Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.199
Timothy Atkinson, Rosemary Kelly
Background Frailty affects a significant proportion of patients attending emergency departments (ED), with estimates suggesting 10% of ED attendees and 30% of acute medical admissions are living with frailty. Delayed access to Comprehensive Geriatric Assessment (CGA) increases the risk of deconditioning, delirium, prolonged hospital stays and poorer outcomes. This project piloted a Frailty Intervention Team (FIT) in the ED, initially focused on early discharge, which evolved to support the principles of Realistic Medicine. Realistic Medicine seeks to ensure patient care is appropriate, evidence-based, and aligned with what matters most to patients and their families. Methods Over a four-week pilot in the ED of a large teaching hospital, 100 patients aged ≥75 with Clinical Frailty Scores ≥6, referred for medical admission, were assessed by a team comprising 1 geriatrician and 3 specialist nurses. Patients were identified via ED whiteboards and assessed face-to-face or virtually depending on resource availability and patient need. Where appropriate, elements of CGA were completed. Data collected included demographics, frailty scores, cognition, reason for attendance, intervention, and outcomes. Results The median age was 85. 71% lived at home and 47% had a diagnosis of dementia. CGA was initiated in 72% of cases. Early discharge was recommended in 42%, with 31% discharged within 24 hours. The 28-day readmission rate for this group was 17%. While the original aim was to identify alternatives to admission, the team’s role expanded—creating space for shared decision-making, anticipatory care planning, and aligning care with patient goals. This included avoiding burdensome interventions in those with life-limiting conditions, including advanced dementia and severe frailty. Conclusion Implementing an ED-based FIT enabled earlier, person-centred conversations and supported a cultural shift toward Realistic Medicine. The approach allowed for personalised care and multidisciplinary collaboration. Future service evaluation will include patient and staff feedback to further inform development and sustainability.
{"title":"Not Just Can We, But Should We? Implementing an ED Frailty Intervention Team and a Turn Toward Realistic Medicine","authors":"Timothy Atkinson, Rosemary Kelly","doi":"10.1093/ageing/afaf318.199","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.199","url":null,"abstract":"Background Frailty affects a significant proportion of patients attending emergency departments (ED), with estimates suggesting 10% of ED attendees and 30% of acute medical admissions are living with frailty. Delayed access to Comprehensive Geriatric Assessment (CGA) increases the risk of deconditioning, delirium, prolonged hospital stays and poorer outcomes. This project piloted a Frailty Intervention Team (FIT) in the ED, initially focused on early discharge, which evolved to support the principles of Realistic Medicine. Realistic Medicine seeks to ensure patient care is appropriate, evidence-based, and aligned with what matters most to patients and their families. Methods Over a four-week pilot in the ED of a large teaching hospital, 100 patients aged ≥75 with Clinical Frailty Scores ≥6, referred for medical admission, were assessed by a team comprising 1 geriatrician and 3 specialist nurses. Patients were identified via ED whiteboards and assessed face-to-face or virtually depending on resource availability and patient need. Where appropriate, elements of CGA were completed. Data collected included demographics, frailty scores, cognition, reason for attendance, intervention, and outcomes. Results The median age was 85. 71% lived at home and 47% had a diagnosis of dementia. CGA was initiated in 72% of cases. Early discharge was recommended in 42%, with 31% discharged within 24 hours. The 28-day readmission rate for this group was 17%. While the original aim was to identify alternatives to admission, the team’s role expanded—creating space for shared decision-making, anticipatory care planning, and aligning care with patient goals. This included avoiding burdensome interventions in those with life-limiting conditions, including advanced dementia and severe frailty. Conclusion Implementing an ED-based FIT enabled earlier, person-centred conversations and supported a cultural shift toward Realistic Medicine. The approach allowed for personalised care and multidisciplinary collaboration. Future service evaluation will include patient and staff feedback to further inform development and sustainability.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"127 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.125
Nicole Cosgrave, Vanessa Farnan, Basmah Karembaks, Anne-Marie Liddy, Rory Durcan, Karl Boyle, David Williams
Background Recurrent ischaemic strokes occur in 9-15% of patients within one year, the majority occurring within the first ninety days and up to 25% of patients who recover from a stroke are likely to have another stroke event within five years. Prompt introduction and optimisation of pharmacological therapy is essential for reducing recurrence. The mainstay of secondary prevention includes antiplatelet agents or anticoagulants, lipid lowering therapy and medications to optimise blood pressure and diabetes control. The primary aim of this study was to evaluate the current adherence to secondary prevention strategies in a tertiary stroke centre with a secondary aim of assessing achievement of target recommendations for LDL-C, HbA1c and blood pressure. Methods A retrospective chart review was conducted in a tertiary stroke centre. Patients were included if they were aged over 18 years and presenting to an outpatient stroke clinic with a diagnosis of an ischaemic stroke. Results A total of 49 patients were reviewed with 40 meeting our inclusion criteria. The median age was 69 years (range 42-90years) and 70% (n=28) were male. Four patients (10%) had a documented history of more than one ischaemic stroke. All patients were appropriately prescribed an anti-thrombotic agent and a cholesterol-lowering medication. 40% (n=16) of patients had LDL-C results above target (<1.8mmol/L; median 2; range 0.6-6.4). 30% (n=12) patients had a documented history of diabetes mellitus with a median HbA1c level of 42mmol/mol (range 28-87mmol/mol). No patient had a documented 24 hour blood pressure monitor result. Conclusion A significant number of patients attending their first follow-up appointment post stroke had inadequate lipid and diabetic control. Regular monitoring and target-driven therapy allow for regular optimisation of secondary prevention therapy which is crucial for improving clinical outcomes preventing recurrence.
