 2017, the INEWS2 was updated to include ‘new confusion’ as part of the disability section (ACVPU). Our hospital included a section on INEWS2 to record 4AT for patients with ‘new confusion’ and a prompt to the delirium guidelines. The aim of our study was to document delirium prevalence in patients admitted under our service and adherence to hospital delirium screening (recording ‘new confusion’ on INEWS2 and 4AT) and management guidelines. Methods A retrospective chart review was conducted of all patients admitted under the geriatric teams during a one-week period. Delirium prevalence was determined by chart review and talking to the medical team. INEWS2 charts were reviewed to determine whether ‘new confusion’ was recorded in the ACVPU section and if a 4AT was completed. For patients with delirium, adherence to the hospital guidelines was determined by chart review. Results We included 78 patients ; 55% were female with a median age of 86.5 years (range 63-99). Thirty-seven patients (47%) were diagnosed with delirium. Only 7 (19%) of these had ‘new confusion’ documented on the INEWS2 chart; 3 (8%) had a 4AT documented. The sensitivity of INEWS2 for delirium detection was 19%; specificity 100%. The hospital delirium management guidelines were followed for all patients. Conclusion We found that almost 1 in 2 older patients admitted under our geriatric medicine service experience delirium. Despite excellent adherence to our delirium management guidelines we found low rates of screening for delirium. The INEWS2 ‘new confusion’ has low sensitivity but high specificity for delirium detection; 4AT’s are rarely documented. Further education of nursing and medical staff is required to ensure that daily screening for delirium occurs to enable rapid identification when it occurs.
{"title":"Delirium in Older Inpatients: Prevalence and audit of adherence to hospital guidelines for screening and management","authors":"Aidan O'Beirne, Emily Crowley, Brian Magennis, Colm Byrne, Lorraine Kyne","doi":"10.1093/ageing/afaf318.116","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.116","url":null,"abstract":"Background Delirium is one of the most common complications of hospitalisation in older people. A 2020 review estimated an inpatient rate of 23%. In 2017, the INEWS2 was updated to include ‘new confusion’ as part of the disability section (ACVPU). Our hospital included a section on INEWS2 to record 4AT for patients with ‘new confusion’ and a prompt to the delirium guidelines. The aim of our study was to document delirium prevalence in patients admitted under our service and adherence to hospital delirium screening (recording ‘new confusion’ on INEWS2 and 4AT) and management guidelines. Methods A retrospective chart review was conducted of all patients admitted under the geriatric teams during a one-week period. Delirium prevalence was determined by chart review and talking to the medical team. INEWS2 charts were reviewed to determine whether ‘new confusion’ was recorded in the ACVPU section and if a 4AT was completed. For patients with delirium, adherence to the hospital guidelines was determined by chart review. Results We included 78 patients ; 55% were female with a median age of 86.5 years (range 63-99). Thirty-seven patients (47%) were diagnosed with delirium. Only 7 (19%) of these had ‘new confusion’ documented on the INEWS2 chart; 3 (8%) had a 4AT documented. The sensitivity of INEWS2 for delirium detection was 19%; specificity 100%. The hospital delirium management guidelines were followed for all patients. Conclusion We found that almost 1 in 2 older patients admitted under our geriatric medicine service experience delirium. Despite excellent adherence to our delirium management guidelines we found low rates of screening for delirium. The INEWS2 ‘new confusion’ has low sensitivity but high specificity for delirium detection; 4AT’s are rarely documented. Further education of nursing and medical staff is required to ensure that daily screening for delirium occurs to enable rapid identification when it occurs.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"35 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160295","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.137
Niamh McCullagh, Robert Fitsimons, Amy Lynch, Connor Martin, Catriona Reddin, Michelle Canavan, Maria Costello
Background Discharge planning for older adults often involves decisions about referring patients to rehabilitation or respite care. Clarity around the purpose, and expected benefits of each service is essential to support effective transitions of care. Methods The objective of this study was to explore healthcare workers’ understanding and experience of respite and rehabilitation. A cross-sectional online survey was completed by multidisciplinary staff working in an Irish hospital. The questionnaire assessed understanding and purpose of rehabilitation and respite, and views on whether patients are expected to optimise functioning. Results Among 47 respondents, 90% of respondents reported understanding the difference between rehabilitation and respite care. Most healthcare workers (87%) agreed that older adults are expected to optimise functioning during rehabilitation. 5% expected function to be optimised in respite care. 57.6% reported the purpose of respite care was to provide informal carers with a break from their caregiving duties to avoid carer burnout, 13.6% reported purpose was to expedite hospital discharge and 3% reported the purpose was to promote independence. Conclusion The majority of healthcare worker's reported understanding the difference between the rehabilitation and respite care. However, there is variation in the purpose identified for respite care. Education regarding the utility of each service may improve discharge planning and service utilisation.
