Pub Date : 2024-09-30DOI: 10.1093/ageing/afae178.298
Elisha Stewart, Catriona Murphy
Background Dementia prevalence is expected to exponentially increase over the coming decades. Across society, an increased awareness of dementia inclusive environments is important, to promote inclusivity and foster empathy. The aim of this study was to explore the experiences of undergraduate students using virtual reality (VR) for dementia inclusive education. Methods Purposive sampling was employed in one University in Ireland to recruit first year undergraduate students who had completed a VR workshop on dementia inclusive environments. Five semi-structured in-person interviews were conducted during February 2024. Interviews were audio-recorded, transcribed, and thematically analysed. Results Three themes were identified. The first theme ‘Food for thought’ represented participants’ greater understanding, as a result of using VR, of the potential for design to impact the dementia experience. Participants felt as though they were able to virtually place themselves in someone else’s shoes, which was described as “eye-opening”. The second theme ‘Impact variation’ revealed that although participants’ showed enhanced levels of awareness, empathy and understanding of this global health issue, the depth of learning depended on the participants’ prior exposure to dementia. The final theme related to ‘The VR experience’ as a whole. Students described the VR experience as positive, engaging, easy to use, and revealed that they were excited to take part in the workshops. Conclusion The student experience of using VR for dementia inclusive education was positive and enlightening. Using VR to introduce universal design concepts could be integrated into a range of undergraduate programmes to foster understanding and has the potential to empower future designers and policymakers to create environments that are accessible and inclusive for everyone. While this is a small-scale study, the difference in impact of this VR initiative on students with prior personal exposure to people with dementia and those without was an interesting finding and requires further research.
{"title":"A Qualitative Exploration of Undergraduate Students’ Experiences of Using Virtual Reality for Dementia Inclusive Education","authors":"Elisha Stewart, Catriona Murphy","doi":"10.1093/ageing/afae178.298","DOIUrl":"https://doi.org/10.1093/ageing/afae178.298","url":null,"abstract":"Background Dementia prevalence is expected to exponentially increase over the coming decades. Across society, an increased awareness of dementia inclusive environments is important, to promote inclusivity and foster empathy. The aim of this study was to explore the experiences of undergraduate students using virtual reality (VR) for dementia inclusive education. Methods Purposive sampling was employed in one University in Ireland to recruit first year undergraduate students who had completed a VR workshop on dementia inclusive environments. Five semi-structured in-person interviews were conducted during February 2024. Interviews were audio-recorded, transcribed, and thematically analysed. Results Three themes were identified. The first theme ‘Food for thought’ represented participants’ greater understanding, as a result of using VR, of the potential for design to impact the dementia experience. Participants felt as though they were able to virtually place themselves in someone else’s shoes, which was described as “eye-opening”. The second theme ‘Impact variation’ revealed that although participants’ showed enhanced levels of awareness, empathy and understanding of this global health issue, the depth of learning depended on the participants’ prior exposure to dementia. The final theme related to ‘The VR experience’ as a whole. Students described the VR experience as positive, engaging, easy to use, and revealed that they were excited to take part in the workshops. Conclusion The student experience of using VR for dementia inclusive education was positive and enlightening. Using VR to introduce universal design concepts could be integrated into a range of undergraduate programmes to foster understanding and has the potential to empower future designers and policymakers to create environments that are accessible and inclusive for everyone. While this is a small-scale study, the difference in impact of this VR initiative on students with prior personal exposure to people with dementia and those without was an interesting finding and requires further research.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"39 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360111","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 : 2024-09-30DOI: 10.1093/ageing/afae178.318
Clara McGurk, Alanna O'Shea, Rachel Fitzgerald, Evelyn Hannon, Emer Ahern
Background The recent NOCA report highlights a significant portion of major trauma cases resulting from falls among older adults, who often face limited access to trauma centres and age-related biases in treatment. Existing protocols and services for older trauma patients are lacking. This study aimed to audit the incidence and outcomes of MTOA admitted under the non-trauma specialties at a Major Trauma Centre. Methods Data from handover documents between January 2019 and December 2023 were screened for cases of “older trauma” (patients >65 with new trauma injuries) and analysed using Microsoft Excel. Results Between 2019 and 2023, 992 older patients were admitted under non-trauma specialties, with a mean age of 83 years and a majority being female 73% (N=170). The mean length of stay was 14 days, with pelvis injuries being most common 31% (N=307). Falls from standing height accounted for 83% (N=823) of injuries. Only 28% (N=217) of patients at immediate risk of further fragility fractures received bone protection. Most patients were discharged home 49% (N=456), while 6% (N=55) were institutionalized. The total mortality rate in hospital was 7% (N=66). The total mortality at one year was 17% (N=121). The injury with the highest mortality in hospital 24% (N=21) and at one year 40% (N=35) was traumatic brain injuries. Conclusion This audit reveals disparities in trauma care for older patients, despite advances in the field. While initiatives like the hip fracture database have improved care for specific injuries, pathways for older trauma patients not requiring surgery are lacking. Given the excess morbidity and mortality among this population, establishing a Geriatric Trauma Service is imperative. This is in line with literature supporting the idea that older trauma patients demand specialist attention; they are not just older adults.
