Background The Emergency Department Admission Prevention Therapy (EDAPT) service was developed by Therapy staff of the Pathfinder team in order to facilitate timely and appropriate discharges from the Emergency Department (ED) and to maximise capacity for the follow-up team. The aim of this pilot is to provide rapid access to therapy post discharge from ED for older adults with acute decline in function in order to prevent hospital admission. The service provides a short-term reablement approach within the home aiming to facilitate patients to regain pre-acuity baseline. EDAPT was modelled from an existing service but has now been expanded to accepting direct referrals from ED Medical Staff and Advanced Nurse Practitioners (ANPs) outside of standard working hours. Methods The pilot was introduced following collaboration and consultation with a number of key stakeholders including respective Therapy Managers, ED Consultants, ANPs and ED Therapists. A new EDAPT referral pathway was created, and documentation including specific referral and assessment forms. A designated area for receipt of referrals in the ED department was chosen and checked daily. Results 64 patients with a mean age of 80.5 years were referred to the EDAPT service from November ’23 to April ’24. 53 of those patients received face-to-face input and had a mean Clinical Frailty Scale score of 5. 27% (n=17) of referrals were initiated out-of-hours via Medical and ANP staff and 48% (n=31) of referrals were falls related. Patients received an average of 2 follow-up visits during EDAPT involvement. Conclusion The EDAPT pilot is successfully facilitating timely and appropriate discharges from the ED, improving patient experience and patient flow from ED to their own home. The pilot integrates acute hospital care and community services, supporting a person-centred approach of the right care, at the right time and in the right place.
{"title":"EDAPT: The Development And Implementation Of A Novel Referral Pathway From The Emergency Department","authors":"Eileen Harty, Eimear Walsh, Elaine O'Keeffe, Aoife Dennehy","doi":"10.1093/ageing/afae178.080","DOIUrl":"https://doi.org/10.1093/ageing/afae178.080","url":null,"abstract":"Background The Emergency Department Admission Prevention Therapy (EDAPT) service was developed by Therapy staff of the Pathfinder team in order to facilitate timely and appropriate discharges from the Emergency Department (ED) and to maximise capacity for the follow-up team. The aim of this pilot is to provide rapid access to therapy post discharge from ED for older adults with acute decline in function in order to prevent hospital admission. The service provides a short-term reablement approach within the home aiming to facilitate patients to regain pre-acuity baseline. EDAPT was modelled from an existing service but has now been expanded to accepting direct referrals from ED Medical Staff and Advanced Nurse Practitioners (ANPs) outside of standard working hours. Methods The pilot was introduced following collaboration and consultation with a number of key stakeholders including respective Therapy Managers, ED Consultants, ANPs and ED Therapists. A new EDAPT referral pathway was created, and documentation including specific referral and assessment forms. A designated area for receipt of referrals in the ED department was chosen and checked daily. Results 64 patients with a mean age of 80.5 years were referred to the EDAPT service from November ’23 to April ’24. 53 of those patients received face-to-face input and had a mean Clinical Frailty Scale score of 5. 27% (n=17) of referrals were initiated out-of-hours via Medical and ANP staff and 48% (n=31) of referrals were falls related. Patients received an average of 2 follow-up visits during EDAPT involvement. Conclusion The EDAPT pilot is successfully facilitating timely and appropriate discharges from the ED, improving patient experience and patient flow from ED to their own home. The pilot integrates acute hospital care and community services, supporting a person-centred approach of the right care, at the right time and in the right place.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360212","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/afae178.148
Máire Ní Neachtain, Cliodhna Fitzmaurice, Aishling Abed, Alma Brehony, Fiona McCleane, Michelle Canavan, Maria Costello
Background The CSO 2022 reported that there were 1,873,997 Irish speakers in Ireland >3yrs of age. Of those, 71,968 speak the language daily. The highest proportion of those who speak Irish in Ireland live in the West of the country. Within our catchment area, we are able to provide an ANP led comprehensive geriatric assessment (CGA) in the Irish language. Methods The aim of this study was to characterise participants referred to an integrated care for older persons (ICPOP) service who had CGAs conducted in Irish from the period of September 2023 to April 2024 and to determine if the patients felt better represented if their CGA was conducted through Irish. Two questions were asked, 1. Do you prefer to have healthcare interaction through Irish? 2. Do you feel better represented by having had your CGA conducted in Irish? Results Over a six-month period 34 patients referred to ICPOP underwent CGA or review through the Irish language. 35.2% (n=12) had their CGA conducted at home. 23.5% (n=8) of those were referred for frailty, 23.5% falls (n=8) and 53% (n=18) for assessment of cognition. Of this cohort 32.3% (n=11) were female, had a median age of 81.5 years and a median clinical frailty score of 5 (range 3-7). The average age of education completion was 14.8yrs. 3% (n=1) had no literacy skills, 23.5% (n=8) had limited and 73.5% (n=25) had good literacy skills. 56% (n=19) gave feedback on their experience. For 23.5% (n=8) it strongly mattered that they had this option. For the remainder, they were indifferent, as they were fluent in both languages. Conclusion We identified that for a proportion of our patient cohort having CGA conducted through Irish was of importance. Ancillary benefits included better understanding of interventions such as deprescribing and brain health techniques when communicated through their primary language.