{"title":"Healthcare Workers’ Perceptions of the Role of Respite vs. Rehabilitation in Hospital Discharge Planning for Older Adults","authors":"Niamh McCullagh, Robert Fitsimons, Amy Lynch, Connor Martin, Catriona Reddin, Michelle Canavan, Maria Costello","doi":"10.1093/ageing/afaf318.137","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.137","url":null,"abstract":"Background Discharge planning for older adults often involves decisions about referring patients to rehabilitation or respite care. Clarity around the purpose, and expected benefits of each service is essential to support effective transitions of care. Methods The objective of this study was to explore healthcare workers’ understanding and experience of respite and rehabilitation. A cross-sectional online survey was completed by multidisciplinary staff working in an Irish hospital. The questionnaire assessed understanding and purpose of rehabilitation and respite, and views on whether patients are expected to optimise functioning. Results Among 47 respondents, 90% of respondents reported understanding the difference between rehabilitation and respite care. Most healthcare workers (87%) agreed that older adults are expected to optimise functioning during rehabilitation. 5% expected function to be optimised in respite care. 57.6% reported the purpose of respite care was to provide informal carers with a break from their caregiving duties to avoid carer burnout, 13.6% reported purpose was to expedite hospital discharge and 3% reported the purpose was to promote independence. Conclusion The majority of healthcare worker's reported understanding the difference between the rehabilitation and respite care. However, there is variation in the purpose identified for respite care. Education regarding the utility of each service may improve discharge planning and service utilisation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"303 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160297","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.038
Róisín Costello, Danielle McCabe, Jaybelyn Rivero, Nabash Kosar, Ruby Jose, Mercy Prince, Mark Kiernan, Laura Keaskin, Blanaid McCabe, Kowshika Thavarajah
Background The Irish National Audit of Dementia-2 (INAD-2) highlighted continued deficits in acute hospital care for people living with dementia (PLwD), particularly around delirium recognition, appropriate prescribing, and dementia-friendly environments. In response, a Specialist Geriatric Ward (SGW) implemented a Dementia/Delirium Care Bundle (DDCB) aligned with INAD-2 recommendations and National Clinical Guidelines (NCG21). Methods A quality improvement project was conducted in SGW, involving a two-phase clinical audit before and after implementation of a multidisciplinary DDCB. The intervention included staff training, use of bedside identifiers, personalized care plans, and environmental enhancements. Data were collected on 27 patients during pre- and post-implementation audits, assessing compliance with dementia care standards in communication, nutrition, elimination, safe mobility, and delirium recognition and management Results post implementation of DDCB and intervention compliance improved from 69% to 87%. Notable gains were observed in delirium recognition (53% to 89%), nutritional care (84% to 95%), food within the reach (38% to 100%) safe mobility (80% to 100%), evidence of pain assessment (0% to 100%), and documentation of personal preferences of patients 9 40% to 88%). Antipsychotic prescribing practices improved by 37 %, with documentation of rationale and alternative non-pharmacological strategies. Environmental changes, including orientation boards, meaningful activity resources, dementia signage with development of a dementia friendly SGW, supported patient-centered care. Conclusion The implementation of a DDCB supported by dementia-friendly environmental design and staff education significantly improved adherence to person-centered dementia care standards. Key enablers included active dementia Clinical Nurse Specialist (CNS), dementia candidate Advance Nurse Practitioner (cANP) support, multidisciplinary engagement, and tailored staff education. Ongoing sustainability efforts are required to address documentation gaps and ensure broader rollout. This model demonstrates the feasibility and impact of translating national dementia strategy recommendations into local practice.