{"title":"An evaluation of medical management for secondary prevention of ischaemic stroke in a tertiary stroke centre","authors":"Nicole Cosgrave, Vanessa Farnan, Basmah Karembaks, Anne-Marie Liddy, Rory Durcan, Karl Boyle, David Williams","doi":"10.1093/ageing/afaf318.125","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.125","url":null,"abstract":"Background Recurrent ischaemic strokes occur in 9-15% of patients within one year, the majority occurring within the first ninety days and up to 25% of patients who recover from a stroke are likely to have another stroke event within five years. Prompt introduction and optimisation of pharmacological therapy is essential for reducing recurrence. The mainstay of secondary prevention includes antiplatelet agents or anticoagulants, lipid lowering therapy and medications to optimise blood pressure and diabetes control. The primary aim of this study was to evaluate the current adherence to secondary prevention strategies in a tertiary stroke centre with a secondary aim of assessing achievement of target recommendations for LDL-C, HbA1c and blood pressure. Methods A retrospective chart review was conducted in a tertiary stroke centre. Patients were included if they were aged over 18 years and presenting to an outpatient stroke clinic with a diagnosis of an ischaemic stroke. Results A total of 49 patients were reviewed with 40 meeting our inclusion criteria. The median age was 69 years (range 42-90years) and 70% (n=28) were male. Four patients (10%) had a documented history of more than one ischaemic stroke. All patients were appropriately prescribed an anti-thrombotic agent and a cholesterol-lowering medication. 40% (n=16) of patients had LDL-C results above target (&lt;1.8mmol/L; median 2; range 0.6-6.4). 30% (n=12) patients had a documented history of diabetes mellitus with a median HbA1c level of 42mmol/mol (range 28-87mmol/mol). No patient had a documented 24 hour blood pressure monitor result. Conclusion A significant number of patients attending their first follow-up appointment post stroke had inadequate lipid and diabetic control. Regular monitoring and target-driven therapy allow for regular optimisation of secondary prevention therapy which is crucial for improving clinical outcomes preventing recurrence.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"372 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.187
Eimear Mullen, Graham Knight, Sinead Feehan, Sean Kennelly
Background The number of people living with a dementia in Ireland is projected to increase from 64,000 to 150,000 by 2045. The Health Service Executive Model of Care for Dementia outlines standardised care pathways to support individuals from the initial diagnostics through to post-diagnostic support. A Brain Health Clinic (BHC) offers individuals diagnosed with a Mild Cognitive Impairment (MCI), specific brain health interventions, including dietary optimisation strategies, to help prevent or slow the progression of cognitive impairment. In Ireland, there is no information on the nutritional profile and dietetic need for individuals diagnosed with a MCI. Methods A secure database containing anthropometry, biochemistry, and final scores from risk factor questionnaires, including the Mediterranean Diet Score Tool, of service users’ initial visit to the BHC was analysed. Further analysis of dietary quality was complete. Statistical analysis was complete on Microsoft Excel. Results Data from 101 individuals was analysed, of which 39% male and 61% female. The majority aged 70-79 years (45%), and an age range from 43 to 88 years. 74% had body mass index within the overweight or obese categories. 31% had low vitamin D status. 42% had low iron levels. 74% had low-to-moderate levels of physical activity. 82% had low-to-moderate adherence to the Mediterranean Diet. 53% used olive oil as their main cooking fat, however 9% took greater than 4 tablespoons of olive oil/day. 24% reported taking at least one glass of wine/day. Conclusion This is a timely piece of research due to an ageing population and increasing rates of dementia. This study demonstrates dietetics is required. Recommendations include:
