Pub Date : 2025-12-06DOI: 10.1093/ageing/afaf318.118
James McEntee, Alanna Crawford, Ellen Wilde, Isra Hussein, Tahira Bibi, Fiyona Pachel, Joseph Deegan, Joseph Browne, Hassan Haswadi, Keneilwe Malomo, Ontefetse Ntlholang
Background Inhaled corticosteroids (ICS) are cornerstone therapies for asthma and chronic obstructive pulmonary disease (COPD), but concerns persist about their impact on bone health. We evaluated dose-dependent ICS effects on fractures, osteoporosis, and bone protection practices in patients with asthma, COPD and asthma-COPD overlap syndrome (ACOS) who were admitted to medical teams through our Emergency Department over a 26 month period. Methods We analysed 338 patients (55 asthma, 266 COPD, 17 ACOS) from a single- centre cohort. Multivariable logistic regression models assessed associations between ICS doses (none, low, moderate, high) and bone outcomes (prior fractures, DEXA-confirmed osteoporosis), adjusting for age, gender, smoking, falls, and comorbidities. Bone protection use (vitamin D/calcium) was evaluated across ICS groups. Results The mean age was 67.4 years (±13.9), with 53.3% female. Most patients used ICS (67.2%), primarily low/moderate doses (40.8% low, 11.8% moderate). There was no direct ICS dose-response relationship with previous fractures. However, moderate (OR 2.66, 95%CI: 1.12–6.33) and high ICS doses (OR 3.79, 95%CI: 1.66–8.64) were linked to osteoporosis/fractures compared to non-users. Women over 60 years had significantly elevated risks (OR 5.15, 95%CI: 1.14–23.29). Despite 30% having prior fractures or osteoporosis, 70% lacked bone protection (vitamin D/calcium). Bone protection was more common in COPD patients (OR 3.55 vs. asthma), those with prior fractures (OR 2.89), or osteoporosis (OR 2.45). Smoking did not modify ICS effects on bone health. Conclusion We determined that higher ICS doses correlated with osteoporosis/fracture risks, particularly in older women, necessitating targeted bone health monitoring. There were suboptimal bone protection practices that highlighted care gaps in high-risk respiratory populations. We recommend balancing ICS benefits with proactive bone health strategies, including DEXA screening and supplementation, especially in older females and COPD patients and the need for longitudinal studies to confirm findings, as cross-sectional studies limit causal inferences.
{"title":"Inhaled Corticosteroids and Bone Health in Asthma, COPD and Asthma-COPD overlap Syndrome (ACOS): Fracture Risks and Protection Gaps","authors":"James McEntee, Alanna Crawford, Ellen Wilde, Isra Hussein, Tahira Bibi, Fiyona Pachel, Joseph Deegan, Joseph Browne, Hassan Haswadi, Keneilwe Malomo, Ontefetse Ntlholang","doi":"10.1093/ageing/afaf318.118","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.118","url":null,"abstract":"Background Inhaled corticosteroids (ICS) are cornerstone therapies for asthma and chronic obstructive pulmonary disease (COPD), but concerns persist about their impact on bone health. We evaluated dose-dependent ICS effects on fractures, osteoporosis, and bone protection practices in patients with asthma, COPD and asthma-COPD overlap syndrome (ACOS) who were admitted to medical teams through our Emergency Department over a 26 month period. Methods We analysed 338 patients (55 asthma, 266 COPD, 17 ACOS) from a single- centre cohort. Multivariable logistic regression models assessed associations between ICS doses (none, low, moderate, high) and bone outcomes (prior fractures, DEXA-confirmed osteoporosis), adjusting for age, gender, smoking, falls, and