{"title":"Improving Care for Patients with Dementia with Development of a Dementia Friendly Specialist Geriatric Ward: A Quality Improvement Initiative","authors":"Róisín Costello, Danielle McCabe, Jaybelyn Rivero, Nabash Kosar, Ruby Jose, Mercy Prince, Mark Kiernan, Laura Keaskin, Blanaid McCabe, Kowshika Thavarajah","doi":"10.1093/ageing/afaf318.038","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.038","url":null,"abstract":"Background The Irish National Audit of Dementia-2 (INAD-2) highlighted continued deficits in acute hospital care for people living with dementia (PLwD), particularly around delirium recognition, appropriate prescribing, and dementia-friendly environments. In response, a Specialist Geriatric Ward (SGW) implemented a Dementia/Delirium Care Bundle (DDCB) aligned with INAD-2 recommendations and National Clinical Guidelines (NCG21). Methods A quality improvement project was conducted in SGW, involving a two-phase clinical audit before and after implementation of a multidisciplinary DDCB. The intervention included staff training, use of bedside identifiers, personalized care plans, and environmental enhancements. Data were collected on 27 patients during pre- and post-implementation audits, assessing compliance with dementia care standards in communication, nutrition, elimination, safe mobility, and delirium recognition and management Results post implementation of DDCB and intervention compliance improved from 69% to 87%. Notable gains were observed in delirium recognition (53% to 89%), nutritional care (84% to 95%), food within the reach (38% to 100%) safe mobility (80% to 100%), evidence of pain assessment (0% to 100%), and documentation of personal preferences of patients 9 40% to 88%). Antipsychotic prescribing practices improved by 37 %, with documentation of rationale and alternative non-pharmacological strategies. Environmental changes, including orientation boards, meaningful activity resources, dementia signage with development of a dementia friendly SGW, supported patient-centered care. Conclusion The implementation of a DDCB supported by dementia-friendly environmental design and staff education significantly improved adherence to person-centered dementia care standards. Key enablers included active dementia Clinical Nurse Specialist (CNS), dementia candidate Advance Nurse Practitioner (cANP) support, multidisciplinary engagement, and tailored staff education. Ongoing sustainability efforts are required to address documentation gaps and ensure broader rollout. This model demonstrates the feasibility and impact of translating national dementia strategy recommendations into local practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"30 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160120","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.189
Belle Wu, Ciarán McAdam, Helen McDonald, Eimear O'Dwyer
Compared to other countries in Europe, Ireland has one of the highest prescribing rates for antimicrobials. Antimicrobial resistance is a worldwide concern, a threat to human health and a contributor to financial burden on the healthcare system. The aim of this audit was to retrospectively investigate the level of adherence to HSE guidelines on the documentation of indication and duration for antimicrobials prescribed in residential care for older adults over the age of 65 in four extended care units. Methods This clinical audit was measured against two HSE standards for antimicrobial prescribing documentation. Residential care prescription charts were retrospectively reviewed over a period of one week in June 2024. Where an antimicrobial prescription was identified, documentation of indication and duration of use at the time of prescribing was assessed. Details were collected and recorded on the HSE NCCA Excel Template for Clinical Audits. Results A total of 55/84 residents (65.5%) had at least one antimicrobial prescribed. There were 136 antimicrobial prescriptions in total (63.24% had an indication documented; 66.18% had a duration documented, 55.88% had both indication and duration documented). Oral/enteral prescriptions (n = 49) had the highest average combined % adherence to HSE standards for indication and duration documentation (88.90%) compared to topical (n = 80; 49.5%), parenteral (n = 6; 75%) or PV route prescriptions (n = 1; 50%). No prophylactic prescriptions (n = 32) had indication or duration recorded (0% adherence). Conclusion Antimicrobials should be prescribed with a clear therapeutic indication and appropriate duration documented on the prescription. Areas of good practice included prescriptions for oral/enteral routes and for active infections. Potential areas of improvement included topical, prophylaxis and stat dose prescriptions. Medical, nursing and pharmacy teams should be made aware of the importance of indication and duration documentation at time of antimicrobial prescribing, and to follow-up any omissions.