{"title":"A Profile of Patients Undergoing Comprehensive Geriatric Assessment Though Irish; An Bhfuil Gaeilge Níos Fearr?","authors":"Máire Ní Neachtain, Cliodhna Fitzmaurice, Aishling Abed, Alma Brehony, Fiona McCleane, Michelle Canavan, Maria Costello","doi":"10.1093/ageing/afae178.148","DOIUrl":"https://doi.org/10.1093/ageing/afae178.148","url":null,"abstract":"Background The CSO 2022 reported that there were 1,873,997 Irish speakers in Ireland >3yrs of age. Of those, 71,968 speak the language daily. The highest proportion of those who speak Irish in Ireland live in the West of the country. Within our catchment area, we are able to provide an ANP led comprehensive geriatric assessment (CGA) in the Irish language. Methods The aim of this study was to characterise participants referred to an integrated care for older persons (ICPOP) service who had CGAs conducted in Irish from the period of September 2023 to April 2024 and to determine if the patients felt better represented if their CGA was conducted through Irish. Two questions were asked, 1. Do you prefer to have healthcare interaction through Irish? 2. Do you feel better represented by having had your CGA conducted in Irish? Results Over a six-month period 34 patients referred to ICPOP underwent CGA or review through the Irish language. 35.2% (n=12) had their CGA conducted at home. 23.5% (n=8) of those were referred for frailty, 23.5% falls (n=8) and 53% (n=18) for assessment of cognition. Of this cohort 32.3% (n=11) were female, had a median age of 81.5 years and a median clinical frailty score of 5 (range 3-7). The average age of education completion was 14.8yrs. 3% (n=1) had no literacy skills, 23.5% (n=8) had limited and 73.5% (n=25) had good literacy skills. 56% (n=19) gave feedback on their experience. For 23.5% (n=8) it strongly mattered that they had this option. For the remainder, they were indifferent, as they were fluent in both languages. Conclusion We identified that for a proportion of our patient cohort having CGA conducted through Irish was of importance. Ancillary benefits included better understanding of interventions such as deprescribing and brain health techniques when communicated through their primary language.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360280","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 Low trauma hip fractures are serious and carry an estimated re-fracture rate of 10.6%, leading increased morbidity, mortality and healthcare cost. Intravenous Zolendronic Acid (IVZ) administration following hip fracture reduces re-fracture risk by approximately 23% and is recommended yearly for three years by National Osteoporosis Guidelines Group (NOGG) 2021. However, a significant treatment gap remains with only one-fifth of patients receiving IVZ pre-discharge, due to implementation challenges, such as suboptimal Vitamin D levels and lack of resources for yearly infusions. Recently published consensus guidelines offer practical advice as to how to overcome these barriers. This service evaluation estimates the proportion of hip fracture patients eligible for IVZ; as well as the re-fracture rate, prior to the introduction of a local IVZ pathway. Methods Approval from local Quality and Patient Safety Department was received. Low trauma hip fracture patients were identified from the local Orthogeriatric database (October 2019 to January 2021). Hospital electronic laboratory and radiology software were used to identify renal function on discharge and evidence of further fractures (at six months, 1 year and 3 years). Subjects were deemed potentially eligible for IVZ if they had an estimated glomerular filtration rate (eGFR) of ≥50 mls/min (a proxy for calculated creatinine clearance ≥30mls/min in this patient cohort). Results Of 463 subjects, 384 (82.9%) had an eGFR ≥50. Re-fracture data was collected for 263 eligible subjects. Seventeen (6.5%) re-fractured within six months, 21 (8%) re-fractured within a year and 45 (17.1%) re-fractured at any stage post discharge. Conclusion IVZ treatment is the most efficacious secondary fracture prevention post-hip fracture, and most patients are eligible for this treatment. Implementing IVZ pathways for hip fracture patients may significantly reduce re-fracture rate, however expansion of resources allocated to Orthogeriatrics and Fracture Liaison teams is required to successfully implement inpatient pathways and ongoing care.
