Background Falls are a common complaint of older adults who present to the Pathfinder service. Pathfinder offers alternative care pathways to older adults when they phone 999 for low acuity concerns. As part of the service, Occupational Therapists and Physiotherapists provide home-based assessments and interventions. The aims of this project were firstly, to develop a falls assessment tool to assist therapists’ compliance with guidelines relating to older adults who have fallen and secondly, to ensure consistency of assessment and intervention among therapists on the team. Methods A falls assessment tool was created in line with the most recent world falls guidelines (Montero-Odasso et al., 2022). The initial roll out began on October 1st, 2024, when the tool was used to assess older adults who presented to the Pathfinder service following a fall. After three months, areas of poor compliance and barriers with usability of the tool were highlighted from a chart review and stakeholder engagement. The document was then revised based on this feedback. From February 1st, 2024, the tool was then used with all older adults who presented to the service. Compliance was re-audited at the end of April 2024 and therapists on the team were surveyed to gather user feedback. Results As a result of the falls assessment tool, compliance with the World Falls Guidelines increased initially from 54% to 86% but continued to improve when reviewed seven months post implementation. Qualitative data was universally positive when stakeholders were surveyed with benefits identified as: improving patient care, consistency across the therapy team and a useful means of communication. Conclusion The development and implementation of a falls assessment tool into the practice of a Pathfinder service increased compliance with the most recent world falls guidelines and received positive feedback from all key stakeholders.
{"title":"The Development And Implementation Of A Multi-Factorial Falls Assessment Tool In A Pathfinder Service","authors":"Bríd O'Donoghue, Dearbhla Burke, Breda Meagher, Aislinn Griffin","doi":"10.1093/ageing/afae178.082","DOIUrl":"https://doi.org/10.1093/ageing/afae178.082","url":null,"abstract":"Background Falls are a common complaint of older adults who present to the Pathfinder service. Pathfinder offers alternative care pathways to older adults when they phone 999 for low acuity concerns. As part of the service, Occupational Therapists and Physiotherapists provide home-based assessments and interventions. The aims of this project were firstly, to develop a falls assessment tool to assist therapists’ compliance with guidelines relating to older adults who have fallen and secondly, to ensure consistency of assessment and intervention among therapists on the team. Methods A falls assessment tool was created in line with the most recent world falls guidelines (Montero-Odasso et al., 2022). The initial roll out began on October 1st, 2024, when the tool was used to assess older adults who presented to the Pathfinder service following a fall. After three months, areas of poor compliance and barriers with usability of the tool were highlighted from a chart review and stakeholder engagement. The document was then revised based on this feedback. From February 1st, 2024, the tool was then used with all older adults who presented to the service. Compliance was re-audited at the end of April 2024 and therapists on the team were surveyed to gather user feedback. Results As a result of the falls assessment tool, compliance with the World Falls Guidelines increased initially from 54% to 86% but continued to improve when reviewed seven months post implementation. Qualitative data was universally positive when stakeholders were surveyed with benefits identified as: improving patient care, consistency across the therapy team and a useful means of communication. Conclusion The development and implementation of a falls assessment tool into the practice of a Pathfinder service increased compliance with the most recent world falls guidelines and received positive feedback from all key stakeholders.","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":"142360214","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/afae178.302
Graceann O'Donnell, Olivia Harte, Carole McFadden, Eleanor Gallagher, Aine Slevin, Joseph Thomas, Ken Mulpeter
Background Hip fractures are a significant cause of morbidity and mortality in older adults. Bone health assessment is key in the reduction of future fracture risk. The aim of our study was to examine the adherence to the fifth Irish Hip Fracture Standard in patients >=70 years presenting to Letterkenny University Hospital (LUH) with a hip fracture and to examine the number of patients who were commenced on bone protection. Methods We included patients >=70 years who were admitted under the Orthopaedic service following a hip fracture between January and June 2023 in LUH and were identified the database maintained by the using Fracture Liaison Nurse. Data collected included age, month in which hip fracture occurred, patient resident in Ireland, patient alive/deceased, patient on bone protection prior to fracture, patient commenced on bone protection or patient declined treatment. Data was recorded in a Microsoft excel spreadsheet and was analysed by the clinical audit facilitator. We measured our data against the British Geriatric Society guideline on the use of IV zoledronate following hip fracture. Results 76 patients were admitted to LUH with a hip fracture >=70 years between January and June 2023. 100% of patients were reviewed by the fracture liaison service and following this it was recommended that 46 patients (60%) be commenced on bone protection. A letter was sent to each patient’s General Practitioner outlining the recommendation for bone protection. On follow up only 7/46 (15.2%) had been started on treatment. Conclusion The fracture liaison service is appropriately identifying patients who require treatment, despite this, patients are not starting the necessary bone protection in the community. This has prompted our service to establish an IV zoledronate clinic for patients following hip fracture and to generate a plan for ongoing treatment of this patient cohort.