comorbidities. Bone protection use (vitamin D/calcium) was evaluated across ICS groups. Results The mean age was 67.4 years (±13.9), with 53.3% female. Most patients used ICS (67.2%), primarily low/moderate doses (40.8% low, 11.8% moderate). There was no direct ICS dose-response relationship with previous fractures. However, moderate (OR 2.66, 95%CI: 1.12–6.33) and high ICS doses (OR 3.79, 95%CI: 1.66–8.64) were linked to osteoporosis/fractures compared to non-users. Women over 60 years had significantly elevated risks (OR 5.15, 95%CI: 1.14–23.29). Despite 30% having prior fractures or osteoporosis, 70% lacked bone protection (vitamin D/calcium). Bone protection was more common in COPD patients (OR 3.55 vs. asthma), those with prior fractures (OR 2.89), or osteoporosis (OR 2.45). Smoking did not modify ICS effects on bone health. Conclusion We determined that higher ICS doses correlated with osteoporosis/fracture risks, particularly in older women, necessitating targeted bone health monitoring. There were suboptimal bone protection practices that highlighted care gaps in high-risk respiratory populations. We recommend balancing ICS benefits with proactive bone health strategies, including DEXA screening and supplementation, especially in older females and COPD patients and the need for longitudinal studies to confirm findings, as cross-sectional studies limit causal inferences.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"36 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-06DOI: 10.1093/ageing/afaf318.126
Máire Ní Neachtain, Margaret Lavelle, Fiona McCleane, Loretta Walsh, Mary Rogan, Aishling Abed, Alma Brehoney, Tómas O Flatharta, Robert Murphy, Alanna Clancy, Patricia Munnelly, Judith Campbell, Cliodhna Fitzmaurice, Maria Costello
Background Rural and remote populations often experience poorer health outcomes due to geographic isolation, limited healthcare access, and economic disadvantage. As part of our Integrated Care Programme for Older Persons (ICPOP), we aimed to address the needs of complex older adults living on an offshore island within our catchment area. Methods The island, located 85 km from the nearest hospital (including road and sea travel), has a resident population of approximately 175–184. In partnership with the island’s Public Health Nurse (PHN), six older adults were identified for comprehensive geriatric assessment (CGA). A joint Advanced Nurse Practitioner (ANP) and consultant clinic was conducted, incorporating assessments at the PHN office and through home visits. Logistical challenges included coordinating ferry schedules and arranging local transport. Results Six residents (three men and three women) underwent CGA. The median age was 88.5 years, with Clinical Frailty Scores ranging from 3 to 6. The median Barthel Index was 18, and the median Lawton IADL score was 3. Key issues identified included a new diagnosis of dementia, polypharmacy, orthostatic hypotension, and previously untreated osteoporosis. Three individuals were referred had later intervention with the team physiotherapist. Conclusion Equitable access to care is vital for older adults in remote rural settings. ICPOP outreach clinics offer an effective means of delivering specialist assessment and timely intervention, reducing the risk of emergency or unscheduled hospital admissions. This model fosters local engagement and supports ageing in place. Future plans include the integration of virtual platforms such as Attend Anywhere to enhance continuity of care and support follow-up interventions.