{"title":"Estimating Patient Eligibility And Benefit Of Intravenous Zolendronic Acid In Hip Fracture Patients: A Service Evaluation","authors":"Tomás Ó Flatharta, Erica Walsh, Joshua Parris, Mubashra Ashraf, Suzanne Laffan, Niamh O'Regan","doi":"10.1093/ageing/afae178.199","DOIUrl":"https://doi.org/10.1093/ageing/afae178.199","url":null,"abstract":"Background Low trauma hip fractures are serious and carry an estimated re-fracture rate of 10.6%, leading increased morbidity, mortality and healthcare cost. Intravenous Zolendronic Acid (IVZ) administration following hip fracture reduces re-fracture risk by approximately 23% and is recommended yearly for three years by National Osteoporosis Guidelines Group (NOGG) 2021. However, a significant treatment gap remains with only one-fifth of patients receiving IVZ pre-discharge, due to implementation challenges, such as suboptimal Vitamin D levels and lack of resources for yearly infusions. Recently published consensus guidelines offer practical advice as to how to overcome these barriers. This service evaluation estimates the proportion of hip fracture patients eligible for IVZ; as well as the re-fracture rate, prior to the introduction of a local IVZ pathway. Methods Approval from local Quality and Patient Safety Department was received. Low trauma hip fracture patients were identified from the local Orthogeriatric database (October 2019 to January 2021). Hospital electronic laboratory and radiology software were used to identify renal function on discharge and evidence of further fractures (at six months, 1 year and 3 years). Subjects were deemed potentially eligible for IVZ if they had an estimated glomerular filtration rate (eGFR) of ≥50 mls/min (a proxy for calculated creatinine clearance ≥30mls/min in this patient cohort). Results Of 463 subjects, 384 (82.9%) had an eGFR ≥50. Re-fracture data was collected for 263 eligible subjects. Seventeen (6.5%) re-fractured within six months, 21 (8%) re-fractured within a year and 45 (17.1%) re-fractured at any stage post discharge. Conclusion IVZ treatment is the most efficacious secondary fracture prevention post-hip fracture, and most patients are eligible for this treatment. Implementing IVZ pathways for hip fracture patients may significantly reduce re-fracture rate, however expansion of resources allocated to Orthogeriatrics and Fracture Liaison teams is required to successfully implement inpatient pathways and ongoing care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329990","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/afae178.131
Michael Oyuga, John P McCormick, Hayley Power, Seán Ryan, Anne Regan, Robert Trueick, Fionn Nally, Faisal Al-Harthi, Patrick O'Boyle
Background Outcomes following in-hospital cardiac arrest remain poor despite advances in resuscitation techniques. Establishing “goals of care” is crucial to optimizing patient care and avoiding burdensome interventions in those who are unlikely to benefit from resuscitation. Doctors often avoid discussions regarding ‘goals of care’ with patients in whom cardiac arrest is not deemed likely at the time of admission. Methods All cardiac arrest team activations for non-pregnant, adult inpatients on medical and surgical wards at our institution from December 2022 – June 2023 were prospectively analysed. Qualitative analysis of inpatient charts was performed to assess; incidence of cardiac arrest, demographic and clinical data, and the degree to which discussions regarding escalation of care had taken place. Results 66 cardiac arrest team activations were screened, of which 23 calls were included for analysis. The estimated incidence of cardiac arrest was 1.11-1.67 events per 1,000 patient discharges. 18 patients (78.2%) were under the care of general medicine or geriatric teams at the time of arrest call. 12 (52%) patients were older than 70 and 4 (17%) were older than 80. Falls were the most common reason for admission (22.7%) among patients for whom the cardiac arrest team was activated. 2 patients (12.5%) with confirmed cardiac arrest survived to hospital discharge. Discussions regarding goals of care were documented for 8/23 patients (34.7%). Conclusion Cardiac arrests were uncommon in our institution. Discussions regarding goals of care were documented in only a third of cases, possibly because many patients presented with issues not typically associated with a risk of subsequent arrest. Given the low survival rates to discharge, routine discussion of goals of care should be considered at the point of admission in all patients who are unlikely to benefit from resuscitation, regardless of the presenting complaint.
