Background Alcohol-related health issues in older adults represent a significant yet often under recognised burden on healthcare services. This study explores the impact of alcohol-related hospital admissions in adults aged 75 and older, focusing on resource utilisation, clinical outcomes, and discharge destinations across 34 acute hospitals in the Republic of Ireland over a five-year period. Methods This was a retrospective, observational study. Using the National NQAIS Clinical data tool, data were collected on adults aged 75 and above with a primary discharge diagnosis relating to alcohol-related morbidity, discharged between December 2019 and December 2024, with N=716 patient discharges identified. Key metrics included length of stay (LOS), mortality, ICU utilisation, allied health involvement, readmission rates, and discharge destinations. Results Of the 716 patient episodes examined, mean length of stay was 15.9 days, with an in-hospital bed day usage of 11,396. An in-hospital mortality rate of 5.4% was recorded among these patients. Similarly, 3.4% required ICU admission, accounting for 110 ICU bed days. A 30-day readmission rate of 16.2% was recorded in the 716 patient episodes, with 4.6% readmitting within 7 days. 17.0% of patients were discharged to nursing homes. Patients discharged to nursing homes had significantly longer LOS (37.7 vs. 11.5 days) and higher comorbidity scores. Conclusion Alcohol-related admissions in older patients impose a substantial burden on acute hospital resources, with prolonged hospital stays, high allied health needs, and significant rates of nursing home discharge. This study reflects that alcohol excess is a significant issue in the older population, as this study only delves into admission wherein alcohol was primary issue on admission. Consideration for alcohol-specific service provision (which have proven beneficial in other cohorts) on the Geriatric ward could have a positive impact on patient outcomes.
{"title":"Ageing and Alcohol: Outcomes and Opportunities for Improved Care in Older Populations","authors":"Alison-Rose Pentony, Eoin Treacy, Shahzad Bakhshi, Catherine McGorrian, Cora McGreevy","doi":"10.1093/ageing/afaf318.139","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.139","url":null,"abstract":"Background Alcohol-related health issues in older adults represent a significant yet often under recognised burden on healthcare services. This study explores the impact of alcohol-related hospital admissions in adults aged 75 and older, focusing on resource utilisation, clinical outcomes, and discharge destinations across 34 acute hospitals in the Republic of Ireland over a five-year period. Methods This was a retrospective, observational study. Using the National NQAIS Clinical data tool, data were collected on adults aged 75 and above with a primary discharge diagnosis relating to alcohol-related morbidity, discharged between December 2019 and December 2024, with N=716 patient discharges identified. Key metrics included length of stay (LOS), mortality, ICU utilisation, allied health involvement, readmission rates, and discharge destinations. Results Of the 716 patient episodes examined, mean length of stay was 15.9 days, with an in-hospital bed day usage of 11,396. An in-hospital mortality rate of 5.4% was recorded among these patients. Similarly, 3.4% required ICU admission, accounting for 110 ICU bed days. A 30-day readmission rate of 16.2% was recorded in the 716 patient episodes, with 4.6% readmitting within 7 days. 17.0% of patients were discharged to nursing homes. Patients discharged to nursing homes had significantly longer LOS (37.7 vs. 11.5 days) and higher comorbidity scores. Conclusion Alcohol-related admissions in older patients impose a substantial burden on acute hospital resources, with prolonged hospital stays, high allied health needs, and significant rates of nursing home discharge. This study reflects that alcohol excess is a significant issue in the older population, as this study only delves into admission wherein alcohol was primary issue on admission. Consideration for alcohol-specific service provision (which have proven beneficial in other cohorts) on the Geriatric ward could have a positive impact on patient outcomes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"16 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160358","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/afaf318.090
Sive Carey, Michael Mitchell, Aine Meehan, Edel O'Grady, Colm Byrne, Róisín Purcell, Elizabeth Callaly
Background People living with moderate to severe frailty should receive timely, holistic and personalised care and support in the community. However, there are a lack of services providing timely rehabilitation at home for older adults. This gap contributes to prolonged hospital stays, delayed discharges, adverse outcomes and increased costs. A recent cohort study showed Early Supported Discharge (ESD) can have significant effects on patient outcomes for older adults admitted to hospital. There is evidence it reduces hospital length of stay (LOS) and costs post stroke. The aim is to identify the feasibility and benefits of a care of the older person (COTOP) ESD service in our setting. Methods A joint prospective review was carried out by the Frailty Intervention Team (FIT) and COTOP occupational therapists over 2 months (September - October 2024) to identify patients suitable for COTOP ESD. Results 20 patients were identified as suitable for discharge with COTOP ESD. Average age was 84 with most living with moderate frailty (60% CFS 5-6). 60% presented post fall. All had ongoing physiotherapy and occupational therapy needs. 8 patients transferred to off-site rehabilitation (direct from Emergency Dept), totaling 211 rehab days (cost €91,966 over 2 months, €551,976 annually) 5 inpatients experienced discharge delays after being deemed medically fit, totaling 216 acute bed days (cost €273,888 over 2 months, €1,643,328 annually). The COTOP ESD would be staffed by a multi-disciplinary team including a senior physiotherapist, occupational therapist and medical social worker, nursing staff, part time geriatrician, rehab assistant and health care assistants. Estimated annual running costs of €761,045. Conclusion COTOP ESD addresses a clear need for frail older adults, providing timely, community-based rehabilitation while adopting an integrated care approach. It would reduce LOS, improve patient outcomes and generate substantial cost savings while supporting patient flow and admission avoidance. Following on from this, a pilot service would be beneficial.