{"title":"“For the Care of the Underserved” A Descriptive Analysis of MTOA Admitted Under the Non-Trauma Specialties in a MTC","authors":"Clara McGurk, Alanna O'Shea, Rachel Fitzgerald, Evelyn Hannon, Emer Ahern","doi":"10.1093/ageing/afae178.318","DOIUrl":"https://doi.org/10.1093/ageing/afae178.318","url":null,"abstract":"Background The recent NOCA report highlights a significant portion of major trauma cases resulting from falls among older adults, who often face limited access to trauma centres and age-related biases in treatment. Existing protocols and services for older trauma patients are lacking. This study aimed to audit the incidence and outcomes of MTOA admitted under the non-trauma specialties at a Major Trauma Centre. Methods Data from handover documents between January 2019 and December 2023 were screened for cases of “older trauma” (patients >65 with new trauma injuries) and analysed using Microsoft Excel. Results Between 2019 and 2023, 992 older patients were admitted under non-trauma specialties, with a mean age of 83 years and a majority being female 73% (N=170). The mean length of stay was 14 days, with pelvis injuries being most common 31% (N=307). Falls from standing height accounted for 83% (N=823) of injuries. Only 28% (N=217) of patients at immediate risk of further fragility fractures received bone protection. Most patients were discharged home 49% (N=456), while 6% (N=55) were institutionalized. The total mortality rate in hospital was 7% (N=66). The total mortality at one year was 17% (N=121). The injury with the highest mortality in hospital 24% (N=21) and at one year 40% (N=35) was traumatic brain injuries. Conclusion This audit reveals disparities in trauma care for older patients, despite advances in the field. While initiatives like the hip fracture database have improved care for specific injuries, pathways for older trauma patients not requiring surgery are lacking. Given the excess morbidity and mortality among this population, establishing a Geriatric Trauma Service is imperative. This is in line with literature supporting the idea that older trauma patients demand specialist attention; they are not just older adults.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"44 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360131","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 : 2024-09-30DOI: 10.1093/ageing/afae178.035
Sinead Knox
Background Malnutrition in older adults increases the risk of frailty. Nutritional interventions can improve frailty. A Senior Dietitian joined our Integrated Care for Older Persons Community Specialist Team (ICPOP-CST) in 2022. Our Complete Geriatric Assessment (CGA) form was redesigned in early 2023 which included the Malnutrition Screening Tool (MST). We commenced measuring handgrip strength (HGS) in late 2023. We measured the prevalence of malnutrition risk among our patients, audited MST use and explored dietetic service provision. Methods Data from the first 101 patients with a completed (new) CGA form were obtained from the service’s electronic patient database. Patients with a MST score of 0 or 1 were considered to be at low risk of malnutrition and those with a MST score of 2 or more were considered to be at risk of malnutrition. Results The mean age was 84.8±5.3 years and 65% were female. Malnutrition risk was identified in 39 (38.6%) patients. The MST was completed for 96 (95%) patients and completed correctly in 67 (69.8%). The total score was not summed in 26 out of 29 incorrectly completed screening tools (89.7%). Half (51, 50.5%) of the group of older adults received dietetic assessment and intervention. High protein, high calorie advice was provided for 38 (74.5%) of those seen by the ICPOP dietitian and for 29 (93.5 %) of those at risk of malnutrition. Onward referral to primary care dietitians was made for 14 (27.5%) of those seen by the ICPOP dietitian. HGS measurement was performed in 20 patients - 15 (75.0%) were identified to have probable sarcopenia – 11 (73.3%) of these were at risk of malnutrition. All received dietetic intervention in relation to protein and sarcopenia. Conclusion Malnutrition risk and probable sarcopenia are common among older adults referred to our ICPOP-CST team. The MST screening tool is practical and identifies those requiring dietetic intervention.