{"title":"Goals of Care Discussions Among Patients Who Suffer Cardiac Arrest","authors":"Michael Oyuga, John P McCormick, Hayley Power, Seán Ryan, Anne Regan, Robert Trueick, Fionn Nally, Faisal Al-Harthi, Patrick O'Boyle","doi":"10.1093/ageing/afae178.131","DOIUrl":"https://doi.org/10.1093/ageing/afae178.131","url":null,"abstract":"Background Outcomes following in-hospital cardiac arrest remain poor despite advances in resuscitation techniques. Establishing “goals of care” is crucial to optimizing patient care and avoiding burdensome interventions in those who are unlikely to benefit from resuscitation. Doctors often avoid discussions regarding ‘goals of care’ with patients in whom cardiac arrest is not deemed likely at the time of admission. Methods All cardiac arrest team activations for non-pregnant, adult inpatients on medical and surgical wards at our institution from December 2022 – June 2023 were prospectively analysed. Qualitative analysis of inpatient charts was performed to assess; incidence of cardiac arrest, demographic and clinical data, and the degree to which discussions regarding escalation of care had taken place. Results 66 cardiac arrest team activations were screened, of which 23 calls were included for analysis. The estimated incidence of cardiac arrest was 1.11-1.67 events per 1,000 patient discharges. 18 patients (78.2%) were under the care of general medicine or geriatric teams at the time of arrest call. 12 (52%) patients were older than 70 and 4 (17%) were older than 80. Falls were the most common reason for admission (22.7%) among patients for whom the cardiac arrest team was activated. 2 patients (12.5%) with confirmed cardiac arrest survived to hospital discharge. Discussions regarding goals of care were documented for 8/23 patients (34.7%). Conclusion Cardiac arrests were uncommon in our institution. Discussions regarding goals of care were documented in only a third of cases, possibly because many patients presented with issues not typically associated with a risk of subsequent arrest. Given the low survival rates to discharge, routine discussion of goals of care should be considered at the point of admission in all patients who are unlikely to benefit from resuscitation, regardless of the presenting complaint.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360278","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 Our Long-Term Residential Care facility provides physiotherapy services for approximately 117 Day Care clients. As part of our local Quality Improvement Programme, we wished to assess client perception of Day Centre Functional physiotherapy classes to help ascertain their perception regarding exercise intensity of classes, ability to follow guidance in class and ask questions. Emphasis of the class is to promote a learning environment, improve health literacy and functional independence of clients. As Falls Prevention is key re National Programme for older people (NCOP) and National Frailty Education, questions related to falls frequency and fear of falls prevalence. Methods This was a survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years), This was a qualitative survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years) Results 70% response rate. 100% reported feeling comfortable asking Physio instructor questions & that exercise guidance was clear and understandable. 96% reported being physically able to keep up with class intensity. 80% reported class intensity as moderate, 20% as high, 0% reported class intensity as easy. 84% reported a fear of falling. 17% reported no fall in the previous year. 68% reported 1-3 falls, 15% reported > 3 falls in last year. Class attendances reported: 4% 0-5 classes, 18% 5-10 classes, 78% more than 10 classes. Conclusion Results obtained from the survey have provided worthwhile feedback and supports that Falls prevention measures should address fear of falls. Significant findings on client satisfaction/perception of exercise intensity noted. Next steps will include tailoring physiotherapy classes for this demographic to include fear of falling, optimising exercise intensity, promoting health literacy and best practice for exercise prescription. Also, consideration of further objective testing of balance post physio class programme period to ascertain success of exercise classes.