{"title":"From Sea to CGA: Delivering Geriatric Assessment to an Island Community","authors":"Máire Ní Neachtain, Margaret Lavelle, Fiona McCleane, Loretta Walsh, Mary Rogan, Aishling Abed, Alma Brehoney, Tómas O Flatharta, Robert Murphy, Alanna Clancy, Patricia Munnelly, Judith Campbell, Cliodhna Fitzmaurice, Maria Costello","doi":"10.1093/ageing/afaf318.126","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.126","url":null,"abstract":"Background Rural and remote populations often experience poorer health outcomes due to geographic isolation, limited healthcare access, and economic disadvantage. As part of our Integrated Care Programme for Older Persons (ICPOP), we aimed to address the needs of complex older adults living on an offshore island within our catchment area. Methods The island, located 85 km from the nearest hospital (including road and sea travel), has a resident population of approximately 175–184. In partnership with the island’s Public Health Nurse (PHN), six older adults were identified for comprehensive geriatric assessment (CGA). A joint Advanced Nurse Practitioner (ANP) and consultant clinic was conducted, incorporating assessments at the PHN office and through home visits. Logistical challenges included coordinating ferry schedules and arranging local transport. Results Six residents (three men and three women) underwent CGA. The median age was 88.5 years, with Clinical Frailty Scores ranging from 3 to 6. The median Barthel Index was 18, and the median Lawton IADL score was 3. Key issues identified included a new diagnosis of dementia, polypharmacy, orthostatic hypotension, and previously untreated osteoporosis. Three individuals were referred had later intervention with the team physiotherapist. Conclusion Equitable access to care is vital for older adults in remote rural settings. ICPOP outreach clinics offer an effective means of delivering specialist assessment and timely intervention, reducing the risk of emergency or unscheduled hospital admissions. This model fosters local engagement and supports ageing in place. Future plans include the integration of virtual platforms such as Attend Anywhere to enhance continuity of care and support follow-up interventions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"18 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680363","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/afaf318.140
Michael Mitchell, Matej Klaric, Colm Byrne, Elizabeth Callaly, Roisin Purcell, Sive Carey, Sophie Lynch, Jennifer Kirwan, Rico Laguna, Helen Bowden, Cian O Caheny, Roisin Riches, Ayesha Masood, Lindsay MacKenzie, Aisling Boyle
Background Older adults presenting to Emergency Departments (EDs) with frailty often have complex needs not fully addressed by ED care models. Evidence shows these patients frequently experience gaps in basic care, including support for daily living, communication, and mobility, as EDs are primarily designed for acute, episodic care. In Ireland. Methods The Frailty Snapshot survey was developed to capture key care domains for frail older adults in the ED: A Rehabilitation Assistant administered the survey to patients aged 65 and over. Data were recorded on standardised forms and uploaded to the patient centre and shared at daily huddles. Results 113 patients were assessed. Most had their own clothes (97.3%) and shoes (96.4%). Over half (54.6%) required a walking aid, but 30.8% of these did not have one available. Additionally, 38.0% had not been mobilised or offered mobilisation. For continence and toileting, 23.0% had not been to the toilet or offered the opportunity, and 32.7% were placed in continence wear. Mouth care was lacking, with 90.2% not having received mouth care and 92.0% without a toothbrush. Sensory aids were often missing: half of those needing hearing aids did not have them, 48% lacked glasses, and 25% were missing dentures. While 92.0% had access to a chair, 59.2% had not sat out Conclusion The Frailty Snapshot highlighted significant gaps in care a lack of access to aids for frail older adults in the ED. A Rehabilitation Assistant was highly beneficial in supporting FIT therapists to led to more efficient identification of identify and prioritise suitable cases, enabling therapists to promptly prioritise and assess patients for assessment. Further evaluation of access to toileting, communication aids, mobility aids, and seating is required to ensure comprehensive improvements in patient care.