{"title":"Malnutrition Risk Screening and Dietitian Intervention within an Integrated Care Team for Older Persons","authors":"Sinead Knox","doi":"10.1093/ageing/afae178.035","DOIUrl":"https://doi.org/10.1093/ageing/afae178.035","url":null,"abstract":"Background Malnutrition in older adults increases the risk of frailty. Nutritional interventions can improve frailty. A Senior Dietitian joined our Integrated Care for Older Persons Community Specialist Team (ICPOP-CST) in 2022. Our Complete Geriatric Assessment (CGA) form was redesigned in early 2023 which included the Malnutrition Screening Tool (MST). We commenced measuring handgrip strength (HGS) in late 2023. We measured the prevalence of malnutrition risk among our patients, audited MST use and explored dietetic service provision. Methods Data from the first 101 patients with a completed (new) CGA form were obtained from the service’s electronic patient database. Patients with a MST score of 0 or 1 were considered to be at low risk of malnutrition and those with a MST score of 2 or more were considered to be at risk of malnutrition. Results The mean age was 84.8±5.3 years and 65% were female. Malnutrition risk was identified in 39 (38.6%) patients. The MST was completed for 96 (95%) patients and completed correctly in 67 (69.8%). The total score was not summed in 26 out of 29 incorrectly completed screening tools (89.7%). Half (51, 50.5%) of the group of older adults received dietetic assessment and intervention. High protein, high calorie advice was provided for 38 (74.5%) of those seen by the ICPOP dietitian and for 29 (93.5 %) of those at risk of malnutrition. Onward referral to primary care dietitians was made for 14 (27.5%) of those seen by the ICPOP dietitian. HGS measurement was performed in 20 patients - 15 (75.0%) were identified to have probable sarcopenia – 11 (73.3%) of these were at risk of malnutrition. All received dietetic intervention in relation to protein and sarcopenia. Conclusion Malnutrition risk and probable sarcopenia are common among older adults referred to our ICPOP-CST team. The MST screening tool is practical and identifies those requiring dietetic intervention.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"74 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360171","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 : 2024-09-30DOI: 10.1093/ageing/afae178.243
Deirdre Kidney, Nicola Jackson, Alice Clancy, Sarah Harrington, Lydia Hendy, Tayla Joubert, Ciara Murphy, Sarah Dooley, Becky Murphy, Kate Grygielewicz
Background In the Dementia Friendly Hospital Guidelines 2018, it recommends we support patient safety, health and well-being. This can be facilitated by supporting diet, nutrition and hydration in a calm, accessible and usable space with appropriate lighting, and clearly visible and easily understood furniture and tableware. We have audited our practices across the hospital to ensure we have practices that promote hydration in all our wards. As we are an MDT team we bring a unique broad perspective on the issue of availability, accessibility and assistance. Methods We prospectively audited the provision and accessibility of drinks of any kind across our hospital. This was carried out on two separate occasions, once in the morning and once in the afternoon. We developed a unique audit tool. We used the HIQA nutrition and hydration standards to develop this tool. This was carried out on two separate occasions, once in the morning and once in the afternoon. Results Total number audited - 131 Availability Accessibility Assistance - 38% required prompting/reminding to drink. Conclusion Almost all of our patients in St. Michael’s Hospital had a drink and water jug available, however not all patients were able to access or independently hydrate themselves. Through making improvements, we aim to improve the hydration for our patients. According to the Food, Nutrition and Hydration policy for adults in acute hospital, by improving patient hydration, we are supporting the reduction of malnutrition amongst our patient cohort, in turn reducing their susceptibility to disease and improving their rate of recovery.
{"title":"A Multidisciplinary Prospective Audit of Practices of Providing Hydration to Patient in An Acute Care Setting. Stop, Think and Drink","authors":"Deirdre Kidney, Nicola Jackson, Alice Clancy, Sarah Harrington, Lydia Hendy, Tayla Joubert, Ciara Murphy, Sarah Dooley, Becky Murphy, Kate Grygielewicz","doi":"10.1093/ageing/afae178.243","DOIUrl":"https://doi.org/10.1093/ageing/afae178.243","url":null,"abstract":"Background In the Dementia Friendly Hospital Guidelines 2018, it recommends we support patient safety, health and well-being. This can be facilitated by supporting diet, nutrition and hydration in a calm, accessible and usable space with appropriate lighting, and clearly visible and easily understood furniture and tableware. We have audited our practices across the hospital to ensure we have practices that promote hydration in all our wards. As we are an MDT team we bring a unique broad perspective on the issue of availability, accessibility and assistance. Methods We prospectively audited the provision and accessibility of drinks of any kind across our hospital. This was carried out on two separate occasions, once in the morning and once in the afternoon. We developed a unique audit tool. We used the HIQA nutrition and hydration standards to develop this tool. This was carried out on two separate occasions, once in the morning and once in the afternoon. Results Total number audited - 131 Availability Accessibility Assistance - 38% required prompting/reminding to drink. Conclusion Almost all of our patients in St. Michael’s Hospital had a drink and water jug available, however not all patients were able to access or independently hydrate themselves. Through making improvements, we aim to improve the hydration for our patients. According to the Food, Nutrition and Hydration policy for adults in acute hospital, by improving patient hydration, we are supporting the reduction of malnutrition amongst our patient cohort, in turn reducing their susceptibility to disease and improving their rate of recovery.