{"title":"The Brain Health Clinic - Nutritional Profile Of Service Users","authors":"Eimear Mullen, Graham Knight, Sinead Feehan, Sean Kennelly","doi":"10.1093/ageing/afaf318.187","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.187","url":null,"abstract":"Background The number of people living with a dementia in Ireland is projected to increase from 64,000 to 150,000 by 2045. The Health Service Executive Model of Care for Dementia outlines standardised care pathways to support individuals from the initial diagnostics through to post-diagnostic support. A Brain Health Clinic (BHC) offers individuals diagnosed with a Mild Cognitive Impairment (MCI), specific brain health interventions, including dietary optimisation strategies, to help prevent or slow the progression of cognitive impairment. In Ireland, there is no information on the nutritional profile and dietetic need for individuals diagnosed with a MCI. Methods A secure database containing anthropometry, biochemistry, and final scores from risk factor questionnaires, including the Mediterranean Diet Score Tool, of service users’ initial visit to the BHC was analysed. Further analysis of dietary quality was complete. Statistical analysis was complete on Microsoft Excel. Results Data from 101 individuals was analysed, of which 39% male and 61% female. The majority aged 70-79 years (45%), and an age range from 43 to 88 years. 74% had body mass index within the overweight or obese categories. 31% had low vitamin D status. 42% had low iron levels. 74% had low-to-moderate levels of physical activity. 82% had low-to-moderate adherence to the Mediterranean Diet. 53% used olive oil as their main cooking fat, however 9% took greater than 4 tablespoons of olive oil/day. 24% reported taking at least one glass of wine/day. Conclusion This is a timely piece of research due to an ageing population and increasing rates of dementia. This study demonstrates dietetics is required. Recommendations include:","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"115 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.080
A Graham Cummiskey, Emma Higgisson, Colm Byrne, Brian Marsh
Background Ireland has an aging population, with the population over 75 projected to increase by 50% between 2022 and 2023. Collaborations, such as Orthopeadics and Trauma Geriatrics, have improved outcomes for older patients. The rise in older patients admitted to Intensive Care Units (ICU) demonstrates a need for further specialist Geriatrician input. Methods A descriptive snapshot of patients over 74 admitted to a quandary hospital’s ICU in 2023. Data collected over 12 months for the National Office of Clinical Audits (NOCA) ICU audit was evaluated for clinical frailty, mortality, and organ supports as a marker of level of care received. Results In 2023, 166 patients aged 75+ (mean 79) were admitted to ICU. Surgical admissions (N= 104) were more common in patients in their 70s; medical admissions (N=62) in those in their 80s. Only 2 patients in their 90s were admitted. The average CFS was 4, 19% were frail on admission to ICU. Mean organ support was 2, increased organ supports was correlated with increased age, but not mortality. Average ICU stay was 9 days (range 1–100). Majority of patients were discharged home or to referring hospital, 1 discharged to LTC. ICU mortality was 17% (29); additional hospital stay mortality 16% (26), further 1% (15) patients passed within the year. Total mortality of 42% in a year, patients in their 80’s (46%) and 90’s (100%) had higher mortality rates than patients in their 70’s (24%). Medical admissions were associated with high mortality (64%), but also higher age. Conclusion Increasing numbers of patients over 74, with increasing level of frailty are admitted to ICU. Overall ICU mortality was low, however there was increased mortality associated with the hospital admission. Geriatric expertise to manage multi-morbid frail patients is essential in the high intensity setting to ensure the best outcomes for patients.