{"title":"Day Centre Functional Physiotherapy Classes for Older People; Client Survey","authors":"Eugene MacDonagh, Ruth Lordan, Florence Horsman Hogan","doi":"10.1093/ageing/afae178.058","DOIUrl":"https://doi.org/10.1093/ageing/afae178.058","url":null,"abstract":"Background Our Long-Term Residential Care facility provides physiotherapy services for approximately 117 Day Care clients. As part of our local Quality Improvement Programme, we wished to assess client perception of Day Centre Functional physiotherapy classes to help ascertain their perception regarding exercise intensity of classes, ability to follow guidance in class and ask questions. Emphasis of the class is to promote a learning environment, improve health literacy and functional independence of clients. As Falls Prevention is key re National Programme for older people (NCOP) and National Frailty Education, questions related to falls frequency and fear of falls prevalence. Methods This was a survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years), This was a qualitative survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years) Results 70% response rate. 100% reported feeling comfortable asking Physio instructor questions & that exercise guidance was clear and understandable. 96% reported being physically able to keep up with class intensity. 80% reported class intensity as moderate, 20% as high, 0% reported class intensity as easy. 84% reported a fear of falling. 17% reported no fall in the previous year. 68% reported 1-3 falls, 15% reported > 3 falls in last year. Class attendances reported: 4% 0-5 classes, 18% 5-10 classes, 78% more than 10 classes. Conclusion Results obtained from the survey have provided worthwhile feedback and supports that Falls prevention measures should address fear of falls. Significant findings on client satisfaction/perception of exercise intensity noted. Next steps will include tailoring physiotherapy classes for this demographic to include fear of falling, optimising exercise intensity, promoting health literacy and best practice for exercise prescription. Also, consideration of further objective testing of balance post physio class programme period to ascertain success of exercise classes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360276","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/afae178.091
Sara Solis, Brian Lawlor, Roman Romero-Ortuno
Background Standing poses a hemodynamic challenge for the cardiovascular system, regulated by neurohumoral reflexes. In 2023, an elevated blood pressure response upon standing was officially defined as a minimum 20 mmHg increase in systolic pressure during position changes, distinguishing Orthostatic Hypertension (OHT) as a condition where blood pressure exceeds 140 mmHg when standing. This new definition underscores the importance of understanding the implications of OHT on individuals' health and quality of life. Methods Retrospective study of the Technology Research for Independent Living (TRIL) Clinic at St. James’s Hospital, from August 2007 to May 2009. The population included healthy community-dwelling adults aged 60 and older. This study aimed to profile individuals with OHT, understand the predictors of this condition, and explore its association with biopsychosocial variables. Results In a study of 442 participants (67.7% female, mean age 72.7), we identified a prevalence rate of 12.9% for an exaggerated orthostatic pressor response and observed OHT in 6.1% of participants at the 120-second mark after standing. Additionally, significant associations were discovered between OHT and conditions such as heart failure, stroke, and the use of certain medications such as SSRI and ACE inhibitors. Conclusion The results of this study highlight the potential health consequences of OHT among older adults, particularly in those with pre-existing cardiovascular conditions. Further research is needed to explore this lesser-known but significant orthostatic disorder.
{"title":"Characteristics and Presentation of Orthostatic Hypertension in Community-Dwelling Older Adults","authors":"Sara Solis, Brian Lawlor, Roman Romero-Ortuno","doi":"10.1093/ageing/afae178.091","DOIUrl":"https://doi.org/10.1093/ageing/afae178.091","url":null,"abstract":"Background Standing poses a hemodynamic challenge for the cardiovascular system, regulated by neurohumoral reflexes. In 2023, an elevated blood pressure response upon standing was officially defined as a minimum 20 mmHg increase in systolic pressure during position changes, distinguishing Orthostatic Hypertension (OHT) as a condition where blood pressure exceeds 140 mmHg when standing. This new definition underscores the importance of understanding the implications of OHT on individuals' health and quality of life. Methods Retrospective study of the Technology Research for Independent Living (TRIL) Clinic at St. James’s Hospital, from August 2007 to May 2009. The population included healthy community-dwelling adults aged 60 and older. This study aimed to profile individuals with OHT, understand the predictors of this condition, and explore its association with biopsychosocial variables. Results In a study of 442 participants (67.7% female, mean age 72.7), we identified a prevalence rate of 12.9% for an exaggerated orthostatic pressor response and observed OHT in 6.1% of participants at the 120-second mark after standing. Additionally, significant associations were discovered between OHT and conditions such as heart failure, stroke, and the use of certain medications such as SSRI and ACE inhibitors. Conclusion The results of this study highlight the potential health consequences of OHT among older adults, particularly in those with pre-existing cardiovascular conditions. Further research is needed to explore this lesser-known but significant orthostatic disorder.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360208","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/afae178.154
Claire Gallagher, Ruth Staunton, Nichola Boyle
Background Clinical Specialist Teams (CST) are a foundational component of the Integrated Care Programme for Older Persons (ICPOP) providing care for older adults with complex needs, completing Comprehensive Geriatric Assessments (CGA) and supporting goals until outcomes are optimised (HSE, 2021). WHO (2014) estimates 400 million individuals worldwide are affected by hearing loss, with prevalence increasing with age. The WHO in 2024 recommended targeted hearing screening and interventions in older age. NICE guidelines (2023) issued specific recommendations for adults with suspected or diagnosed dementia or mild cognitive impairment (MCI). The aim of this study was to review current practice of sensory assessment with respect to these recommendations. Methods This is a retrospective audit to evaluate current practice against established standards and to identify areas for improvement to achieve best practice. This will form part of an ongoing quality improvement initiative. Data was collected using a team designed tool gathering information on sensory assessment, interventions and onward referrals. A sample of 65 ICPOP clients was chosen from the last quarter of 2023. Results Preliminary results: Conclusion Screening rates for sensory impairment in the CST is high but needs improvement to reach the target of 100%. Referral onto appropriate services for specialised sensory intervention is actioned adequately, but there is need for the CST to advise timely hearing and vision testing to clients in order to adhere to international guidelines, especially those clients with dementia/MCI.