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"56 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360206","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 : 2024-09-30DOI: 10.1093/ageing/afae178.269
Anna Healy, Siobhan Ryan, Linda Brewer
Background Incontinence is a common and troublesome feature of frailty (NCPOP 2012), routinely examined in a comprehensive geriatric assessment (CGA). It can impact on life quality, mobility, falls and overall care needs. Patients often develop incontinence during hospital admission and staff knowledge of continence status (CS) and efforts to drive improvements are often poor. We sought to explore these issues on our wards. Methods We conducted a point prevalence study, reviewed medical charts and interviewed ward nurses on three specialist geriatric wards. Patients >65y over a six-week period were included. We developed a proforma and recorded current and pre-admission CS, and use of continence wear. Nursing staff awareness of CS was also explored. Results 104 patients (57% female, mean age 81y) were included. Overall, 34 (32.7%) had urinary incontinence (UI), of whom 22 (64%) developed new UI since admission. 27 (25.7%) patients had a urinary catheter inserted, most (23; 85%) for short-term use. Almost half (46; 44.2%) had faecal incontinence (FI), of which 74% was new FI since admission. Overall, 19 patients (18%) were doubly incontinent. Continence wear was also reviewed; 57 (54%) were in full wrap-around continence wear, 28 (27%) in pull-ups. 26 (25%) wore continence wear despite being continent. Only 28 (27%) had a call bell within reach. Nursing awareness was examined, 85 nurses (81.7%) were aware of their patient’s CS, and 15 (14.4%) were partially aware. In all cases, nursing handover documents were consulted. For 35 patients, (33%) CS impacted on their discharge plan. Conclusion Rates of UI and FI were high in our cohort and further increased during hospital admission. Staff knowledge was satisfactory but suboptimal efforts were made to improve CS. Consequently, an education session was delivered to clinical staff to embed continence assessment into CGA. Additionally, continence advocates have been appointed to each ward.
{"title":"A Review of Patient Continence and Related Staff Knowledge on Specialist Geriatric Wards","authors":"Anna Healy, Siobhan Ryan, Linda Brewer","doi":"10.1093/ageing/afae178.269","DOIUrl":"https://doi.org/10.1093/ageing/afae178.269","url":null,"abstract":"Background Incontinence is a common and troublesome feature of frailty (NCPOP 2012), routinely examined in a comprehensive geriatric assessment (CGA). It can impact on life quality, mobility, falls and overall care needs. Patients often develop incontinence during hospital admission and staff knowledge of continence status (CS) and efforts to drive improvements are often poor. We sought to explore these issues on our wards. Methods We conducted a point prevalence study, reviewed medical charts and interviewed ward nurses on three specialist geriatric wards. Patients >65y over a six-week period were included. We developed a proforma and recorded current and pre-admission CS, and use of continence wear. Nursing staff awareness of CS was also explored. Results 104 patients (57% female, mean age 81y) were included. Overall, 34 (32.7%) had urinary incontinence (UI), of whom 22 (64%) developed new UI since admission. 27 (25.7%) patients had a urinary catheter inserted, most (23; 85%) for short-term use. Almost half (46; 44.2%) had faecal incontinence (FI), of which 74% was new FI since admission. Overall, 19 patients (18%) were doubly incontinent. Continence wear was also reviewed; 57 (54%) were in full wrap-around continence wear, 28 (27%) in pull-ups. 26 (25%) wore continence wear despite being continent. Only 28 (27%) had a call bell within reach. Nursing awareness was examined, 85 nurses (81.7%) were aware of their patient’s CS, and 15 (14.4%) were partially aware. In all cases, nursing handover documents were consulted. For 35 patients, (33%) CS impacted on their discharge plan. Conclusion Rates of UI and FI were high in our cohort and further increased during hospital admission. Staff knowledge was satisfactory but suboptimal efforts were made to improve CS. Consequently, an education session was delivered to clinical staff to embed continence assessment into CGA. Additionally, continence advocates have been appointed to each ward.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360134","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 : 2024-09-30DOI: 10.1093/ageing/afae178.270
Clodagh McDermott, Allie Seminer, Catriona Reddin, Finn Krewer, Martin O'Donnell