{"title":"Early Supported Discharge for Care of the Older Person: A Proposal","authors":"Sive Carey, Michael Mitchell, Aine Meehan, Edel O'Grady, Colm Byrne, Róisín Purcell, Elizabeth Callaly","doi":"10.1093/ageing/afaf318.090","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.090","url":null,"abstract":"Background People living with moderate to severe frailty should receive timely, holistic and personalised care and support in the community. However, there are a lack of services providing timely rehabilitation at home for older adults. This gap contributes to prolonged hospital stays, delayed discharges, adverse outcomes and increased costs. A recent cohort study showed Early Supported Discharge (ESD) can have significant effects on patient outcomes for older adults admitted to hospital. There is evidence it reduces hospital length of stay (LOS) and costs post stroke. The aim is to identify the feasibility and benefits of a care of the older person (COTOP) ESD service in our setting. Methods A joint prospective review was carried out by the Frailty Intervention Team (FIT) and COTOP occupational therapists over 2 months (September - October 2024) to identify patients suitable for COTOP ESD. Results 20 patients were identified as suitable for discharge with COTOP ESD. Average age was 84 with most living with moderate frailty (60% CFS 5-6). 60% presented post fall. All had ongoing physiotherapy and occupational therapy needs. 8 patients transferred to off-site rehabilitation (direct from Emergency Dept), totaling 211 rehab days (cost €91,966 over 2 months, €551,976 annually) 5 inpatients experienced discharge delays after being deemed medically fit, totaling 216 acute bed days (cost €273,888 over 2 months, €1,643,328 annually). The COTOP ESD would be staffed by a multi-disciplinary team including a senior physiotherapist, occupational therapist and medical social worker, nursing staff, part time geriatrician, rehab assistant and health care assistants. Estimated annual running costs of €761,045. Conclusion COTOP ESD addresses a clear need for frail older adults, providing timely, community-based rehabilitation while adopting an integrated care approach. It would reduce LOS, improve patient outcomes and generate substantial cost savings while supporting patient flow and admission avoidance. Following on from this, a pilot service would be beneficial.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"242 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160359","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/afaf318.043
Hadeel AS Abdalla, Sara Mirghni, Nur Atikah Mohd Asri, Luke Helier Walsh, Cameron Forword, Mark Rogan
Background Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of osteoporosis, with vertebral compression fractures contributing to reduced pulmonary function. While the association between inhaled corticosteroids and osteoporosis remains inconclusive, NICE guidelines advocate for osteoporosis prevention in patients frequently prescribed oral corticosteroids. This audit aimed to assess osteoporosis risk in COPD patients using the FRAX tool and evaluate treatment rates in those identified as high risk. Methods A cross-sectional audit conducted in March 2025 included COPD patients aged >60 years admitted to an Irish university hospital. Osteoporosis risk was assessed using the FRAX tool, with stratification based on National Osteoporosis Guideline Group (NOGG) recommendations. Statistical analysis was performed using DATAtab, with ANOVA applied for significance testing. Results Fifty-two patients were included (65% male; median age 79.5 ± 8.19 years). Only 10% were on regular oral corticosteroids, yet 92% had ≥1 steroid-requiring exacerbation in the past year (mean 2.1 ± 1.68; max 8). Higher exacerbation frequency correlated with increased fracture risk (p<0.001). The mean 10-year probability of major osteoporotic and hip fractures was 14.9% ± 10.04 and 8.89% ± 8.25, respectively. Based on NOGG, 20% were deemed at high risk of fracture and 30% warranted osteoporosis treatment; yet only 44% of these were on treatment. Of those for whom bone density assessment was recommended, only 15% underwent testing. Conclusion The audit highlights suboptimal adherence to osteoporosis screening and treatment guidelines in COPD patients. Enhanced implementation of FRAX-based risk assessment and targeted intervention could reduce fracture risk and improve outcomes in this vulnerable cohort.