{"title":"An Audit of the Fifth Irish Hip Fracture Standard in patients >=70 years following hip fracture","authors":"Graceann O'Donnell, Olivia Harte, Carole McFadden, Eleanor Gallagher, Aine Slevin, Joseph Thomas, Ken Mulpeter","doi":"10.1093/ageing/afae178.302","DOIUrl":"https://doi.org/10.1093/ageing/afae178.302","url":null,"abstract":"Background Hip fractures are a significant cause of morbidity and mortality in older adults. Bone health assessment is key in the reduction of future fracture risk. The aim of our study was to examine the adherence to the fifth Irish Hip Fracture Standard in patients >=70 years presenting to Letterkenny University Hospital (LUH) with a hip fracture and to examine the number of patients who were commenced on bone protection. Methods We included patients >=70 years who were admitted under the Orthopaedic service following a hip fracture between January and June 2023 in LUH and were identified the database maintained by the using Fracture Liaison Nurse. Data collected included age, month in which hip fracture occurred, patient resident in Ireland, patient alive/deceased, patient on bone protection prior to fracture, patient commenced on bone protection or patient declined treatment. Data was recorded in a Microsoft excel spreadsheet and was analysed by the clinical audit facilitator. We measured our data against the British Geriatric Society guideline on the use of IV zoledronate following hip fracture. Results 76 patients were admitted to LUH with a hip fracture >=70 years between January and June 2023. 100% of patients were reviewed by the fracture liaison service and following this it was recommended that 46 patients (60%) be commenced on bone protection. A letter was sent to each patient’s General Practitioner outlining the recommendation for bone protection. On follow up only 7/46 (15.2%) had been started on treatment. Conclusion The fracture liaison service is appropriately identifying patients who require treatment, despite this, patients are not starting the necessary bone protection in the community. This has prompted our service to establish an IV zoledronate clinic for patients following hip fracture and to generate a plan for ongoing treatment of this patient cohort.","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":"142360108","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/afae178.021
Helena Dolphin, Adam H Dyer, Tim Dukelow, Ciaran Finucane, Amparo Zamora Gomollo, Sean Commins, Sean P Kennelly
Background New treatments are urgently needed for individuals with Mild Cognitive Impairment (MCI) - in particular for those with amnestic MCI, of whom a high proportion have underlying Alzheimer's Disease (AD). Transcutaneous Vagus Nerve Stimulation (tVNS) is a non-invasive neuro-modulatory treatment which has not been extensively examined in older adults with amnestic MCI. Methods A single site, single-blind, randomised three-arm crossover pilot trial of acute (60 minutes) tVNS (baseline, sham or active stimulation) was conducted a Regional Specialist Memory Service. Forty participants (age 71.7 ±6.9; 22/40 male) with diagnosed amnestic MCI were recruited. Given the links between AD and neuro-cardiovascular instability, potential adverse effects of active tVNS were assessed using beat-to-beat peripheral (Blood Pressure (BP) and Heart Rate [HR]) and central (via Near Infra-red Spectroscopy) haemodynamic responses to Active Stand (AS). Cognition was assessed between 21.3 ±4.9 and 60.5 ±4.4 minutes using a domain-specific cognitive performance battery with results analysed using mixed-effects linear regression. Results In older adults with amnestic MCI, tVNS was safe, tolerable and acceptable with 98% of participants stating they would use the device again. There was no significant effect on BP, or HR responses to AS and cerebral oxygenation remained stable during AS. After tVNS stimulation, performance on tests of spatial navigation were significantly improved compared to both baseline (ß= -8.76; [-14.91, -2.56]; p=0.01) and sham (ß= -4.15; [-7.32, -0.99]; p=0.01) conditions. Conclusion tVNS is a safe and tolerable treatment modality in older adults with amnestic MCI. Future studies should explore sustained effects and feasibility of domiciliary use.