Background Stroke is the 2nd leading cause of death worldwide. Stroke is diagnosed by the combination of clinical symptoms and signs, and neuroimaging. Clinical features may differ between the subtypes of ischaemic and haemorrhagic stroke. We investigated whether there are differences in clinical presentation of acute ischaemic and haemorrhagic stroke. Methods We conducted a systematic review and meta-analysis according to the PRISMA statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, randomised controlled trial, systematic review or meta-analysis; (2) consecutive admissions of adult individuals with an acute ischaemic or haemorrhagic stroke, confirmed by neuroimaging and (3) comparisons possible between stroke subtypes in acute stroke symptom(s). A random-effects model was used for our analyses. Results We included 58 studies (n=12,878,716; ischaemic stroke=10,814,293; haemorrhagic stroke=2,064,423). The mean age of participants was 65.54+13.84 with 44.98% women. In haemorrhagic stroke, altered GCS occurred more frequently than in ischaemic stroke (OR, 3.93 [95% CI, 2.81–5.49]; AIS/ICH=382,110/59,877, 40 studies), as did headache (OR, 3.34 [95% CI, 2.68–4.17]; AIS/ICH=22,413/6,018; 43 studies), seizure (OR, 2.42 [95% CI, 1.62–3.65]; AIS/ICH=10,427,262/2,004,681; 20 studies), vomiting (OR, 3.82 [95% CI, 2.62–5.57]; AIS/ICH=7,736/3,225; 25 studies), neck stiffness (OR, 5.21 [95% CI, 2.22–12.21]; AIS/ICH=511/168; 3 studies), syncope (OR, 2.95 [95% CI, 2.12–4.12]; AIS/ICH=2,427/494; 6 studies) and dizziness (OR, 1.33 [95% CI, 1.05–1.68]; AIS/ICH=4,730/1,213; 11 studies). Hemiplegia occurred more frequently in ischaemic stroke (OR, 0.67 [95% CI, 0.49–0.91]; AIS/ICH=15,857/4,338; 31 studies) than haemorrhagic stroke, as did ataxia (OR, 0.73 [95% CI, 0.61–0.86]; AIS/ICH=7,741/2,244; 8 studies) and morning onset (OR, 0.41 [95% CI, 0.32– 0.54]; AIS/ICH=2,721/495; 4 studies). Conclusion This review focused on synthesizing existing evidence on differences in clinical presentation between ischaemic and haemorrhagic stroke. It suggests there are substantive differences in stroke symptoms between these subtypes. These results may provide insights into future directions for clinical prediction tool development.
{"title":"Differences in Presentation of Ischaemic and Haemorrhagic Stroke: A Systematic Review and Meta-Analysis","authors":"Clodagh McDermott, Allie Seminer, Catriona Reddin, Finn Krewer, Martin O'Donnell","doi":"10.1093/ageing/afae178.270","DOIUrl":"https://doi.org/10.1093/ageing/afae178.270","url":null,"abstract":"Background Stroke is the 2nd leading cause of death worldwide. Stroke is diagnosed by the combination of clinical symptoms and signs, and neuroimaging. Clinical features may differ between the subtypes of ischaemic and haemorrhagic stroke. We investigated whether there are differences in clinical presentation of acute ischaemic and haemorrhagic stroke. Methods We conducted a systematic review and meta-analysis according to the PRISMA statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, randomised controlled trial, systematic review or meta-analysis; (2) consecutive admissions of adult individuals with an acute ischaemic or haemorrhagic stroke, confirmed by neuroimaging and (3) comparisons possible between stroke subtypes in acute stroke symptom(s). A random-effects model was used for our analyses. Results We included 58 studies (n=12,878,716; ischaemic stroke=10,814,293; haemorrhagic stroke=2,064,423). The mean age of participants was 65.54+13.84 with 44.98% women. In haemorrhagic stroke, altered GCS occurred more frequently than in ischaemic stroke (OR, 3.93 [95% CI, 2.81–5.49]; AIS/ICH=382,110/59,877, 40 studies), as did headache (OR, 3.34 [95% CI, 2.68–4.17]; AIS/ICH=22,413/6,018; 43 studies), seizure (OR, 2.42 [95% CI, 1.62–3.65]; AIS/ICH=10,427,262/2,004,681; 20 studies), vomiting (OR, 3.82 [95% CI, 2.62–5.57]; AIS/ICH=7,736/3,225; 25 studies), neck stiffness (OR, 5.21 [95% CI, 2.22–12.21]; AIS/ICH=511/168; 3 studies), syncope (OR, 2.95 [95% CI, 2.12–4.12]; AIS/ICH=2,427/494; 6 studies) and dizziness (OR, 1.33 [95% CI, 1.05–1.68]; AIS/ICH=4,730/1,213; 11 studies). Hemiplegia occurred more frequently in ischaemic stroke (OR, 0.67 [95% CI, 0.49–0.91]; AIS/ICH=15,857/4,338; 31 studies) than haemorrhagic stroke, as did ataxia (OR, 0.73 [95% CI, 0.61–0.86]; AIS/ICH=7,741/2,244; 8 studies) and morning onset (OR, 0.41 [95% CI, 0.32– 0.54]; AIS/ICH=2,721/495; 4 studies). Conclusion This review focused on synthesizing existing evidence on differences in clinical presentation between ischaemic and haemorrhagic stroke. It suggests there are substantive differences in stroke symptoms between these subtypes. These results may provide insights into future directions for clinical prediction tool development.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"8 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360167","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 Ireland is experiencing substantial growth in the older population. Data from The Irish Longitudinal Study on Ageing (TILDA) suggests that up to 25% of older people in Ireland are living with frailty while a further 45% are at risk of being pre-frail (Roe L et al, 2017). Frailty in older adults can be a predictor to adverse health outcomes including hospitalization, falls, and increased mortality risk. Ambulatory day units proactively identify older adults at risk of frailty living in the community using a comprehensive geriatric assessment (CGA), potentially reducing adverse outcomes. Methods Plan-Do- Study-Act (PDSA) cycle was used. Waiting lists were reviewed with Consultant Geriatricians for the ambulatory units. Referral pathways for RANP Gerontology Clinics with inclusion and