{"title":"FRAXing the Gap: Revealing Missed Osteoporosis Treatment in COPD Admissions","authors":"Hadeel AS Abdalla, Sara Mirghni, Nur Atikah Mohd Asri, Luke Helier Walsh, Cameron Forword, Mark Rogan","doi":"10.1093/ageing/afaf318.043","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.043","url":null,"abstract":"Background Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of osteoporosis, with vertebral compression fractures contributing to reduced pulmonary function. While the association between inhaled corticosteroids and osteoporosis remains inconclusive, NICE guidelines advocate for osteoporosis prevention in patients frequently prescribed oral corticosteroids. This audit aimed to assess osteoporosis risk in COPD patients using the FRAX tool and evaluate treatment rates in those identified as high risk. Methods A cross-sectional audit conducted in March 2025 included COPD patients aged &gt;60 years admitted to an Irish university hospital. Osteoporosis risk was assessed using the FRAX tool, with stratification based on National Osteoporosis Guideline Group (NOGG) recommendations. Statistical analysis was performed using DATAtab, with ANOVA applied for significance testing. Results Fifty-two patients were included (65% male; median age 79.5 ± 8.19 years). Only 10% were on regular oral corticosteroids, yet 92% had ≥1 steroid-requiring exacerbation in the past year (mean 2.1 ± 1.68; max 8). Higher exacerbation frequency correlated with increased fracture risk (p&lt;0.001). The mean 10-year probability of major osteoporotic and hip fractures was 14.9% ± 10.04 and 8.89% ± 8.25, respectively. Based on NOGG, 20% were deemed at high risk of fracture and 30% warranted osteoporosis treatment; yet only 44% of these were on treatment. Of those for whom bone density assessment was recommended, only 15% underwent testing. Conclusion The audit highlights suboptimal adherence to osteoporosis screening and treatment guidelines in COPD patients. Enhanced implementation of FRAX-based risk assessment and targeted intervention could reduce fracture risk and improve outcomes in this vulnerable cohort.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"98 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160360","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/afaf318.086
Rory Plant, Linda Brewer
Background Effective pain assessment and management are important in preventing functional decline and increased length of stay post hip fracture. We conducted an audit in a University Teaching Hospital to examine our interdisciplinary approach to pain assessment. Methods Over three months we sampled patients with hip fracture, over 65y on an orthopaedic ward. The tool used was modified from the ‘Pain Audit Tools’ from City of Hope and Pain Palliative Resource Centre, previously piloted and used in audit. We examined 1) documentation of pain assessments by medical, nursing and physiotherapy staff 2) medications prescribed for pain 3) pain score during an ad hoc patient interview 4) if paracetamol dose was appropriately weight-adjusted. Results We included 20 patients, mean age 78.5y. 14/20 (70%) were female. Average post-operative days to assessment was 13.3 days. Only 2/20 (10%) were assessed pre-operatively, before physio input. Pain assessment: Medical Staff documented a pain assessment in 18/20 (90%), with 12/20 (60%) using an objective rating. Nursing staff documented a pain assessment in all 20 cases; all used an objective rating. Physiotherapists documented a pain assessment in 10/18 (60%) of their first assessments with patients, 40% (4/10) used objective ratings. 6/20 (30%) of patients reported a pain score >6/10 during ad hoc interview. Pain assessments decreased as length of stay increased. Medications Prescribed: Paracetamol 95% (19/20); OxyContin 40% (8/20); OxyNorm PRN; 60% (12/20). 9/20 (45%) patients received >2 PRN doses within 72h of assessment. 14/20 (70%) patients had weight documented, all of whom were on appropriately dosed paracetamol. Conclusion Documentation of pain assessments decreases throughout admission. Nurses are most likely, and physiotherapists least likely, to document pain assessments. Of those patients with documented weight, all were on weight-adjusted paracetamol dose. We recommend better use of objective pain assessments and improved weight documentation for important medication dose-adjustments.
背景有效的疼痛评估和管理对于预防髋部骨折后的功能下降和住院时间的增加是重要的。我们在一所大学教学医院进行了一次审计，以检验我们在疼痛评估方面的跨学科方法。方法对在骨科病房就诊的65岁以上髋部骨折患者进行为期3个月的抽样调查。所使用的工具是根据City of Hope and Pain Palliative Resource Centre的“疼痛审计工具”修改而来的，该工具之前在审计中进行了试点和使用。我们检查了1)医疗、护理和物理治疗人员的疼痛评估文件；2)处方的疼痛药物；3)临时患者访谈时的疼痛评分；4)扑热息痛剂量是否适当调整体重。结果入选患者20例，平均年龄78.5岁。14/20（70%）为女性。术后至评估的平均时间为13.3天。只有2/20（10%）在术前进行评估。疼痛评估：医务人员在18/20（90%）记录了疼痛评估，12/20（60%）使用客观评分。护理人员记录了所有20例患者的疼痛评估；都使用了客观评级。物理治疗师在10/18（60%）的患者首次评估中记录了疼痛评估，40%（4/10）使用客观评分。6/20（30%）的患者报告了疼痛评分。6/10在特别面试期间。疼痛评估随着住院时间的增加而降低。处方药物：扑热息痛95% (19/20)；奥施康定40% (8/20)；OxyNorm打印;60%(12/20)。9/20（45%）患者接受了&；gt；评估后72小时内服用2剂PRN。14/20（70%）的患者有体重记录，所有患者都服用了适当剂量的扑热息痛。结论住院期间疼痛评估的文献记录减少。护士最有可能记录疼痛评估，而物理治疗师最不可能。在记录体重的患者中，所有患者都服用了调整体重的扑热息痛剂量。我们建议在重要的药物剂量调整时更好地使用客观疼痛评估和改进的体重记录。
{"title":"VLSHPB","authors":"Rory Plant, Linda Brewer","doi":"10.1093/ageing/afaf318.086","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.086","url":null,"abstract":"Background Effective pain assessment and management are important in preventing functional decline and increased length of stay post hip fracture. We conducted an audit in a University Teaching Hospital to examine our interdisciplinary approach to pain assessment. Methods Over three months we sampled patients with hip fracture, over 65y on an orthopaedic ward. The tool used was modified from the ‘Pain Audit Tools’ from City of Hope and Pain Palliative Resource Centre, previously piloted and used in audit. We examined 1) documentation of pain assessments by medical, nursing and physiotherapy staff 2) medications prescribed for pain 3) pain score during an ad hoc patient interview 4) if paracetamol dose was appropriately weight-adjusted. Results We included 20 patients, mean age 78.5y. 14/20 (70%) were female. Average post-operative days to assessment was 13.3 days. Only 2/20 (10%) were assessed pre-operatively, before physio input. Pain assessment: Medical Staff documented a pain assessment in 18/20 (90%), with 12/20 (60%) using an objective rating. Nursing staff documented a pain assessment in all 20 cases; all used an objective rating. Physiotherapists documented a pain assessment in 10/18 (60%) of their first assessments with patients, 40% (4/10) used objective ratings. 