{"title":"Frailty Snapshot in the Emergency Department: Surveying the Needs of Older Adults","authors":"Michael Mitchell, Matej Klaric, Colm Byrne, Elizabeth Callaly, Roisin Purcell, Sive Carey, Sophie Lynch, Jennifer Kirwan, Rico Laguna, Helen Bowden, Cian O Caheny, Roisin Riches, Ayesha Masood, Lindsay MacKenzie, Aisling Boyle","doi":"10.1093/ageing/afaf318.140","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.140","url":null,"abstract":"Background Older adults presenting to Emergency Departments (EDs) with frailty often have complex needs not fully addressed by ED care models. Evidence shows these patients frequently experience gaps in basic care, including support for daily living, communication, and mobility, as EDs are primarily designed for acute, episodic care. In Ireland. Methods The Frailty Snapshot survey was developed to capture key care domains for frail older adults in the ED: A Rehabilitation Assistant administered the survey to patients aged 65 and over. Data were recorded on standardised forms and uploaded to the patient centre and shared at daily huddles. Results 113 patients were assessed. Most had their own clothes (97.3%) and shoes (96.4%). Over half (54.6%) required a walking aid, but 30.8% of these did not have one available. Additionally, 38.0% had not been mobilised or offered mobilisation. For continence and toileting, 23.0% had not been to the toilet or offered the opportunity, and 32.7% were placed in continence wear. Mouth care was lacking, with 90.2% not having received mouth care and 92.0% without a toothbrush. Sensory aids were often missing: half of those needing hearing aids did not have them, 48% lacked glasses, and 25% were missing dentures. While 92.0% had access to a chair, 59.2% had not sat out Conclusion The Frailty Snapshot highlighted significant gaps in care a lack of access to aids for frail older adults in the ED. A Rehabilitation Assistant was highly beneficial in supporting FIT therapists to led to more efficient identification of identify and prioritise suitable cases, enabling therapists to promptly prioritise and assess patients for assessment. Further evaluation of access to toileting, communication aids, mobility aids, and seating is required to ensure comprehensive improvements in patient care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"12 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673578","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/afaf318.197
Patrick Doyle, Suzanne Dunne, Nicola Cogan, Rachel Walsh, Emma Murtagh, Derek Hayden, Dan Ryan, Rónán Collins, Sarah Coveney
Background In Ireland, the ACT FAST campaign has been a central strategy to raise public awareness of stroke symptoms, with initiatives in 2010, 2015, and 2023. While the FAST (Face, Arm, Speech, Time) acronym targets core anterior circulation symptoms, the expanded BE-FAST criteria include Balance and Eye symptoms to improve detection of posterior circulation strokes. This study evaluates whether expanding symptom recognition improves timely hospital presentation and treatment access. Methods A retrospective review of a stroke register at a single Irish centre was conducted, analysing patients who presented between January and December 2022. Data collected included demographics, mode of arrival (self vs ambulance), symptom type (FAST or BE-FAST), and time from symptom onset to hospital arrival. Symptom classification was based on clinical documentation. Results Of 316 stroke patients, 74.4% were FAST-positive and 87% were BE-FAST-positive. While BE-FAST improved overall sensitivity, FAST-positive patients were significantly more likely to arrive by ambulance (p = 0.035). Only speech symptoms were independently associated with both earlier presentation and a higher likelihood of receiving endovascular treatment (EVT) (p = 0.021). No significant time-to-treatment benefit was found for BE-FAST-positive patients compared to FAST-positive alone. Conclusion Although the BE-FAST criteria identify more patients with stroke symptoms, they do not appear to meaningfully enhance time-to-treatment or increase ambulance use. Speech symptoms remain the most predictive of early arrival and intervention. These findings suggest that while broader symptom messaging increases sensitivity, continued emphasis on the core FAST symptoms—especially speech—may be more effective in prompting timely presentation and treatment.