exclusion criteria were developed. RANP clinics were established in 2023 in the ambulatory day units utilising Slaíntecare’s strategy. Referrals were triaged by Consultants Geriatricians resulting in the RANP clinic caseload. Results During 2023, 844 older adults were reviewed in the RANP clinics. This contributed to a reduction in Consultant Geriatricians’ waiting lists and allowed reduced wait times for new Consultant Geriatricians’ referrals. This service also enhanced communication pathways between primary and secondary care settings and became a point of contact for families in crisis, with rapid access review and care planning to avoid unnecessary Emergency Department attendances. Patients attending the RANP clinics, if admitted to hospital, were seen by the RANP during their admission, ensuring continuity of care. Conclusion Overall, establishment of RANP Gerontology clinics resulted in a better streamlined service for the older adult. This service ensures continuity of patient care through a working knowledge of patient cohort and rapid access for those known to the service, potentially avoiding an Emergency Department attendance.
{"title":"Establishment of Registered Advanced Nurse Practitioners (RANP) Gerontology Clinics in Two Ambulatory Day Units","authors":"Nicola McShane, Fiona Monaghan-Tyer, Rebecca Toner","doi":"10.1093/ageing/afae178.231","DOIUrl":"https://doi.org/10.1093/ageing/afae178.231","url":null,"abstract":"Background Ireland is experiencing substantial growth in the older population. Data from The Irish Longitudinal Study on Ageing (TILDA) suggests that up to 25% of older people in Ireland are living with frailty while a further 45% are at risk of being pre-frail (Roe L et al, 2017). Frailty in older adults can be a predictor to adverse health outcomes including hospitalization, falls, and increased mortality risk. Ambulatory day units proactively identify older adults at risk of frailty living in the community using a comprehensive geriatric assessment (CGA), potentially reducing adverse outcomes. Methods Plan-Do- Study-Act (PDSA) cycle was used. Waiting lists were reviewed with Consultant Geriatricians for the ambulatory units. Referral pathways for RANP Gerontology Clinics with inclusion and exclusion criteria were developed. RANP clinics were established in 2023 in the ambulatory day units utilising Slaíntecare’s strategy. Referrals were triaged by Consultants Geriatricians resulting in the RANP clinic caseload. Results During 2023, 844 older adults were reviewed in the RANP clinics. This contributed to a reduction in Consultant Geriatricians’ waiting lists and allowed reduced wait times for new Consultant Geriatricians’ referrals. This service also enhanced communication pathways between primary and secondary care settings and became a point of contact for families in crisis, with rapid access review and care planning to avoid unnecessary Emergency Department attendances. Patients attending the RANP clinics, if admitted to hospital, were seen by the RANP during their admission, ensuring continuity of care. Conclusion Overall, establishment of RANP Gerontology clinics resulted in a better streamlined service for the older adult. This service ensures continuity of patient care through a working knowledge of patient cohort and rapid access for those known to the service, potentially avoiding an Emergency Department attendance.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360176","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 : 2024-09-30DOI: 10.1093/ageing/afae178.138
Timothy Geraghty, Niamh Boyle, Mary McNamee, James Kelly, Kieran Lucey, Eithne Harkin
Background Inpatient falls are the largest category of preventable inpatient adverse events in hospitals coming at both great financial and safety cost to a healthcare system. Approximately 30% of inpatient falls result in injury, 4-6% resulting in serious injury with older patients have the highest risk of falling and injury. The aim of this retrospective audit cycle was to improve standards of falls assessments performed by junior doctors. Methods We initially conducted a retrospective review of 7 medical inpatient falls in July 2023. Standards were compared against NICE Guidelines on Assessment and Prevention of Falls in older people 2013 and NICE guidelines on Assessment and early management of head injury 2023. 15 key elements were analysed: doctor identifier, date and time, history of fall, confusion, pain, loss of consciousness, amnesia, seizure, vomiting, medication review, hip fracture, wrist fracture, skull fracture, Glasgow Coma Scale and neurological deficit. One point was given for each of the 15 key elements noted in the falls review. Following introduction of a falls proforma, we re-audited 18 falls in February 2024 to analyse differences in scores. Results Prior to proforma introduction, 7 falls reviewed had an average score of 3 points. 4 falls were reviewed by SHOs, 1 each by an SpR and Intern and 1 NCHD review was unidentifiable. Mean age was 72. Following proforma introduction, 18 falls in 13 patients were analysed. 2 patients did not have a falls review, 15 were reviewed by SHOs, 1 by an Intern. Average age was 81. Proforma was used in 7 cases with an average score of 12.7, and no proforma was used in 11 cases with an average score of 5. Conclusion These findings demonstrate improved quality of falls reviews using proformas in line with guidelines compared to those without. More education is needed to incorporate proformas into standard practice.