{"title":"“Addressing the Silent Need”","authors":"Claire Gallagher, Ruth Staunton, Nichola Boyle","doi":"10.1093/ageing/afae178.154","DOIUrl":"https://doi.org/10.1093/ageing/afae178.154","url":null,"abstract":"Background Clinical Specialist Teams (CST) are a foundational component of the Integrated Care Programme for Older Persons (ICPOP) providing care for older adults with complex needs, completing Comprehensive Geriatric Assessments (CGA) and supporting goals until outcomes are optimised (HSE, 2021). WHO (2014) estimates 400 million individuals worldwide are affected by hearing loss, with prevalence increasing with age. The WHO in 2024 recommended targeted hearing screening and interventions in older age. NICE guidelines (2023) issued specific recommendations for adults with suspected or diagnosed dementia or mild cognitive impairment (MCI). The aim of this study was to review current practice of sensory assessment with respect to these recommendations. Methods This is a retrospective audit to evaluate current practice against established standards and to identify areas for improvement to achieve best practice. This will form part of an ongoing quality improvement initiative. Data was collected using a team designed tool gathering information on sensory assessment, interventions and onward referrals. A sample of 65 ICPOP clients was chosen from the last quarter of 2023. Results Preliminary results: Conclusion Screening rates for sensory impairment in the CST is high but needs improvement to reach the target of 100%. Referral onto appropriate services for specialised sensory intervention is actioned adequately, but there is need for the CST to advise timely hearing and vision testing to clients in order to adhere to international guidelines, especially those clients with dementia/MCI.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360275","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/afae178.001
Adam Dyer, Helena Dolphin, Laura Morrison, Antoinette O'Connor, Gavin Sedgwick, Conor Young, Emily Killeen, Conal Gallagher, Aoife McFeely, Eimear Connolly, Naomi Davey, Paddy Doyle, Paul Claffey, Shane Lyons, Christine Gaffney, Ruth Ennis, Cathy McHale, Jasmine Joseph, Graham Knight, Emmet Kelly, Cliona O'Farrelly, Aoife Fallon, Sean O'Dowd, Brian Lawlor, Nollaig Bourke, Sean Kennelly
Background There has been unprecedented progress in the development of blood-based biomarkers (BBMs such as p-tau217 to detect Alzheimer Disease (AD) pathology – characterised by the accumulation of Amyloid-Beta (Aβ) and hyper-phosphorylated tau (T). However, BBM performance in “real-world” memory clinic contexts remains unclear. Methods Using high-sensitivity immunoassays, plasma p-tau217 was assessed in 554 participants. Two cohorts were studied: (i) a memory clinic validation cohort of 108 older adults (69 ± 6.5 years; 54.6% female) with early cognitive symptoms and paired plasma/cerebrospinal fluid (CSF) at time of diagnostic Lumbar Puncture (LP) and (ii) a broader replication cohort of 446 individuals ranging from cognitively-unimpaired middle-aged adults to older adults with established AD with 18-month follow-up. Plasma P-tau217 performance was examined against clinically established CSF Aβ+/T+ cut-offs using Area-Under the Curve (AUC) analysis. Plasma cut-offs were optimised vs CSF based on maximal Youden index. Results In the memory clinic cohort, plasma p-tau217 exhibited excellent performance for the detection of Aβ pathology (AUC: 0.91, 0.86-0.97). Plasma p-tau217 was nearly 4-fold higher in Aβ+ (13.89; 7.36-19.0pg/mL) vs Aβ- (3.72; 2.80-4.09pg/mL, U = 230, p<0.001) participants. Plasma p-tau217 was superior in the identification of Aβ vs T pathology (p<0.05, DeLong Test) and outperformed p-tau181 and other BBMs(all p<0.05, DeLong Test). In the replication cohort, plasma p-tau217 maintained >90% accuracy for clinical AD and was significantly associated with clinically meaningful cognitive decline over 18 months (Odds Ratio 1.40; 1.06-1.85, p=0.02). In the initial memory clinic cohort, application of plasma p-tau217 as a diagnostic test would have reduced the need for LPs by over half (56.5%). Conclusion Plasma p-217 demonstrates excellent diagnostic and prognostic performance in older adults with AD, representing an amyloid-responsive measure which also predicts meaningful cognitive decline in established AD. Incorporation of plasma p-tau217 in memory clinic settings may substantially reduce the need for over half of diagnostic LPs.