6/20 (30%) of patients reported a pain score &gt;6/10 during ad hoc interview. Pain assessments decreased as length of stay increased. Medications Prescribed: Paracetamol 95% (19/20); OxyContin 40% (8/20); OxyNorm PRN; 60% (12/20). 9/20 (45%) patients received &gt;2 PRN doses within 72h of assessment. 14/20 (70%) patients had weight documented, all of whom were on appropriately dosed paracetamol. Conclusion Documentation of pain assessments decreases throughout admission. Nurses are most likely, and physiotherapists least likely, to document pain assessments. Of those patients with documented weight, all were on weight-adjusted paracetamol dose. We recommend better use of objective pain assessments and improved weight documentation for important medication dose-adjustments.","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":"146160547","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/afaf318.183
Aneesa Mangalam Lonappan, David Delaney, Cathal Macdonnacha, Margaret O' Connor, Lauren Fernandes
Background Post-anaesthesia care units (PACUs) are critical for stabilising patients following surgery. Delays in transferring patients from PACU to ward or critical care settings can lead to bottlenecks in patient flow. Older individuals may be particularly vulnerable to such delays due to increased clinical complexity, slower physiological recovery, and higher rates of comorbidity. Methods A retrospective observational audit was conducted over a three-month period from October to December 2024. Data from 294 post-operative patients were analysed, including time of PACU admission and discharge and patient age. Descriptive statistics were used to calculate average, median, and range of PACU length of stay (LOS), with subgroup analysis comparing outcomes between older and younger patients. Results The average PACU LOS was 49 minutes, with a median of 20 minutes. The shortest stay was 5 minutes, and the longest was 7 hours. While most patients were discharged within an hour, 19% experienced prolonged stays. Patients aged over 65 years accounted for 32% of the sample, and 43% of them experienced PACU stays exceeding one hour, compared to only 12% of younger patients. Extended LOS in older individuals was often associated with delayed ward availability, prolonged monitoring, and challenges in meeting discharge criteria. These delays may contribute to postoperative complications such as delirium, hypothermia, and reduced mobilisation. Conclusion Older patients are disproportionately affected by PACU delays, which can impact recovery quality and increase hospital resource strain. Enhanced discharge protocols, improved inpatient bed coordination, and age-specific recovery pathways may help reduce LOS and improve outcomes. Further study is warranted to evaluate targeted interventions for this high-risk group. References 1. Kehlet, H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17. 2. Wong, DJN, Harris, SK, Moonesinghe, SR. Measuring outcomes in perioperative care: quality and impact of recovery. Anaesthesia. 2019;74:40–51.
{"title":"Impact Of Post-Anaesthesia Care Unit Delays On Older Post-Surgical Patients","authors":"Aneesa Mangalam Lonappan, David Delaney, Cathal Macdonnacha, Margaret O' Connor, Lauren Fernandes","doi":"10.1093/ageing/afaf318.183","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.183","url":null,"abstract":"Background Post-anaesthesia care units (PACUs) are critical for stabilising patients following surgery. Delays in transferring patients from PACU to ward or critical care settings can lead to bottlenecks in patient flow. Older individuals may be particularly vulnerable to such delays due to increased clinical complexity, slower physiological recovery, and higher rates of comorbidity. Methods A retrospective observational audit was conducted over a three-month period from October to December 2024. Data from 294 post-operative patients were analysed, including time of PACU admission and discharge and patient age. Descriptive statistics were used to calculate average, median, and range of PACU length of stay (LOS), with subgroup analysis comparing outcomes between older and younger patients. Results The average PACU LOS was 49 minutes, with a median of 20 minutes. The shortest stay was 5 minutes, and the longest was 7 hours. While most patients were discharged within an hour, 19% experienced prolonged stays. Patients aged over 65 years accounted for 32% of the sample, and 43% of them experienced PACU stays exceeding one hour, compared to only 12% of younger patients. Extended LOS in older individuals was often associated with delayed ward availability, prolonged monitoring, and challenges in meeting discharge criteria. These delays may contribute to postoperative complications such as delirium, hypothermia, and reduced mobilisation. Conclusion Older patients are disproportionately affected by PACU delays, which can impact recovery quality and increase hospital resource strain. Enhanced discharge protocols, improved inpatient bed coordination, and age-specific recovery pathways may help reduce LOS and improve outcomes. Further study is warranted to evaluate targeted interventions for this high-risk group. References 1. Kehlet, H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17. 2. Wong, DJN, Harris, SK, Moonesinghe, SR. Measuring outcomes in perioperative care: quality and impact of recovery. Anaesthesia. 2019;74:40–51.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160116","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/afaf318.156
Deirdre McCartan, Nur Sakinah Binti Zulkifli, Pardeep Kumar, Ali Abubakr, James Romaniuk, John McManus