{"title":"Frailty in Intensive Care: Demonstrating A Need For Geriatric ICU Service","authors":"A Graham Cummiskey, Emma Higgisson, Colm Byrne, Brian Marsh","doi":"10.1093/ageing/afaf318.080","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.080","url":null,"abstract":"Background Ireland has an aging population, with the population over 75 projected to increase by 50% between 2022 and 2023. Collaborations, such as Orthopeadics and Trauma Geriatrics, have improved outcomes for older patients. The rise in older patients admitted to Intensive Care Units (ICU) demonstrates a need for further specialist Geriatrician input. Methods A descriptive snapshot of patients over 74 admitted to a quandary hospital’s ICU in 2023. Data collected over 12 months for the National Office of Clinical Audits (NOCA) ICU audit was evaluated for clinical frailty, mortality, and organ supports as a marker of level of care received. Results In 2023, 166 patients aged 75+ (mean 79) were admitted to ICU. Surgical admissions (N= 104) were more common in patients in their 70s; medical admissions (N=62) in those in their 80s. Only 2 patients in their 90s were admitted. The average CFS was 4, 19% were frail on admission to ICU. Mean organ support was 2, increased organ supports was correlated with increased age, but not mortality. Average ICU stay was 9 days (range 1–100). Majority of patients were discharged home or to referring hospital, 1 discharged to LTC. ICU mortality was 17% (29); additional hospital stay mortality 16% (26), further 1% (15) patients passed within the year. Total mortality of 42% in a year, patients in their 80’s (46%) and 90’s (100%) had higher mortality rates than patients in their 70’s (24%). Medical admissions were associated with high mortality (64%), but also higher age. Conclusion Increasing numbers of patients over 74, with increasing level of frailty are admitted to ICU. Overall ICU mortality was low, however there was increased mortality associated with the hospital admission. Geriatric expertise to manage multi-morbid frail patients is essential in the high intensity setting to ensure the best outcomes for patients.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"26 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.134
Mikar Singh, Emily Buckley, Paul Dunne, Paul Maguire, Patrick Doyle, Tara Coughlan
Background Urinary incontinence is a common problem in older adults. Hospital-acquired incontinence can result in increased morbidity and increased length of stay. The aim of this audit was to assess hospital-acquired incontinence in older adults in an acute hospital. Methods This audit and re-audit was guided by Royal College of Physicians (RCP) National Audit of Continence Care (NACC) standard. A prospective audit was carried out over a three-day period on general medical and surgical wards at the beginning of continence awareness month. Nursing notes and medical charts on all patients over 65 years old were reviewed for documentation of continence status pre-admission, inpatient continence status, continence wear and reason for continence wear. A re-audit was conducted eight weeks later. Results All patients had a documented continence status. Fifty-nine patients were included in the initial audit. Forty-four were continent preadmission. Of these, twelve had documented incontinence wear as inpatients. Documented rationale for incontinence wear included frequency (n=2) secondary to [urinary tract infection (UTI) (n=1), and not documented (n=1)], mixed continence (n=1), cognition (n=1), mobility (n=7) and not documented (n=1). Sixty-eight patients were included in a re-audit. Forty patients were continent preadmission. Among them, fourteen had documented incontinence wear as an inpatient. Documented rationale for incontinence wear included frequency (n=1) with no documented reason, acutely unwell (n=1), cognition (n=5), mobility (n=3), reassurance (n=2) and not documented (n=2). Conclusion Although continence status was well documented, a significant number of patients who were continent pre-admission were using incontinence wear as inpatients. The rationale for incontinence wear varied significantly. The increase in incontinence wear usage between audits highlights the need for sustained proactive identification of patients at high risk for hospital-acquired incontinence. Future projects should focus on continence promotion strategies in this population, quality improvement and education of appropriate use of incontinence wear to mitigate these risks.
{"title":"Assessment Of Hospital-acquired Incontinence In An Acute Hospital: A Re-audit","authors":"Mikar Singh, Emily Buckley, Paul Dunne, Paul Maguire, Patrick Doyle, Tara Coughlan","doi":"10.1093/ageing/afaf318.134","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.134","url":null,"abstract":"Background Urinary incontinence is a common problem in older adults. Hospital-acquired incontinence can result in increased morbidity and increased length of stay. The aim of this audit was to assess hospital-acquired incontinence in older adults in an acute hospital. Methods This audit and re-audit was guided by Royal College of Physicians (RCP) National Audit of Continence Care (NACC) standard. A prospective audit was carried out over a three-day period on general medical and surgical wards at the beginning of continence awareness month. Nursing notes and medical charts on all patients over 65 years old were reviewed for documentation of continence status pre-admission, inpatient continence status, continence wear and reason for continence wear. A re-audit was conducted eight weeks later. Results All patients had a documented continence status. Fifty-nine patients were included in the initial audit. Forty-four were continent preadmission. Of these, twelve had documented incontinence wear as inpatients. Documented rationale for incontinence wear included frequency (n=2) secondary to [urinary tract infection (UTI) (n=1), and not documented (n=1)], mixed continence (n=1), cognition (n=1), mobility (n=7) and