{"title":"Beyond FAST: Evaluating the Impact of Expanded Stroke Criteria on Emergency Response","authors":"Patrick Doyle, Suzanne Dunne, Nicola Cogan, Rachel Walsh, Emma Murtagh, Derek Hayden, Dan Ryan, Rónán Collins, Sarah Coveney","doi":"10.1093/ageing/afaf318.197","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.197","url":null,"abstract":"Background In Ireland, the ACT FAST campaign has been a central strategy to raise public awareness of stroke symptoms, with initiatives in 2010, 2015, and 2023. While the FAST (Face, Arm, Speech, Time) acronym targets core anterior circulation symptoms, the expanded BE-FAST criteria include Balance and Eye symptoms to improve detection of posterior circulation strokes. This study evaluates whether expanding symptom recognition improves timely hospital presentation and treatment access. Methods A retrospective review of a stroke register at a single Irish centre was conducted, analysing patients who presented between January and December 2022. Data collected included demographics, mode of arrival (self vs ambulance), symptom type (FAST or BE-FAST), and time from symptom onset to hospital arrival. Symptom classification was based on clinical documentation. Results Of 316 stroke patients, 74.4% were FAST-positive and 87% were BE-FAST-positive. While BE-FAST improved overall sensitivity, FAST-positive patients were significantly more likely to arrive by ambulance (p = 0.035). Only speech symptoms were independently associated with both earlier presentation and a higher likelihood of receiving endovascular treatment (EVT) (p = 0.021). No significant time-to-treatment benefit was found for BE-FAST-positive patients compared to FAST-positive alone. Conclusion Although the BE-FAST criteria identify more patients with stroke symptoms, they do not appear to meaningfully enhance time-to-treatment or increase ambulance use. Speech symptoms remain the most predictive of early arrival and intervention. These findings suggest that while broader symptom messaging increases sensitivity, continued emphasis on the core FAST symptoms—especially speech—may be more effective in prompting timely presentation and treatment.","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":"145673635","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/afaf318.026
Patrick Doyle, Sinéad McHugh, Desmond O'Neill
Background Nursing home residents in Ireland experienced a disproportionate burden of illness and death during the COVID-19 pandemic, highlighting longstanding systemic deficiencies in governance, staffing, and research engagement. Prior to the pandemic, this vulnerable population, characterised by high levels of multimorbidity and disability, received limited research attention. A subgroup from the National Clinical Programme for Older People recommended the development of a research agenda in nursing homes, including resident involvement. This study aimed to characterise the extent and nature of Irish nursing home research from 1966 to 2024. Methods A bibliometric review was conducted using PubMed to identify publications related to Irish nursing homes from January 1966 to March 2020 (pre-pandemic) and April 2020 to July 2024 (post-pandemic). Data extracted included publication type, number of authors, institutional affiliations, countries of origin, disciplines involved, and acknowledgement of nursing home staff or residents. Descriptive analysis was performed using Excel and SPSS. Results A total of 144 publications were identified. Most papers (n=106; 73.6%) were published pre-pandemic, while 38 (26.4%) appeared in the shorter post-pandemic period, showing a substantial increase in publication rate (1.9 to 9.5/year). Original research comprised 81.3% of papers. Interdisciplinary authorship was common, yet only 12.5% of papers listed a nursing home as an author affiliation—primarily from public or voluntary sectors. Less than 40% of papers acknowledged staff or resident contributions. While COVID-19-focused publications increased markedly post-2020, broader topics in nursing home care remained underrepresented. Conclusion Despite increased research activity during the pandemic, engagement with nursing home research in Ireland remains limited, especially from the private sector. The lack of consistent stakeholder involvement and sustained research investment signals a need for a national strategy. Key priorities include implementing the interRAI tool, improving professional engagement, and enhancing research funding to ensure evidence-based policy and care for nursing home residents.