Background The aim of the UHL DNACPR policy is to provide a decision-making framework to facilitate the timely discussion of CPR and DNACPR orders regarding patients of the UL Hospitals Group and to ensure that decisions relating to CPR and DNACPR orders are made consistently, transparently and in line with best national and international practice. This audit aimed to assess the current use of the UHL DNACPR form in clinical practice against the official UHL DNACPR policy. Methods The healthcare records of all medically admitted patients were reviewed using a point prevalence approach across 14 wards and the Emergency Department in UHL on 11/4/25. Pre-specified data points were collected from each healthcare record including assessment of patient capacity, documentation of discussions related to decision making and the signatures of those involved in those discussions. No personal data was collected. Results 75/247 (23.1%) of the 324 patients medically admitted to UHL on 11/4/25 had a DNACPR form in their medical charts. 3 of these were from previous admissions. Of the 72 patients with current DNACPR forms 31% were female. 62/72 (86%) DNACPR forms were signed by an NCHD. 26/72 (36%) were signed by a consultant. 8/72 (11%) were signed by a nurse. 46/72 (63.8%) were signed only by an NCHD. 11 DNACPR forms that were signed only by an NCHD had no documented discussion with the patient or their family member. Conclusion NCHDs assume a significant level of professional risk as the sole-signatories of DNACPR forms, particularly when forms are signed without documentation of discussion with patients and/or family members. Training for NCHDs, nurses and consultants on the appropriate use of the UHL DNACPR form should ensure that patient-centred decision making is a) undertaken and b) appropriately documented by all relevant staff (NCHD, consultant and nursing), for all DNACPR discussions and decisions in UHL.
{"title":"The UHL DNACPR Process in Practice: An Audit of Documentation, Communication and Signatory Compliance","authors":"Deirdre McCartan, Nur Sakinah Binti Zulkifli, Pardeep Kumar, Ali Abubakr, James Romaniuk, John McManus","doi":"10.1093/ageing/afaf318.156","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.156","url":null,"abstract":"Background The aim of the UHL DNACPR policy is to provide a decision-making framework to facilitate the timely discussion of CPR and DNACPR orders regarding patients of the UL Hospitals Group and to ensure that decisions relating to CPR and DNACPR orders are made consistently, transparently and in line with best national and international practice. This audit aimed to assess the current use of the UHL DNACPR form in clinical practice against the official UHL DNACPR policy. Methods The healthcare records of all medically admitted patients were reviewed using a point prevalence approach across 14 wards and the Emergency Department in UHL on 11/4/25. Pre-specified data points were collected from each healthcare record including assessment of patient capacity, documentation of discussions related to decision making and the signatures of those involved in those discussions. No personal data was collected. Results 75/247 (23.1%) of the 324 patients medically admitted to UHL on 11/4/25 had a DNACPR form in their medical charts. 3 of these were from previous admissions. Of the 72 patients with current DNACPR forms 31% were female. 62/72 (86%) DNACPR forms were signed by an NCHD. 26/72 (36%) were signed by a consultant. 8/72 (11%) were signed by a nurse. 46/72 (63.8%) were signed only by an NCHD. 11 DNACPR forms that were signed only by an NCHD had no documented discussion with the patient or their family member. Conclusion NCHDs assume a significant level of professional risk as the sole-signatories of DNACPR forms, particularly when forms are signed without documentation of discussion with patients and/or family members. Training for NCHDs, nurses and consultants on the appropriate use of the UHL DNACPR form should ensure that patient-centred decision making is a) undertaken and b) appropriately documented by all relevant staff (NCHD, consultant and nursing), for all DNACPR discussions and decisions in UHL.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"28 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160214","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/afaf318.130
Michelle Mc Morrow, Ciara Moran, Aoife Kelly
Background The Advanced Nurse Practitioner (ANP) Frailty Clinic Audit Project was developed in response to the increasing recognition of frailty as a critical healthcare issue in our ageing population. The project aimed to evaluate the effectiveness of the newly established outreach ANP-Led Frailty Clinic in delivering timely and comprehensive care to older adults, improving patient outcomes and optimising healthcare resource utilisation. Frailty is a multidimensional syndrome that increases an individual's vulnerability to adverse health outcomes such as falls, hospitalisation, functional decline and mortality. There was a growing demand for specialised services to identify and manage frailty early, preventing unnecessary hospital admissions and promoting independence among older adults with direct referrals form General Practitioners. The audit sought to determine whether early interventions in the clinic led to improved patient outcomes reduced hospital admission and enhance quality of life. Understanding the clinics performance ensured future service development based in real-world data. Methods Prospective clinical audit was conducted (September 2023-December 2024 inclusive) Inclusion Criteria: Patients >65 years referred to the ANP Frailty Clinic by Geriatrician or General Practitioner Results A total of 95 patients were included in the audit. Ten primary referral issues were identified with cognitive impairment and polypharmacy emerging as the most frequent concerns. Following initial assessment at the clinic, 30 patients (31.5%) re presented to the Emergency Department. The reasons for readmission varied and included falls resulting in fracture, respiratory illness and in some cases death. These outcomes highlight the high vulnerability of the older population and underscore the importance of early intervention strategies. Conclusion The results suggest that while the clinic plays a critical role in early assessment and intervention, there is a need to further strengthen follow up care enhance integration with community services and implement proactive management plans to help reduce avoidable hospital admissions and improve long term patient outcomes.