not documented (n=1). Sixty-eight patients were included in a re-audit. Forty patients were continent preadmission. Among them, fourteen had documented incontinence wear as an inpatient. Documented rationale for incontinence wear included frequency (n=1) with no documented reason, acutely unwell (n=1), cognition (n=5), mobility (n=3), reassurance (n=2) and not documented (n=2). Conclusion Although continence status was well documented, a significant number of patients who were continent pre-admission were using incontinence wear as inpatients. The rationale for incontinence wear varied significantly. The increase in incontinence wear usage between audits highlights the need for sustained proactive identification of patients at high risk for hospital-acquired incontinence. Future projects should focus on continence promotion strategies in this population, quality improvement and education of appropriate use of incontinence wear to mitigate these risks.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.077
Muhammad Arif Mohd Sofee, Elhussein AE Elhassan, Abhilasha Thapa, Orla Connaughton, Ciarán Donegan, Carmel Curran, Linda Brewer, Alan Moore
Background With cardiac arrest, the probability of survival-to-discharge diminishes with increasing morbidity. Discussion and documentation of ceilings of care are essential, as advanced age should not disqualify patients from resuscitation attempts. We audited documentation and communication adherence as per our Hospital’s "Do Not Attempt Resuscitation" (DNAR) policy. Methods We prospectively reviewed records of inpatients aged ≥65y admitted to our 70 acute and 20 rehabilitation beds between August 2024 and January 2025. All had admissions ≥48 hours. Baseline patient characteristics and DNAR decision factors were collected. Temporal patterns and DNAR documentation were assessed at three time-points: ≤48h, between 48h and 7 days, and >7 days. Univariate logistic regression analysis was performed to identify factors associated with incomplete DNAR forms. Results Of 289 adults admitted to our wards, 48 had a DNAR form completed [70.8% female; median age: 85.5y; median clinical frailty scale: 6 (IQR: 5-7)]. Most common reasons for admission were falls and sepsis (41.6%). Within 48 hours of admission, 60.4% of DNAR decisions were recorded. Decisions were based on clinical judgement (45.8%) and patient preferences or advance directives (22.9%). Rationale was not documented in one-third. The clinical team signed and dated 97.9% of DNAR forms while nursing staff signed only 18 (37.5%). In 16.7% cases, communication to patients and/or relatives around the treatment escalation plan and DNAR decision was completed. Males (Odds ratio (OR): 2.24; 95% confidence interval (CI): 0.23-21.14), early-documentation (≤48h) of DNAR (OR: 3.6; 95% CI; 0.58-22.01), higher frailty (frailty scale ≥6) (OR: 4; (95% CI:0.65-24.54) were more likely to have incomplete documentation, yet statistically insignificant (P value > 0.05). Conclusion We found suboptimal documentation of important decisions around DNAR in a cohort with high comorbidity burden. Continuous education and compliance promotion of DNAR documentation on our wards is necessary.
{"title":"Documentation and Discussion Patterns of Cardiopulmonary Resuscitation Decisions in Frail Adults","authors":"Muhammad Arif Mohd Sofee, Elhussein AE Elhassan, Abhilasha Thapa, Orla Connaughton, Ciarán Donegan, Carmel Curran, Linda Brewer, Alan Moore","doi":"10.1093/ageing/afaf318.077","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.077","url":null,"abstract":"Background With cardiac arrest, the probability of survival-to-discharge diminishes with increasing morbidity. Discussion and documentation of ceilings of care are essential, as advanced age should not disqualify patients from resuscitation attempts. We audited documentation and communication adherence as per our Hospital’s \"Do Not Attempt Resuscitation\" (DNAR) policy. Methods We prospectively reviewed records of inpatients aged ≥65y admitted to our 70 acute and 20 rehabilitation beds between August 2024 and January 2025. All had admissions ≥48 hours. Baseline patient characteristics and DNAR decision factors were collected. Temporal patterns and DNAR documentation were assessed at three time-points: ≤48h, between 48h and 7 days, and &gt;7 days. Univariate logistic regression analysis was performed to identify factors associated with incomplete DNAR forms. Results Of 289 adults admitted to our wards, 48 had a DNAR form completed [70.8% female; median age: 85.5y; median clinical frailty scale: 6 (IQR: 5-7)]. Most common reasons for admission were falls and sepsis (41.6%). Within 48 hours of admission, 60.4% of DNAR decisions were recorded. Decisions were based on clinical judgement (45.8%) and patient preferences or advance directives (22.9%). Rationale was not documented in one-third. The clinical team signed and dated 97.9% of DNAR forms while nursing staff signed only 18 (37.5%). In 16.7% cases, communication to patients and/or relatives around the treatment escalation plan and DNAR decision was completed. Males (Odds ratio (OR): 2.24; 95% confidence interval (CI): 0.23-21.14), early-documentation (≤48h) of DNAR (OR: 3.6; 95% CI; 0.58-22.01), higher frailty (frailty scale ≥6) (OR: 4; (95% CI:0.65-24.54) were more likely to have incomplete documentation, yet statistically insignificant (P value &gt; 0.05). Conclusion We found suboptimal documentation of important decisions around DNAR in a cohort with high comorbidity burden. Continuous education and compliance promotion of DNAR documentation on our wards is necessary.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"36 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.191
Robert M Callaghan, Kieran Dalton, Tony Foley, Rachel D Moloney, Christian Waeber, Irene Hartigan