{"title":"From Silence to Surge: Nursing Home Research in Ireland Before and After the Pandemic","authors":"Patrick Doyle, Sinéad McHugh, Desmond O'Neill","doi":"10.1093/ageing/afaf318.026","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.026","url":null,"abstract":"Background Nursing home residents in Ireland experienced a disproportionate burden of illness and death during the COVID-19 pandemic, highlighting longstanding systemic deficiencies in governance, staffing, and research engagement. Prior to the pandemic, this vulnerable population, characterised by high levels of multimorbidity and disability, received limited research attention. A subgroup from the National Clinical Programme for Older People recommended the development of a research agenda in nursing homes, including resident involvement. This study aimed to characterise the extent and nature of Irish nursing home research from 1966 to 2024. Methods A bibliometric review was conducted using PubMed to identify publications related to Irish nursing homes from January 1966 to March 2020 (pre-pandemic) and April 2020 to July 2024 (post-pandemic). Data extracted included publication type, number of authors, institutional affiliations, countries of origin, disciplines involved, and acknowledgement of nursing home staff or residents. Descriptive analysis was performed using Excel and SPSS. Results A total of 144 publications were identified. Most papers (n=106; 73.6%) were published pre-pandemic, while 38 (26.4%) appeared in the shorter post-pandemic period, showing a substantial increase in publication rate (1.9 to 9.5/year). Original research comprised 81.3% of papers. Interdisciplinary authorship was common, yet only 12.5% of papers listed a nursing home as an author affiliation—primarily from public or voluntary sectors. Less than 40% of papers acknowledged staff or resident contributions. While COVID-19-focused publications increased markedly post-2020, broader topics in nursing home care remained underrepresented. Conclusion Despite increased research activity during the pandemic, engagement with nursing home research in Ireland remains limited, especially from the private sector. The lack of consistent stakeholder involvement and sustained research investment signals a need for a national strategy. Key priorities include implementing the interRAI tool, improving professional engagement, and enhancing research funding to ensure evidence-based policy and care for nursing home residents.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"156 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673696","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/afaf318.153
Antoinette Larkin, Joan Naughton, Aoife Treston, Jarlath Keady, Niamh Hannon, Christine Mc Carthy
Background Complex polypharmacy management is common in the care of frail older adults. Research has demonstrated that multidisciplinary management of complex can be effective at reducing potentially inappropriate prescribing. We sought to review our own practice in an Integrated Care Program for Older Persons setting, where multidisciplinary management of polypharmacy is commonplace. Methods As part of our new patient assessments, patient’s medications and their management are discussed at a multidisciplinary meeting, where feedback on improved adherence and potential changes are made. We reviewed the notes of new patient’s in the previous year in relation to the medications prescribed, in addition to changes made. Continuous data was described by way of means/standard deviations, and categorical data was described by way of numbers/proportions. Results The notes of 61 patients who completed a comprehensive geriatric assessment were reviewed. The mean age was 84.5 (SD=6.1), mean clinical frails scale was 5 (SD=1.2), and 52.5% (n=32) were women. The mean number of medications at initial assessment was 10.3 (SD=4.3), with 80.3% (n=49) needing support taking medications, and 57.4% (n=35) having their medications blister packed. At least one potentially inappropriate medication was identified in 31.1% (n=19) patients, with 44.3% (n=27) having at least one medication de-prescribed and 41% (n=25) having at least one new medication started. De-prescribed medications included nutritional supplements (n=6), beta-blockers (n=5) and proton pump inhibitors (n=3), with medications started including vitamin D/calcium (n=9) and paracetamol (n=3). Conclusion Multidisciplinary management of complex polypharmacy in frail older adults may be effective, with further research required.