{"title":"A Retrospective Audit of Indication and Duration Documentation in Relation to Antimicrobial Prescribing in Residential Care","authors":"Belle Wu, Ciarán McAdam, Helen McDonald, Eimear O'Dwyer","doi":"10.1093/ageing/afaf318.189","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.189","url":null,"abstract":"Compared to other countries in Europe, Ireland has one of the highest prescribing rates for antimicrobials. Antimicrobial resistance is a worldwide concern, a threat to human health and a contributor to financial burden on the healthcare system. The aim of this audit was to retrospectively investigate the level of adherence to HSE guidelines on the documentation of indication and duration for antimicrobials prescribed in residential care for older adults over the age of 65 in four extended care units. Methods This clinical audit was measured against two HSE standards for antimicrobial prescribing documentation. Residential care prescription charts were retrospectively reviewed over a period of one week in June 2024. Where an antimicrobial prescription was identified, documentation of indication and duration of use at the time of prescribing was assessed. Details were collected and recorded on the HSE NCCA Excel Template for Clinical Audits. Results A total of 55/84 residents (65.5%) had at least one antimicrobial prescribed. There were 136 antimicrobial prescriptions in total (63.24% had an indication documented; 66.18% had a duration documented, 55.88% had both indication and duration documented). Oral/enteral prescriptions (n = 49) had the highest average combined % adherence to HSE standards for indication and duration documentation (88.90%) compared to topical (n = 80; 49.5%), parenteral (n = 6; 75%) or PV route prescriptions (n = 1; 50%). No prophylactic prescriptions (n = 32) had indication or duration recorded (0% adherence). Conclusion Antimicrobials should be prescribed with a clear therapeutic indication and appropriate duration documented on the prescription. Areas of good practice included prescriptions for oral/enteral routes and for active infections. Potential areas of improvement included topical, prophylaxis and stat dose prescriptions. Medical, nursing and pharmacy teams should be made aware of the importance of indication and duration documentation at time of antimicrobial prescribing, and to follow-up any omissions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"71 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160293","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.120
Kate Lee MacDonagh, Ann Marie White, Almida Lynam
Background Sexually transmitted infection cases are present among all genders and ages. This review looked at presentations & demographics of patients 65years and older attending STI clinics in a tertiary hospital in 2022 & 2023 Methods The electronic records of patients aged 65 years and older attending the general STI clinic between January 2022 and December 2023 were reviewed. Descriptive statistics were analysed using Excel Results 111 presentations were included incorporating 93 individual patients.13/93 (14%) were reviewed more than once. 54/111 (49%) self-presented, 48/111 (43%) were referred by a healthcare provider, and 9/111 (8%) were previously known to the clinic and rebooked. The median age was 70 [IQR 67 – 73]. A previous STI history was reported in 40/93 (43%). 68/93 (73%) were cis-gender males. 25/68 (37%) of males identified as gay, bisexual, or men who have sex with men (gbMSM) of whom 23/25 (92%) received education on PEP and PrEP. 36/111(33%) presentations were due to viral dermatological conditions (HSV/HPV) and 25/111(22.5%) were due to other dermatological concerns. 6/111(5.4%) were due to a different bacterial STI. 14/111(12.5%) were related to Syphilis of which 3/14 (21%) were early infectious syphilis, 1/14 (7%) were Neurosyphilis, 4/14 (29%) were Late latent syphilis, 5/14 (36%) were previously adequately treated syphilis & 1/14 (7%) was false positive. 13/93(14%) patients were reviewed on more than one occasion of which 8/13(61.5%) were due to genital herpes simplex virus (HSV). Conclusion Sexual health remains an important aspect of care for patients as they age. While many patients’ self referred to the service it is likely that there are others that are not aware of the service or do not know how to access it. Older patients often have multiple comorbidities and complex care needs and may benefit from additional allotted time or dedicated clinic.
{"title":"A Two Year Retrospective Review Of Patients 65-Years And Older Attending Genitourinary Clinic In A Tertiary Centre","authors":"Kate Lee MacDonagh, Ann Marie White, Almida Lynam","doi":"10.1093/ageing/afaf318.120","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.120","url":null,"abstract":"Background Sexually transmitted infection cases are present among all genders and ages. This review looked at presentations & demographics of patients 65years and older attending STI clinics in a tertiary hospital in 2022 & 2023 Methods The electronic records of patients aged 65 years and older attending the general STI clinic between January 2022 and December 2023 were reviewed. Descriptive statistics were analysed using Excel Results 111 presentations were included incorporating 93 individual patients.13/93 (14%) were reviewed more than once. 54/111 (49%) self-presented, 48/111 (43%) were referred by a healthcare provider, and 9/111 (8%) were previously known to the clinic and rebooked. The median age was 70 [IQR 67 – 73]. A previous STI history was reported in 40/93 (43%). 68/93 (73%) were cis-gender males. 