{"title":"Plasma P-tau217 Demonstrates Excellent Diagnostic and Prognostic Performance as a Blood-Based Biomarker for Alzheimer Disease in Older Adults","authors":"Adam Dyer, Helena Dolphin, Laura Morrison, Antoinette O'Connor, Gavin Sedgwick, Conor Young, Emily Killeen, Conal Gallagher, Aoife McFeely, Eimear Connolly, Naomi Davey, Paddy Doyle, Paul Claffey, Shane Lyons, Christine Gaffney, Ruth Ennis, Cathy McHale, Jasmine Joseph, Graham Knight, Emmet Kelly, Cliona O'Farrelly, Aoife Fallon, Sean O'Dowd, Brian Lawlor, Nollaig Bourke, Sean Kennelly","doi":"10.1093/ageing/afae178.001","DOIUrl":"https://doi.org/10.1093/ageing/afae178.001","url":null,"abstract":"Background There has been unprecedented progress in the development of blood-based biomarkers (BBMs such as p-tau217 to detect Alzheimer Disease (AD) pathology – characterised by the accumulation of Amyloid-Beta (Aβ) and hyper-phosphorylated tau (T). However, BBM performance in “real-world” memory clinic contexts remains unclear. Methods Using high-sensitivity immunoassays, plasma p-tau217 was assessed in 554 participants. Two cohorts were studied: (i) a memory clinic validation cohort of 108 older adults (69 ± 6.5 years; 54.6% female) with early cognitive symptoms and paired plasma/cerebrospinal fluid (CSF) at time of diagnostic Lumbar Puncture (LP) and (ii) a broader replication cohort of 446 individuals ranging from cognitively-unimpaired middle-aged adults to older adults with established AD with 18-month follow-up. Plasma P-tau217 performance was examined against clinically established CSF Aβ+/T+ cut-offs using Area-Under the Curve (AUC) analysis. Plasma cut-offs were optimised vs CSF based on maximal Youden index. Results In the memory clinic cohort, plasma p-tau217 exhibited excellent performance for the detection of Aβ pathology (AUC: 0.91, 0.86-0.97). Plasma p-tau217 was nearly 4-fold higher in Aβ+ (13.89; 7.36-19.0pg/mL) vs Aβ- (3.72; 2.80-4.09pg/mL, U = 230, p&lt;0.001) participants. Plasma p-tau217 was superior in the identification of Aβ vs T pathology (p&lt;0.05, DeLong Test) and outperformed p-tau181 and other BBMs(all p&lt;0.05, DeLong Test). In the replication cohort, plasma p-tau217 maintained &gt;90% accuracy for clinical AD and was significantly associated with clinically meaningful cognitive decline over 18 months (Odds Ratio 1.40; 1.06-1.85, p=0.02). In the initial memory clinic cohort, application of plasma p-tau217 as a diagnostic test would have reduced the need for LPs by over half (56.5%). Conclusion Plasma p-217 demonstrates excellent diagnostic and prognostic performance in older adults with AD, representing an amyloid-responsive measure which also predicts meaningful cognitive decline in established AD. Incorporation of plasma p-tau217 in memory clinic settings may substantially reduce the need for over half of diagnostic LPs.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360132","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/afae178.307
Maeve Ryan, John Paul Yun, Niju Thomas, Una Moffatt, Paula Hickey, Grainne O'Malley
Background The American Heart Association scientific statement (2022) addressing inpatient stroke recommends the delivery of stroke-response training to all hospital staff. While performing a service evaluation on in-patient stroke metrics, we explored the self-perceived confidence levels of medical registrars at this hospital, and whether formal on-site teaching was received. We explored various components including awareness of local stroke protocol and teaching pedagogy. Methods Using Google Forms, a survey was sent to all medical registrars in our hospital. A 5-point Likert scale was used to assess the confidence levels of various topics. Results The response-rate was 63% (N=12). Fifty percent (N=6) of participants were on Higher Training Schemes while the remaining 50% (N=6) occupied standalone appointments. Most respondents (83%, N=10) reported experience managing an acute stroke as a registrar. Forty-two percent (N=5) of registrars ‘strongly agreed’ they were confident in assessment of acute stroke, with 50% (N=6) ‘agreeing’, and one respondent remaining ‘neutral’ (N=1). Some registrars were unfamiliar with local stroke protocol (23%, N=3). Half of respondents (50%, N=6) reported no formal teaching on acute stroke. Fifty percent (N=6) of registrars reported that most teaching occurred primarily on ward rounds, with 42% (N=5) reported teaching through lectures. The vast majority (83%, N=10) selected simulation as their preferred teaching method. Conclusion While our medical registrars were confident in their ability to assess and manage acute stroke, significant improvements can be made to ensure formal teaching is prioritized. As stroke protocol can change from site-to-site, it is crucial to define expectations and standards for registrars to ensure timely care for patients. There is a clear preference for simulation as a teaching pedagogy, hence we plan on introducing a formal stroke simulation curriculum. Stroke response is a multidisciplinary effort, hence future research directions include exploring stroke training in nurses, junior doctors, and other healthcare professionals.