Background Post-stroke mood changes currently affect a significant proportion of stroke survivors and are seldom recognised or treated in clinical practice. As general practitioners (GPs) typically know their patients well and see them regularly, they may be well-positioned to identify these mood changes. Methods A survey was distributed both postally and electronically to GPs currently practicing in Ireland assessing their beliefs around post-stroke mood changes, and confidence identifying and managing these conditions. Preferred treatment strategies and perceived barriers associated with identifying and managing these conditions were also explored. Quantitative data was analysed using descriptive and inferential statistics. A free-text section capturing any additional comments regarding GPs addressing post-stroke mood changes underwent reflexive thematic content analysis. Results Of 292 respondents, 85% agreed that currently post-stroke mood changes are underdiagnosed, and nearly two-thirds of GPs viewed themselves as the healthcare professionals most responsible for identifying and managing these mood changes. Despite this perceived responsibility, confidence in their ability to address these conditions were low, with only about one in four GPs expressing that they were at least very confident in their ability to both diagnose and manage post-stroke depression (27%), anxiety (26%), apathy (15%), and fatigue (15%). Similarly, the proportion of GPs that often or always screened for these conditions were low with post-stroke depression (45%), and anxiety (34%) being screened for more often than apathy (17%), and fatigue (23%). Conclusion This survey highlights that GPs often fail to diagnosis post-stroke mood changes in stroke survivors, presenting a crucial opportunity for earlier recognition. Enhanced support and resources are needed to help GPs effectively diagnose and manage symptoms such as low mood, fatigue and apathy. These findings can guide targeted resource allocation to overcome barriers in providing mental healthcare to stroke survivors.
{"title":"General Practitioners’ Views on Mental Health Following Stroke: Findings from a Cross-Sectional Study","authors":"Robert M Callaghan, Kieran Dalton, Tony Foley, Rachel D Moloney, Christian Waeber, Irene Hartigan","doi":"10.1093/ageing/afaf318.191","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.191","url":null,"abstract":"Background Post-stroke mood changes currently affect a significant proportion of stroke survivors and are seldom recognised or treated in clinical practice. As general practitioners (GPs) typically know their patients well and see them regularly, they may be well-positioned to identify these mood changes. Methods A survey was distributed both postally and electronically to GPs currently practicing in Ireland assessing their beliefs around post-stroke mood changes, and confidence identifying and managing these conditions. Preferred treatment strategies and perceived barriers associated with identifying and managing these conditions were also explored. Quantitative data was analysed using descriptive and inferential statistics. A free-text section capturing any additional comments regarding GPs addressing post-stroke mood changes underwent reflexive thematic content analysis. Results Of 292 respondents, 85% agreed that currently post-stroke mood changes are underdiagnosed, and nearly two-thirds of GPs viewed themselves as the healthcare professionals most responsible for identifying and managing these mood changes. Despite this perceived responsibility, confidence in their ability to address these conditions were low, with only about one in four GPs expressing that they were at least very confident in their ability to both diagnose and manage post-stroke depression (27%), anxiety (26%), apathy (15%), and fatigue (15%). Similarly, the proportion of GPs that often or always screened for these conditions were low with post-stroke depression (45%), and anxiety (34%) being screened for more often than apathy (17%), and fatigue (23%). Conclusion This survey highlights that GPs often fail to diagnosis post-stroke mood changes in stroke survivors, presenting a crucial opportunity for earlier recognition. Enhanced support and resources are needed to help GPs effectively diagnose and manage symptoms such as low mood, fatigue and apathy. These findings can guide targeted resource allocation to overcome barriers in providing mental healthcare to stroke survivors.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.057
Colin Barry, Suzanne Denieffe
Background Older adults are particularly vulnerable to the adverse health effects of energy hardship, which occurs when households cannot afford adequate energy for heating, cooling, or other essential needs. Their increased susceptibility is due to both physiological needs—such as maintaining higher indoor temperatures—and social factors like fixed incomes and isolation. Methods A scoping review was conducted using Arksey and O’Malley’s framework, examining literature from 2013–2024 across 12 databases. Only four studies focusing on energy hardship and health that included an older adult sample, were identified. Results Energy hardship was linked to worsened physical, mental, and cognitive health among older adults. Studies in China and Australia found that multidimensional energy poverty increased depression and cognitive decline in older populations, especially those living alone or in urban settings. A qualitative study in Australia revealed impacts including thermal discomfort, social exclusion, food insecurity, and delayed medical care. Many older adults did not recognize or report their energy hardship, leading to underestimation of the issue. One study proposed integrating energy assistance into in-home aged care, though stakeholder support was mixed. Conclusion Energy hardship has significant health consequences for older adults, compounding existing vulnerabilities. Mental health, physical wellbeing, and access to care are all negatively impacted. Despite clear risks, underreporting and policy gaps limit effective responses. There is a need for targeted interventions and for more inclusive data collection to capture hidden hardship in this group.