{"title":"An Audit of a newly established Advanced Nurse Practitioner Led Frailty Outreach Clinic","authors":"Michelle Mc Morrow, Ciara Moran, Aoife Kelly","doi":"10.1093/ageing/afaf318.130","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.130","url":null,"abstract":"Background The Advanced Nurse Practitioner (ANP) Frailty Clinic Audit Project was developed in response to the increasing recognition of frailty as a critical healthcare issue in our ageing population. The project aimed to evaluate the effectiveness of the newly established outreach ANP-Led Frailty Clinic in delivering timely and comprehensive care to older adults, improving patient outcomes and optimising healthcare resource utilisation. Frailty is a multidimensional syndrome that increases an individual's vulnerability to adverse health outcomes such as falls, hospitalisation, functional decline and mortality. There was a growing demand for specialised services to identify and manage frailty early, preventing unnecessary hospital admissions and promoting independence among older adults with direct referrals form General Practitioners. The audit sought to determine whether early interventions in the clinic led to improved patient outcomes reduced hospital admission and enhance quality of life. Understanding the clinics performance ensured future service development based in real-world data. Methods Prospective clinical audit was conducted (September 2023-December 2024 inclusive) Inclusion Criteria: Patients &gt;65 years referred to the ANP Frailty Clinic by Geriatrician or General Practitioner Results A total of 95 patients were included in the audit. Ten primary referral issues were identified with cognitive impairment and polypharmacy emerging as the most frequent concerns. Following initial assessment at the clinic, 30 patients (31.5%) re presented to the Emergency Department. The reasons for readmission varied and included falls resulting in fracture, respiratory illness and in some cases death. These outcomes highlight the high vulnerability of the older population and underscore the importance of early intervention strategies. Conclusion The results suggest that while the clinic plays a critical role in early assessment and intervention, there is a need to further strengthen follow up care enhance integration with community services and implement proactive management plans to help reduce avoidable hospital admissions and improve long term patient outcomes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"6 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160549","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 Burnout syndrome is defined as an emotional response to chronic stress, however research on the extent of this problem among Directors of Nursing in the long-term care (LTC) sector is limited. The intent of this study was to contribute to a better understanding of factors associated with burnout in Directors of Nursing in the LTC sector. Methods This study is part of a broader multi-phase mixed methods research study. This component involved a cross-sectional online survey, data was collected using the Maslach Burnout Inventory (MBI) measuring three dimensions of burnout emotional exhaustion (EE) depersonalization (DP) and personal accomplishment (PA), the Nurse Manager Practice Environment Scale (NMPES) and the Utrecht Work Engagement Scale -9 (UWES-9). The sample population consisted of 195 directors of nursing and assistant directors of nursing from the LTC sector in the Republic of Ireland. Results Among those surveyed the mean EE subscale was 26.9 (SD;12.8), DP subscale was 7.24 (SD;6.10) and the mean PA subscale was 35.4 (SD;7.47). For this cohort the mean EE subscale was significantly higher than the published normative data for the MBI 22.19 (SD;9.53). Factors significantly associated with directors of nursing intention to leave their current position were a lower UWES-9 score (OR 0.18; 95% CI 0.05-0.70), a lower NMPES total score (OR 0.11; 95% CI 0.02-0.68) and higher EE total score (OR 1.21; 95% CI 1.06-1.37) Conclusion Nurse managers presented with increased levels of burnout, manifested by feelings of higher emotional exhaustion. Psychological and work-related factors such as staffing shortages, staff turnover and recruitment, scope of responsibility, general feeling of being unsupported, and lack of protected time off work may play an important role in the development of this syndrome. Addressing factors associated with burnout in nurse managers is essential in order to maintain adequate healthcare delivery in the long-term care sector.