{"title":"Evaluation Of Medical Registrar Confidence In Approach To Acute Stroke And Experience Of Stroke Teaching","authors":"Maeve Ryan, John Paul Yun, Niju Thomas, Una Moffatt, Paula Hickey, Grainne O'Malley","doi":"10.1093/ageing/afae178.307","DOIUrl":"https://doi.org/10.1093/ageing/afae178.307","url":null,"abstract":"Background The American Heart Association scientific statement (2022) addressing inpatient stroke recommends the delivery of stroke-response training to all hospital staff. While performing a service evaluation on in-patient stroke metrics, we explored the self-perceived confidence levels of medical registrars at this hospital, and whether formal on-site teaching was received. We explored various components including awareness of local stroke protocol and teaching pedagogy. Methods Using Google Forms, a survey was sent to all medical registrars in our hospital. A 5-point Likert scale was used to assess the confidence levels of various topics. Results The response-rate was 63% (N=12). Fifty percent (N=6) of participants were on Higher Training Schemes while the remaining 50% (N=6) occupied standalone appointments. Most respondents (83%, N=10) reported experience managing an acute stroke as a registrar. Forty-two percent (N=5) of registrars ‘strongly agreed’ they were confident in assessment of acute stroke, with 50% (N=6) ‘agreeing’, and one respondent remaining ‘neutral’ (N=1). Some registrars were unfamiliar with local stroke protocol (23%, N=3). Half of respondents (50%, N=6) reported no formal teaching on acute stroke. Fifty percent (N=6) of registrars reported that most teaching occurred primarily on ward rounds, with 42% (N=5) reported teaching through lectures. The vast majority (83%, N=10) selected simulation as their preferred teaching method. Conclusion While our medical registrars were confident in their ability to assess and manage acute stroke, significant improvements can be made to ensure formal teaching is prioritized. As stroke protocol can change from site-to-site, it is crucial to define expectations and standards for registrars to ensure timely care for patients. There is a clear preference for simulation as a teaching pedagogy, hence we plan on introducing a formal stroke simulation curriculum. Stroke response is a multidisciplinary effort, hence future research directions include exploring stroke training in nurses, junior doctors, and other healthcare professionals.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360137","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/afae178.323
Joshua Ramjohn, Joseph Kelly, Amal Abdalla, Ahmed Hamad, Juliana Carvalho, Ciara Gibbons, Lynn Quigley, Katherine Finan
Background Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national HSE guidelines after education sessions, comparing results with the pre-education audit in a Model 3 Hospital. Methods A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants. Results Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both of which were unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. This elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. Therefore, we posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan. Conclusion Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.
{"title":"DNAR: All or Nothing: Impact of Education Sessions Re-Audit in a Model 3 Hospital","authors":"Joshua Ramjohn, Joseph Kelly, Amal Abdalla, Ahmed Hamad, Juliana Carvalho, Ciara Gibbons, Lynn Quigley, Katherine Finan","doi":"10.1093/ageing/afae178.323","DOIUrl":"https://doi.org/10.1093/ageing/afae178.323","url":null,"abstract":"Background Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national HSE guidelines after education sessions, comparing results with the pre-education audit in a Model 3 Hospital. Methods A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants. Results Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both of which were unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. This elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. Therefore, we posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan. Conclusion Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360130","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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