25/68 (37%) of males identified as gay, bisexual, or men who have sex with men (gbMSM) of whom 23/25 (92%) received education on PEP and PrEP. 36/111(33%) presentations were due to viral dermatological conditions (HSV/HPV) and 25/111(22.5%) were due to other dermatological concerns. 6/111(5.4%) were due to a different bacterial STI. 14/111(12.5%) were related to Syphilis of which 3/14 (21%) were early infectious syphilis, 1/14 (7%) were Neurosyphilis, 4/14 (29%) were Late latent syphilis, 5/14 (36%) were previously adequately treated syphilis & 1/14 (7%) was false positive. 13/93(14%) patients were reviewed on more than one occasion of which 8/13(61.5%) were due to genital herpes simplex virus (HSV). Conclusion Sexual health remains an important aspect of care for patients as they age. While many patients’ self referred to the service it is likely that there are others that are not aware of the service or do not know how to access it. Older patients often have multiple comorbidities and complex care needs and may benefit from additional allotted time or dedicated clinic.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"133 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160115","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 : 2026-02-09DOI: 10.1093/ageing/afaf318.007
Caoimhe McGarvey, Rose Anne Kenny, Sean Kennelly, Donal Sexton, Robert Briggs
Background Dementia is preventable and deferrable yet remains a major cause of disability and dependency and the seventh leading cause of death worldwide. The Lancet Commission on dementia published a report in July 2024, identifying 14 modifiable dementia risk factors and estimating a 45% reduction in dementia cases with risk factor elimination. The aim of this study is to assess the prevalence of modifiable dementia risk factors, providing crucial context for the delivery of dementia prevention in Ireland. Methods This is a longitudinal study using data from three waves of the Irish Longitudinal Study on Ageing (TILDA) to quantify the prevalence of modifiable dementia risk factors in Ireland over a 10·93 (±0·37) year follow-up. TILDA is a population-based prospective cohort study, representative of community-dwelling adults aged 50 years and older, living in Ireland. Data were analysed using Stata 15·1 applying inverse probability weighting. Results 8,171, 6,615 and 4,318 participants were included in wave one, three and six analyses. 70·6%, 61·1% and 54·2% of the population had 4 or more modifiable risk factors for dementia at consecutive waves amounting to over 500,000 people with 4 or more modifiable risk factors for dementia on weighted population analysis at wave six.77% of those with severe decline in cognitive performance during follow-up had 4 or more risk factors at baseline. An estimated 32,480 cases of severe decline in cognitive performance during follow-up were potentially preventable if risk factors were eliminated. Conclusion This study identifies a high prevalence of modifiable dementia risk factors in Ireland and highlights the need for public education on the concept of brain health and the development of a clinical framework focused on delivering on the opportunity of dementia prevention. Preventing and delaying dementia onset has the potential to compress morbidity and increase healthy lifespan in older age.
{"title":"Opportunities for Dementia Prevention: Modifiable Dementia Risk Factors in Ireland","authors":"Caoimhe McGarvey, Rose Anne Kenny, Sean Kennelly, Donal Sexton, Robert Briggs","doi":"10.1093/ageing/afaf318.007","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.007","url":null,"abstract":"Background Dementia is preventable and deferrable yet remains a major cause of disability and dependency and the seventh leading cause of death worldwide. The Lancet Commission on dementia published a report in July 2024, identifying 14 modifiable dementia risk factors and estimating a 45% reduction in dementia cases with risk factor elimination. The aim of this study is to assess the prevalence of modifiable dementia risk factors, providing crucial context for the delivery of dementia prevention in Ireland. Methods This is a longitudinal study using data from three waves of the Irish Longitudinal Study on Ageing (TILDA) to quantify the prevalence of modifiable dementia risk factors in Ireland over a 10·93 (±0·37) year follow-up. TILDA is a population-based prospective cohort study, representative of community-dwelling adults aged 50 years and older, living in Ireland. Data were analysed using Stata 15·1 applying inverse probability weighting. Results 8,171, 6,615 and 4,318 participants were included in wave one, three and six analyses. 70·6%, 61·1% and 54·2% of the population had 4 or more modifiable risk factors for dementia at consecutive waves amounting to over 500,000 people with 4 or more modifiable risk factors for dementia on weighted population analysis at wave six.77% of those with severe decline in cognitive performance during follow-up had 4 or more risk factors at baseline. An estimated 32,480 cases of severe decline in cognitive performance during follow-up were potentially preventable if risk factors were eliminated. Conclusion This study identifies a high prevalence of modifiable dementia risk factors in Ireland and highlights the need for public education on the concept of brain health and the development of a clinical framework focused on delivering on the opportunity of dementia prevention. Preventing and delaying dementia onset has the potential to compress morbidity and increase healthy lifespan in older age.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"10 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160213","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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