{"title":"Multidisciplinary Management of Complex Polypharmacy in an Integrated Care Program for Older Persons","authors":"Antoinette Larkin, Joan Naughton, Aoife Treston, Jarlath Keady, Niamh Hannon, Christine Mc Carthy","doi":"10.1093/ageing/afaf318.153","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.153","url":null,"abstract":"Background Complex polypharmacy management is common in the care of frail older adults. Research has demonstrated that multidisciplinary management of complex can be effective at reducing potentially inappropriate prescribing. We sought to review our own practice in an Integrated Care Program for Older Persons setting, where multidisciplinary management of polypharmacy is commonplace. Methods As part of our new patient assessments, patient’s medications and their management are discussed at a multidisciplinary meeting, where feedback on improved adherence and potential changes are made. We reviewed the notes of new patient’s in the previous year in relation to the medications prescribed, in addition to changes made. Continuous data was described by way of means/standard deviations, and categorical data was described by way of numbers/proportions. Results The notes of 61 patients who completed a comprehensive geriatric assessment were reviewed. The mean age was 84.5 (SD=6.1), mean clinical frails scale was 5 (SD=1.2), and 52.5% (n=32) were women. The mean number of medications at initial assessment was 10.3 (SD=4.3), with 80.3% (n=49) needing support taking medications, and 57.4% (n=35) having their medications blister packed. At least one potentially inappropriate medication was identified in 31.1% (n=19) patients, with 44.3% (n=27) having at least one medication de-prescribed and 41% (n=25) having at least one new medication started. De-prescribed medications included nutritional supplements (n=6), beta-blockers (n=5) and proton pump inhibitors (n=3), with medications started including vitamin D/calcium (n=9) and paracetamol (n=3). Conclusion Multidisciplinary management of complex polypharmacy in frail older adults may be effective, with further research required.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673754","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/afaf318.160
Edith Okoye, Nisha Thomas, Keneilwe Malomo
Background Continence status is a critical yet often underrecognized factor in the care of older adults. Incontinence, both bladder and bowel, has been associated with increased frailty, more extended hospital stays, and a higher incidence of complications such as delirium. In this retrospective observational study, we aimed to explore the relationship between continence status and key outcomes, including length of stay, delirium, and living arrangements among older hospitalised adults. Methods Thirty patients admitted to a rehabilitation ward were evaluated for their continence status on admission and at discharge. Data on age, gender, living situation, delirium incidence, and hospital length of stay were collected. Kruskal-Wallis tests were used to assess differences in length of stay across continence categories, and chi-square tests were employed to evaluate associations with delirium. All analyses were conducted using R software. Results The average age (SD) was 83.3 (6.6) years, with a median (IQR) hospital length of stay of 56 (37.5) days. Bowel continence improved from 15 to 20 patients by discharge, while bladder continence improved slightly (12 to 13), though occasional incontinence increased. Patients who were fully continent had the shortest median hospital stays (48.5 days), while those with dual incontinence had the longest median (72.5 days). Delirium occurred exclusively in patients with both bowel and bladder incontinence (p = 0.0163). Additionally, continent patients were more likely to live alone versus those doubly incontinent (54.5% vs 38.5%), suggesting greater independence. Conclusion In this small cohort, incontinence was strongly associated with increased hospital length of stay and the occurrence of delirium. These findings highlight the importance of continence as a marker of vulnerability in older adults and support early continence assessment and intervention as part of comprehensive geriatric care. Larger studies are warranted to validate these trends and inform best practices in hospital-based continence management.
{"title":"Continence Status as a Marker of Vulnerability in Hospitalised Older Adults in a Post-Acute Rehabilitation Unit","authors":"Edith Okoye, Nisha Thomas, Keneilwe Malomo","doi":"10.1093/ageing/afaf318.160","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.160","url":null,"abstract":"Background Continence status is a critical yet often underrecognized factor in the care of older adults. Incontinence, both bladder and bowel, has been associated with increased frailty, more extended hospital stays, and a higher incidence of complications such as delirium. In this retrospective observational study, we aimed to explore the relationship between continence status and key outcomes, including length of stay, delirium, and living arrangements among older hospitalised adults. Methods Thirty patients admitted to a rehabilitation ward were evaluated for their continence status on admission and at discharge. Data on age, gender, living situation, delirium incidence, and hospital length of stay were collected. Kruskal-Wallis tests were used to assess differences in length of stay across continence categories, and chi-square tests were employed to evaluate associations with delirium. All analyses were conducted using R software. Results The average age (SD) was 83.3 (6.6) years, with a median (IQR) hospital length of stay of 56 (37.5) days. Bowel continence improved from 15 to 20 patients by discharge, while bladder continence improved slightly (12 to 13), though occasional incontinence increased. Patients who were fully continent had the shortest median hospital stays (48.5 days), while those with dual incontinence had the longest median (72.5 days). Delirium occurred exclusively in patients with both bowel and bladder incontinence (p = 0.0163). Additionally, continent patients were more likely to live alone versus those doubly incontinent (54.5% vs 38.5%), suggesting greater independence. Conclusion In this small cohort, incontinence was strongly associated with increased hospital length of stay and the occurrence of delirium. These findings highlight the importance of continence as a marker of vulnerability in older adults and support early continence assessment and intervention as part of comprehensive geriatric care. Larger studies are warranted to validate these trends and inform best practices in hospital-based continence management.