职业倦怠综合征被定义为对慢性压力的情绪反应，然而，关于长期护理（LTC）部门护理主任中这一问题的研究程度有限。本研究的目的是为了更好地了解LTC部门护理主任职业倦怠的相关因素。方法本研究是一项更广泛的多阶段混合方法研究的一部分。该部分采用横断面在线调查，数据收集使用测量倦怠、情绪耗竭（EE）、人格解体（DP）和个人成就（PA）三个维度的Maslach倦怠量表（MBI）、护士经理实践环境量表（NMPES）和乌得勒支工作投入量表-9 （UWES-9）。样本人口包括来自爱尔兰共和国LTC部门的195名护理主任和助理护理主任。结果被调查者的情感表达量表均值为26.9 (SD;12.8)，情感表达量表均值为7.24 (SD;6.10)，情感表达量表均值为35.4 （SD;7.47）。在这个队列中，平均情感表达量表显著高于已发表的MBI标准数据22.19 （SD;9.53）。与护理主管离职意向显著相关的因素有：较低的UWES-9评分（OR 0.18; 95% CI 0.05-0.70）、较低的NMPES总分（OR 0.11; 95% CI 0.05- 0.68）和较高的EE总分（OR 1.21; 95% CI 1.06-1.37）。结论护理管理者的职业倦怠水平增加，表现为较高的情绪耗竭。心理和与工作相关的因素，如人员短缺、人员流动和招聘、责任范围、不受支持的普遍感觉以及缺乏受保护的下班时间，可能在这种综合征的发展中发挥重要作用。为了在长期护理部门维持足够的医疗保健服务，解决与护士管理人员职业倦怠相关的因素至关重要。
{"title":"Directors of Nursing experiences of work environment, burnout and turnover intention in the long-term care sector","authors":"Catherine Fitzgerald, Niamh Walsh, Nicola Pagnucci, Carmel Kelly, Clodagh Killeen, Giuseppe Aleo","doi":"10.1093/ageing/afaf318.200","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.200","url":null,"abstract":"Background Burnout syndrome is defined as an emotional response to chronic stress, however research on the extent of this problem among Directors of Nursing in the long-term care (LTC) sector is limited. The intent of this study was to contribute to a better understanding of factors associated with burnout in Directors of Nursing in the LTC sector. Methods This study is part of a broader multi-phase mixed methods research study. This component involved a cross-sectional online survey, data was collected using the Maslach Burnout Inventory (MBI) measuring three dimensions of burnout emotional exhaustion (EE) depersonalization (DP) and personal accomplishment (PA), the Nurse Manager Practice Environment Scale (NMPES) and the Utrecht Work Engagement Scale -9 (UWES-9). The sample population consisted of 195 directors of nursing and assistant directors of nursing from the LTC sector in the Republic of Ireland. Results Among those surveyed the mean EE subscale was 26.9 (SD;12.8), DP subscale was 7.24 (SD;6.10) and the mean PA subscale was 35.4 (SD;7.47). For this cohort the mean EE subscale was significantly higher than the published normative data for the MBI 22.19 (SD;9.53). Factors significantly associated with directors of nursing intention to leave their current position were a lower UWES-9 score (OR 0.18; 95% CI 0.05-0.70), a lower NMPES total score (OR 0.11; 95% CI 0.02-0.68) and higher EE total score (OR 1.21; 95% CI 1.06-1.37) Conclusion Nurse managers presented with increased levels of burnout, manifested by feelings of higher emotional exhaustion. Psychological and work-related factors such as staffing shortages, staff turnover and recruitment, scope of responsibility, general feeling of being unsupported, and lack of protected time off work may play an important role in the development of this syndrome. Addressing factors associated with burnout in nurse managers is essential in order to maintain adequate healthcare delivery in the long-term care sector.","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":"146160296","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/afaf318.121
Tiago Filipe Rodrigues do Amaral, Josephine Soh, Claire Noonan
Background Nursing home residents (NHRs) represent a complex and growing patient population with increasing Emergency Department (ED) attendances. Their care frequently requires multidisciplinary input, while specialised geriatric services tailored to this cohort exist, their availability is often limited to daytime hours. Methods A retrospective analysis was conducted on out of hours medical ED admissions of NHRs over a six month period, from November 2023 to April 2024. Data collected included demographics, time of arrival, presenting complaints, clinical acuity, and length of stay. Out of hours was defined as attendance after 17:00 on weekdays and anytime during weekends or public holidays. Results A total of 77 (60.2%) NHRs medical admissions occurred out of hours, with 45.5% presenting by 21:00. Infectious symptoms were the most common presenting complaints, accounting for 48.1%, (n=37), followed by gastrointestinal issues with 14.3%, (n=11) and neurological problems at 13%, (n=10). Upon arrival, 58.8% (n=45) were triaged as category 2 (very urgent) according to the Manchester Triage System, 26% (n=20) met sepsis criteria and 16.9% (n=13) had an oxygen requirement. The average duration of symptoms before presentation was 2.08 days (0–14). The average ED stay was 0.86 days, with a mean inpatient length of stay of 9.33 days. The three month mortality rate was 24.7%, with 7.68% (n=6) of NHRs dying during their inpatient stay. Conclusion This study demonstrates that the majority of NHRs presented to ED outside of regular working hours, when specialised geriatrician led services are limited. A significant number did not meet sepsis criteria or had a new oxygen requirement. Their three monthly mortality was 24.7%. These findings support the need to consider enhanced, ambulatory nursing homes outreach services, to deliver timely, and coordinated care, and potentially reduce ED presentations.