{"title":"Energy Poverty and Aging: A Scoping Review of Health Impacts and Policy Gaps","authors":"Colin Barry, Suzanne Denieffe","doi":"10.1093/ageing/afaf318.057","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.057","url":null,"abstract":"Background Older adults are particularly vulnerable to the adverse health effects of energy hardship, which occurs when households cannot afford adequate energy for heating, cooling, or other essential needs. Their increased susceptibility is due to both physiological needs—such as maintaining higher indoor temperatures—and social factors like fixed incomes and isolation. Methods A scoping review was conducted using Arksey and O’Malley’s framework, examining literature from 2013–2024 across 12 databases. Only four studies focusing on energy hardship and health that included an older adult sample, were identified. Results Energy hardship was linked to worsened physical, mental, and cognitive health among older adults. Studies in China and Australia found that multidimensional energy poverty increased depression and cognitive decline in older populations, especially those living alone or in urban settings. A qualitative study in Australia revealed impacts including thermal discomfort, social exclusion, food insecurity, and delayed medical care. Many older adults did not recognize or report their energy hardship, leading to underestimation of the issue. One study proposed integrating energy assistance into in-home aged care, though stakeholder support was mixed. Conclusion Energy hardship has significant health consequences for older adults, compounding existing vulnerabilities. Mental health, physical wellbeing, and access to care are all negatively impacted. Despite clear risks, underreporting and policy gaps limit effective responses. There is a need for targeted interventions and for more inclusive data collection to capture hidden hardship in this group.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"124 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.194
Siobhan Ryan, Walid Baloch, Aine O'Reilly, Lorna King, Karen Sayers, Christina Donnellan
Background Frailty and delirium are associated with adverse clinical outcomes in hospitalised older adults. Specialist geriatric ward admission improves care. Screening for both conditions has been introduced to an Irish teaching hospital Emergency Department (ED). The profile of these conditions was studied to identify service needs. Methods A retrospective study of all inpatients ≥70 years admitted following ED presentation was completed on a specified date in February 2025. Records of frailty screening in ED using the Variable Indicative of Placement (VIP) score and delirium screening in ED using the 4AT score were assessed. Data collated on Excel was analysed using Chi-square tests. Results In the 256 bedded hospital, 166 patients aged ≥70 years were admitted through ED. The mean age was 80.65 (SD=6.99) years. Eighty-five (51.2%) were female and were significantly older than male patients (p<0.01). Screening for frailty was completed in 166 (100%) patients and delirium in 87 (52.4%) patients. The prevalence of frailty was 68% (n=113) and of delirium, in those screened was 27.6% (n=24). Twenty one (87.5%) patients who had delirium were frail. Frailty was associated with a higher likelihood of having delirium (p=0.037) and being older than non-frail patients (p<0.001). There was no significant gender difference in prevalence of frailty (p=0.296) or delirium (p=0.343). Frail patients were admitted under 12 different specialists (including 2 geriatricians) to all 11 acute wards. Conclusion Frailty and delirium are prevalent in older patients in hospital and highlight the need to implement hospital wide age friendly healthcare to ensure optimal outcomes.