{"title":"Retrospective Review of Falls in Medical Inpatients Following Introduction of a Falls Proforma at Wexford General Hospital","authors":"Timothy Geraghty, Niamh Boyle, Mary McNamee, James Kelly, Kieran Lucey, Eithne Harkin","doi":"10.1093/ageing/afae178.138","DOIUrl":"https://doi.org/10.1093/ageing/afae178.138","url":null,"abstract":"Background Inpatient falls are the largest category of preventable inpatient adverse events in hospitals coming at both great financial and safety cost to a healthcare system. Approximately 30% of inpatient falls result in injury, 4-6% resulting in serious injury with older patients have the highest risk of falling and injury. The aim of this retrospective audit cycle was to improve standards of falls assessments performed by junior doctors. Methods We initially conducted a retrospective review of 7 medical inpatient falls in July 2023. Standards were compared against NICE Guidelines on Assessment and Prevention of Falls in older people 2013 and NICE guidelines on Assessment and early management of head injury 2023. 15 key elements were analysed: doctor identifier, date and time, history of fall, confusion, pain, loss of consciousness, amnesia, seizure, vomiting, medication review, hip fracture, wrist fracture, skull fracture, Glasgow Coma Scale and neurological deficit. One point was given for each of the 15 key elements noted in the falls review. Following introduction of a falls proforma, we re-audited 18 falls in February 2024 to analyse differences in scores. Results Prior to proforma introduction, 7 falls reviewed had an average score of 3 points. 4 falls were reviewed by SHOs, 1 each by an SpR and Intern and 1 NCHD review was unidentifiable. Mean age was 72. Following proforma introduction, 18 falls in 13 patients were analysed. 2 patients did not have a falls review, 15 were reviewed by SHOs, 1 by an Intern. Average age was 81. Proforma was used in 7 cases with an average score of 12.7, and no proforma was used in 11 cases with an average score of 5. Conclusion These findings demonstrate improved quality of falls reviews using proformas in line with guidelines compared to those without. More education is needed to incorporate proformas into standard practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"56 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360274","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 : 2024-09-30DOI: 10.1093/ageing/afae178.200
Niamh Heraughty, Laura Douglas, Orla Montague
Background In November 2020 the referral rate for residents with dementia for communication assessment was only 18% of all referrals. The Speech and Language Therapy (SLT) Department had no standard pathway for assessment and intervention of communication for those residents. Part of the aim of devising this pathway was to empower our fellow Health Care Workers (HCWs) to have meaningful, successful and satisfying conversations and facilitate positive, person-centred communication. Methods Results Qualitative feedback received from staff and families highlight our residents' “personhood” and how the tools help preserve residents' memories. The tools are available in resident's files for all HCWs to use. SLTs continue to complete the cognitive and language screens but student nurses complete the Getting To Know Me questionnaire. Since commencement of this initiative there have been more than 230 residents whom have at least 1 of the tools is completed. Conclusion These tools can help reveal the personhood of our residents and can empower all HCWs in conversation with residents. They help to provide comfort and attachment to people with dementia by helping us maintain their identity and foster inclusion by empowering residents and staff in conversations. This project is easily replicated and practical.