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"129 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674125","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/afaf318.015
Iracema Leroi, Suzanne Timmons, Aoife O'Brien, Jayne Conlon, Irina Kinchin, Loredana Frau, Anusha Yasoda-Mohan, Patrick Chirilele, Sue Thomas
Background It is estimated that fewer than 5% of people with LBD (Lewy body dementia) in Ireland receive a formal diagnosis and many are misdiagnosed or have delayed diagnosis, leading to poorer outcomes. This study aimed to develop a nationally agreed integrated care pathway (ICP), co-produced with service users and fully integrated into existing/developing pathways and services. This would map patient care from initial presentation to end of life, to enhance healthcare quality, coordination, efficiency and patient satisfaction. Methods Guided by an ICP expert, a multi-stakeholder team (including service users and families), we co-produced the ICP, linked to ongoing policy and service development through Ireland’s National Dementia Service, and incorporating the DIAMOND Lewy diagnostic-management framework, adapted for Ireland. Consensus and expert opinion was gained through iterative steps, including: (1) Preliminary pathway development - to identify key care to be delivered and map care flows and activity; (2) Systematic problem identification - to understand people with LBD’s priority care elements, and most concerning problem areas; and (3) Pathway refinement - to obtain expert panel input using a modified Delphi iterative review process. Results The developed ICP is aligned with Ireland’s developing network of memory, movement disorder, and related health services and designed to reduce unwarranted variation and improve the quality of service/support for people with LBD and their families. It enables health care services to scope service provision gaps, making explicit, at a system level, the services required to effectively manage LBD. Conclusion The ICP will be the basis to improve diagnosis and care for people with LBD in Ireland. Next steps involve structured implementation, and evaluation, across health services in Ireland.
{"title":"Developing An Integrated Care Pathway (ICP) For Lewy Body Dementia In Ireland","authors":"Iracema Leroi, Suzanne Timmons, Aoife O'Brien, Jayne Conlon, Irina Kinchin, Loredana Frau, Anusha Yasoda-Mohan, Patrick Chirilele, Sue Thomas","doi":"10.1093/ageing/afaf318.015","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.015","url":null,"abstract":"Background It is estimated that fewer than 5% of people with LBD (Lewy body dementia) in Ireland receive a formal diagnosis and many are misdiagnosed or have delayed diagnosis, leading to poorer outcomes. This study aimed to develop a nationally agreed integrated care pathway (ICP), co-produced with service users and fully integrated into existing/developing pathways and services. This would map patient care from initial presentation to end of life, to enhance healthcare quality, coordination, efficiency and patient satisfaction. Methods Guided by an ICP expert, a multi-stakeholder team (including service users and families), we co-produced the ICP, linked to ongoing policy and service development through Ireland’s National Dementia Service, and incorporating the DIAMOND Lewy diagnostic-management framework, adapted for Ireland. Consensus and expert opinion was gained through iterative steps, including: (1) Preliminary pathway development - to identify key care to be delivered and map care flows and activity; (2) Systematic problem identification - to understand people with LBD’s priority care elements, and most concerning problem areas; and (3) Pathway refinement - to obtain expert panel input using a modified Delphi iterative review process. Results The developed ICP is aligned with Ireland’s developing network of memory, movement disorder, and related health services and designed to reduce unwarranted variation and improve the quality of service/support for people with LBD and their families. It enables health care services to scope service provision gaps, making explicit, at a system level, the services required to effectively manage LBD. Conclusion The ICP will be the basis to improve diagnosis and care for people with LBD in Ireland. Next steps involve structured implementation, and evaluation, across health services in Ireland.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"4 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674127","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 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}
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