{"title":"Profile of Frailty and Delirium in Older Adults in an Irish Teaching Hospital","authors":"Siobhan Ryan, Walid Baloch, Aine O'Reilly, Lorna King, Karen Sayers, Christina Donnellan","doi":"10.1093/ageing/afaf318.194","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.194","url":null,"abstract":"Background Frailty and delirium are associated with adverse clinical outcomes in hospitalised older adults. Specialist geriatric ward admission improves care. Screening for both conditions has been introduced to an Irish teaching hospital Emergency Department (ED). The profile of these conditions was studied to identify service needs. Methods A retrospective study of all inpatients ≥70 years admitted following ED presentation was completed on a specified date in February 2025. Records of frailty screening in ED using the Variable Indicative of Placement (VIP) score and delirium screening in ED using the 4AT score were assessed. Data collated on Excel was analysed using Chi-square tests. Results In the 256 bedded hospital, 166 patients aged ≥70 years were admitted through ED. The mean age was 80.65 (SD=6.99) years. Eighty-five (51.2%) were female and were significantly older than male patients (p&lt;0.01). Screening for frailty was completed in 166 (100%) patients and delirium in 87 (52.4%) patients. The prevalence of frailty was 68% (n=113) and of delirium, in those screened was 27.6% (n=24). Twenty one (87.5%) patients who had delirium were frail. Frailty was associated with a higher likelihood of having delirium (p=0.037) and being older than non-frail patients (p&lt;0.001). There was no significant gender difference in prevalence of frailty (p=0.296) or delirium (p=0.343). Frail patients were admitted under 12 different specialists (including 2 geriatricians) to all 11 acute wards. Conclusion Frailty and delirium are prevalent in older patients in hospital and highlight the need to implement hospital wide age friendly healthcare to ensure optimal outcomes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"34 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1093/ageing/afaf318.062
Haodong Wei
Background Frailty, translated into Chinese as “衰弱”, combining “衰” (decline) and “弱” (weakness), is increasingly recognised as a key factor in designing sustainable, age-friendly healthcare systems. In China, frailty research began relatively late. Western standards often lack applicability among Chinese older adults, particularly those with differing health beliefs. The influence of Traditional Chinese Medicine also introduces culturally specific understandings that may obscure or conflict with standard definitions. Without clear, localised frameworks, frailty identification, assessment and care risk being delayed or fragmented. This makes the development of culturally appropriate definitions urgent for both policy and clinical practice. The lack of shared understanding between policy-makers and practitioners further complicates early identification and service integration. Methods A systematic review is underway, examining Chinese biomedical literature from 2014 to 2024. Articles are retrieved using the term “衰弱” from databases such as Chinese Medical Journal, SinoMed, and others. Definitions are categorised by source (original/adapted), conceptual aspect (biological, psychological, sociological), and features including stress, vulnerability, dynamicity, reversibility, and geriatric syndromes. Results Most studies cite existing definitions rather than propose new ones. Following the Chinese Geriatrics Society’s official definition, more articles have adopted its content as a standard reference. Stress and vulnerability frequently co-occur with geriatric syndromes, while dynamicity and reversibility are less commonly mentioned. Although awareness of frailty’s modifiable nature is increasing, psychological and social dimensions remain underrepresented. Some authors still rely solely on Western frameworks, resulting in a fragmented conceptual landscape. Conclusion Findings highlight the need for consistent and culturally adapted frailty definitions to support age-friendly clinical assessment and service design in China. By clarifying key features and gaps, this review lays a foundation for further research and contributes to developing healthcare models that are both sustainable and culturally sensitive. Aligning frailty definitions with local beliefs and clinical realities will support more equitable and age-inclusive service delivery.
{"title":"Frailty Definitions In Chinese Literature: A Systematic Review To Inform Age-Friendly Healthcare","authors":"Haodong Wei","doi":"10.1093/ageing/afaf318.062","DOIUrl":"https://doi.org/10.1093/ageing/afaf318.062","url":null,"abstract":"Background Frailty, translated into Chinese as “衰弱”, combining “衰” (decline) and “弱” (weakness), is increasingly recognised as a key factor in designing sustainable, age-friendly healthcare systems. In China, frailty research began relatively late. Western standards often lack applicability among Chinese older adults, particularly those with differing health beliefs. The influence of Traditional Chinese Medicine also introduces culturally specific understandings that may obscure or conflict with standard definitions. Without clear, localised frameworks, frailty identification, assessment and care risk being delayed or fragmented. This makes the development of culturally appropriate definitions urgent for both policy and clinical practice. The lack of shared understanding between policy-makers and practitioners further complicates early identification and service integration. Methods A systematic review is underway, examining Chinese biomedical literature from 2014 to 2024. Articles are retrieved using the term “衰弱” from databases such as Chinese Medical Journal, SinoMed, and others. Definitions are categorised by source (original/adapted), conceptual aspect (biological, psychological, sociological), and features including stress, vulnerability, dynamicity, reversibility, and geriatric syndromes. Results Most studies cite existing definitions rather than propose new ones. Following the Chinese Geriatrics Society’s official definition, more articles have adopted its content as a standard reference. Stress and vulnerability frequently co-occur with geriatric syndromes, while dynamicity and reversibility are less commonly mentioned. Although awareness of frailty’s modifiable nature is increasing, psychological and social dimensions remain underrepresented. Some authors still rely solely on Western frameworks, resulting in a fragmented conceptual landscape. Conclusion Findings highlight the need for consistent and culturally adapted frailty definitions to support age-friendly clinical assessment and service design in China. By clarifying key features and gaps, this review lays a foundation for further research and contributes to developing healthcare models that are both sustainable and culturally sensitive. Aligning frailty definitions with local beliefs and clinical realities will support more equitable and age-inclusive service delivery.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"29 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673972","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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