{"title":"Providing A ‘Helping Hand’ To ‘Get to Know Me’ And What ‘I Can’ Do For People With Dementia","authors":"Niamh Heraughty, Laura Douglas, Orla Montague","doi":"10.1093/ageing/afae178.200","DOIUrl":"https://doi.org/10.1093/ageing/afae178.200","url":null,"abstract":"Background In November 2020 the referral rate for residents with dementia for communication assessment was only 18% of all referrals. The Speech and Language Therapy (SLT) Department had no standard pathway for assessment and intervention of communication for those residents. Part of the aim of devising this pathway was to empower our fellow Health Care Workers (HCWs) to have meaningful, successful and satisfying conversations and facilitate positive, person-centred communication. Methods Results Qualitative feedback received from staff and families highlight our residents' “personhood” and how the tools help preserve residents' memories. The tools are available in resident's files for all HCWs to use. SLTs continue to complete the cognitive and language screens but student nurses complete the Getting To Know Me questionnaire. Since commencement of this initiative there have been more than 230 residents whom have at least 1 of the tools is completed. Conclusion These tools can help reveal the personhood of our residents and can empower all HCWs in conversation with residents. They help to provide comfort and attachment to people with dementia by helping us maintain their identity and foster inclusion by empowering residents and staff in conversations. This project is easily replicated and practical.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"19 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329989","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 : 2024-09-30DOI: 10.1093/ageing/afae178.312
Ross O'Grady, Aine O'Reilly, Doctor Tom Lee
Background Echocardiography (Echo) is frequently utilized as part of the work up for ischemic stroke. National guidelines suggest using echo to assess for source of unexplained stroke “if detection of a structural cardiac abnormality would prompt a change of management”. This study aims to describe the use of Echocardiography post-stroke in Mayo University Hospital (MUH). Methods The study population was derived from a list of strokes admitted to MUH from July to December 2023 which was compiled by the Stroke ANP. The radiology system was consulted to assess time to echo and findings. Results 86 ischemic strokes were identified. 77 (89%) had echocardiography ordered as inpatient. 61 of 77 echoes ordered were filmed during admission. The mean wait for echo was 6.4 days. No PFO or LV thrombus was detected. In 52% (n=32) of echo’s performed for work up of aetiology of stroke there was no mention of intra-atrial septum (IAS) in the report. 24% had Modified Rankin Scale on discharge of 4 or above. Of these, 75% had echo ordered as inpatient despite 60% already having atrial fibrillation diagnosed. Conclusion Echocardiography appeared to be an over-utilised resource in ischemic strokes in MUH. The vast majority of patients with stroke, even if frail, elderly, or severely disabled, had echocardiography ordered despite national guidelines suggesting usage of echo only when diagnosis of structural heart disease was likely to change management. The intra-atrial septum wasn’t even mentioned in the majority of studies. The wait for echocardiography appears to be extending bed days for patients putting strain on hospital inpatient capacity and emergency departments. A more nuanced approach to ordering echo in the setting of acute stroke could be advocated for, this will take a collaborative effort between Cardiology and Stroke Medicine in order to prioritise that will most benefit from this precious resource.
{"title":"Echocardiography In Acute Stroke - A Precious Resource","authors":"Ross O'Grady, Aine O'Reilly, Doctor Tom Lee","doi":"10.1093/ageing/afae178.312","DOIUrl":"https://doi.org/10.1093/ageing/afae178.312","url":null,"abstract":"Background Echocardiography (Echo) is frequently utilized as part of the work up for ischemic stroke. National guidelines suggest using echo to assess for source of unexplained stroke “if detection of a structural cardiac abnormality would prompt a change of management”. This study aims to describe the use of Echocardiography post-stroke in Mayo University Hospital (MUH). Methods The study population was derived from a list of strokes admitted to MUH from July to December 2023 which was compiled by the Stroke ANP. The radiology system was consulted to assess time to echo and findings. Results 86 ischemic strokes were identified. 77 (89%) had echocardiography ordered as inpatient. 61 of 77 echoes ordered were filmed during admission. The mean wait for echo was 6.4 days. No PFO or LV thrombus was detected. In 52% (n=32) of echo’s performed for work up of aetiology of stroke there was no mention of intra-atrial septum (IAS) in the report. 24% had Modified Rankin Scale on discharge of 4 or above. Of these, 75% had echo ordered as inpatient despite 60% already having atrial fibrillation diagnosed. Conclusion Echocardiography appeared to be an over-utilised resource in ischemic strokes in MUH. The vast majority of patients with stroke, even if frail, elderly, or severely disabled, had echocardiography ordered despite national guidelines suggesting usage of echo only when diagnosis of structural heart disease was likely to change management. The intra-atrial septum wasn’t even mentioned in the majority of studies. The wait for echocardiography appears to be extending bed days for patients putting strain on hospital inpatient capacity and emergency departments. A more nuanced approach to ordering echo in the setting of acute stroke could be advocated for, this will take a collaborative effort between Cardiology and Stroke Medicine in order to prioritise that will most benefit from this precious resource.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360092","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：