{"title":"Out of Hours Emergency Department Admissions of Nursing Home Residents","authors":"Tiago Filipe Rodrigues do Amaral, Josephine Soh, Claire Noonan","doi":"10.1093/ageing/afaf318.121","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.121","url":null,"abstract":"Background Nursing home residents (NHRs) represent a complex and growing patient population with increasing Emergency Department (ED) attendances. Their care frequently requires multidisciplinary input, while specialised geriatric services tailored to this cohort exist, their availability is often limited to daytime hours. Methods A retrospective analysis was conducted on out of hours medical ED admissions of NHRs over a six month period, from November 2023 to April 2024. Data collected included demographics, time of arrival, presenting complaints, clinical acuity, and length of stay. Out of hours was defined as attendance after 17:00 on weekdays and anytime during weekends or public holidays. Results A total of 77 (60.2%) NHRs medical admissions occurred out of hours, with 45.5% presenting by 21:00. Infectious symptoms were the most common presenting complaints, accounting for 48.1%, (n=37), followed by gastrointestinal issues with 14.3%, (n=11) and neurological problems at 13%, (n=10). Upon arrival, 58.8% (n=45) were triaged as category 2 (very urgent) according to the Manchester Triage System, 26% (n=20) met sepsis criteria and 16.9% (n=13) had an oxygen requirement. The average duration of symptoms before presentation was 2.08 days (0–14). The average ED stay was 0.86 days, with a mean inpatient length of stay of 9.33 days. The three month mortality rate was 24.7%, with 7.68% (n=6) of NHRs dying during their inpatient stay. Conclusion This study demonstrates that the majority of NHRs presented to ED outside of regular working hours, when specialised geriatrician led services are limited. A significant number did not meet sepsis criteria or had a new oxygen requirement. Their three monthly mortality was 24.7%. These findings support the need to consider enhanced, ambulatory nursing homes outreach services, to deliver timely, and coordinated care, and potentially reduce ED presentations.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"4 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160361","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 Falls are the leading cause of Emergency Department (ED) visits in adults aged 65 and over (Stoeckle et al., 2019). They present a significant healthcare challenge, with up to 33% requiring hospital admission (Choi et al., 2019). Timely falls risk assessment in the ED is essential to guide interventions and reduce further morbidity. Methods A clinical audit was conducted on 20 medical charts of patients who attended the Geriatric Emergency Medicine Unit (GEM-U) with a fall as their index presentation in Q4 2023. Re-audits were completed in Q2 2024 and Q1 2025. To ensure a representative sample, Manchester Triage System categories included “falls,” “limb problems,” “collapse,” and “back pain.” An audit tool comprising 11 standards was developed, informed by the World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative (2022) and the European Society of Cardiology Guidelines for the Diagnosis and Management of Syncope (2018). Results were analysed using descriptive statistics. Results In the initial audit cycle, compliance varied across all 11 standards ranging from 15-100%. A number of clinical practice improvements were implemented including team-based education on assessment practices and introduction of a "falls from a standing height checklist" informed by Major Trauma Audit. Composite compliance increased from 65% in cycle 1 to 90% in cycle 3. Cycle 2 and 3 results showed a composite increase in compliance in the areas of: careful history taking (55%-100%), completion of an electrocardiograph (60%-90%) and completion of lying & standing blood pressure (25%-65%). Conclusion This audit identified key areas for team-based clinical practice development, supported by the implementation of a structured quality improvement plan. Improvements in compliance across multiple assessment standards highlight the impact of targeted education and documentation tools. Future efforts should prioritise sustaining these improvements and exploring further evidence-based interventions to enhance falls assessment and prevention in the ED.
{"title":"A Clinical Audit of Staff Compliance With Local, National & International Guidelines Regarding Falls Assessment in The Geriatric Emergency Medicine Unit","authors":"Hannah Murphy, Killian Armstrong, Ronan Callanan, Aoife McCarthy, Binu Chacko, Claire Bailey, Leonora Carey, Jessie Ryan, Susan Williams, Íde O'Shaughnessy","doi":"10.1093/ageing/afaf318.048","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.048","url":null,"abstract":"Background Falls are the leading cause of Emergency Department (ED) visits in adults aged 65 and over (Stoeckle et al., 2019). They present a significant healthcare challenge, with up to 33% requiring hospital admission (Choi et al., 2019). Timely falls risk assessment in the ED is essential to guide interventions and reduce further morbidity. Methods A clinical audit was conducted on 20 medical charts of patients who attended the Geriatric Emergency Medicine Unit (GEM-U) with a fall as their index presentation in Q4 2023. Re-audits were completed in Q2 2024 and Q1 2025. To ensure a representative sample, Manchester Triage System categories included “falls,” “limb problems,” “collapse,” and “back pain.” An audit tool comprising 11 standards was developed, informed by the World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative (2022) and the European Society of Cardiology Guidelines for the Diagnosis and Management of Syncope (2018). Results were analysed using descriptive statistics. Results In the initial audit cycle, compliance varied across all 11 standards ranging from 15-100%. A number of clinical practice improvements were implemented including team-based education on assessment practices and introduction of a \"falls from a standing height checklist\" informed by Major Trauma Audit. Composite compliance increased from 65% in cycle 1 to 90% in cycle 3. Cycle 2 and 3 results showed a composite increase in compliance in the areas of: careful history taking (55%-100%), completion of an electrocardiograph (60%-90%) and completion of lying & standing blood pressure (25%-65%). Conclusion This audit identified key areas for team-based clinical practice development, supported by the implementation of a structured quality improvement plan. Improvements in compliance across multiple assessment standards highlight the impact of targeted education and documentation tools. Future efforts should prioritise sustaining these improvements and exploring further evidence-based interventions to enhance falls assessment and prevention in the ED.","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":"146160550","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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