{"title":"Investigating Transcutaneous Vagus Nerve Stimulation in Amnestic Mild Cognitive Impairment","authors":"Helena Dolphin, Adam H Dyer, Tim Dukelow, Ciaran Finucane, Amparo Zamora Gomollo, Sean Commins, Sean P Kennelly","doi":"10.1093/ageing/afae178.021","DOIUrl":"https://doi.org/10.1093/ageing/afae178.021","url":null,"abstract":"Background New treatments are urgently needed for individuals with Mild Cognitive Impairment (MCI) - in particular for those with amnestic MCI, of whom a high proportion have underlying Alzheimer's Disease (AD). Transcutaneous Vagus Nerve Stimulation (tVNS) is a non-invasive neuro-modulatory treatment which has not been extensively examined in older adults with amnestic MCI. Methods A single site, single-blind, randomised three-arm crossover pilot trial of acute (60 minutes) tVNS (baseline, sham or active stimulation) was conducted a Regional Specialist Memory Service. Forty participants (age 71.7 ±6.9; 22/40 male) with diagnosed amnestic MCI were recruited. Given the links between AD and neuro-cardiovascular instability, potential adverse effects of active tVNS were assessed using beat-to-beat peripheral (Blood Pressure (BP) and Heart Rate [HR]) and central (via Near Infra-red Spectroscopy) haemodynamic responses to Active Stand (AS). Cognition was assessed between 21.3 ±4.9 and 60.5 ±4.4 minutes using a domain-specific cognitive performance battery with results analysed using mixed-effects linear regression. Results In older adults with amnestic MCI, tVNS was safe, tolerable and acceptable with 98% of participants stating they would use the device again. There was no significant effect on BP, or HR responses to AS and cerebral oxygenation remained stable during AS. After tVNS stimulation, performance on tests of spatial navigation were significantly improved compared to both baseline (ß= -8.76; [-14.91, -2.56]; p=0.01) and sham (ß= -4.15; [-7.32, -0.99]; p=0.01) conditions. Conclusion tVNS is a safe and tolerable treatment modality in older adults with amnestic MCI. Future studies should explore sustained effects and feasibility of domiciliary use.","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":"142360133","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/afae178.208
Sarah Donnelly, Marie Ward, Donlon Josephine, Una Geary, Paula Markey, Sharon O'Hara, Una Healy, Sinead McGarry
Background The idea that older people can be victims of unwanted sexual behaviour or sexual assault in health and social care settings is relatively recent. In the Irish context, 165 reports of sexual abuse of older people were made to the HSE National Safeguarding and Protection teams in 2022. The prevalence of sexual abuse against older people in health and social care settings is poorly understood and there is an acknowledgement that hospital staff require additional training to understand and manage incidents. Methods In response to the need for training and support for staff, an online awareness-raising course based on a pre-developed course from Australia ‘Preventing unwanted sexual behaviour against older people in health and social care settings’ will be adapted, trialled and tested in a large acute teaching hospital. This course sets out to support acute care staff to identify and manage incidents of sexualised behaviour, to seek expert help and to ensure that older people are protected from unwanted and at times, what may constitute illegal sexual behaviour. Results The adapted course ‘Understanding and Responding to Unwanted or Illegal Sexual Behaviour Perpetrated against Older People in Health and Social Care Settings’ utilises a trauma-informed lens and key themes covered include defining unwanted sexual behaviours, understanding older people and sexual behaviour, risk factors for sexual abuse, barriers to recognising and reporting abuse and managing incidents. Conclusion The ‘trial and test’ will involve a feedback survey (N=50 respondents) and focus groups with participating healthcare professionals from the hospital site informing further refinement of the course content in preparation for wider rollout and implementation across Ireland's health and social care settings.
{"title":"Developing An Online Course To Increase Staff Awareness And Responses To Unwanted And Illegal Sexual Behaviour Perpetrated Against Older People","authors":"Sarah Donnelly, Marie Ward, Donlon Josephine, Una Geary, Paula Markey, Sharon O'Hara, Una Healy, Sinead McGarry","doi":"10.1093/ageing/afae178.208","DOIUrl":"https://doi.org/10.1093/ageing/afae178.208","url":null,"abstract":"Background The idea that older people can be victims of unwanted sexual behaviour or sexual assault in health and social care settings is relatively recent. In the Irish context, 165 reports of sexual abuse of older people were made to the HSE National Safeguarding and Protection teams in 2022. The prevalence of sexual abuse against older people in health and social care settings is poorly understood and there is an acknowledgement that hospital staff require additional training to understand and manage incidents. Methods In response to the need for training and support for staff, an online awareness-raising course based on a pre-developed course from Australia ‘Preventing unwanted sexual behaviour against older people in health and social care settings’ will be adapted, trialled and tested in a large acute teaching hospital. This course sets out to support acute care staff to identify and manage incidents of sexualised behaviour, to seek expert help and to ensure that older people are protected from unwanted and at times, what may constitute illegal sexual behaviour. Results The adapted course ‘Understanding and Responding to Unwanted or Illegal Sexual Behaviour Perpetrated against Older People in Health and Social Care Settings’ utilises a trauma-informed lens and key themes covered include defining unwanted sexual behaviours, understanding older people and sexual behaviour, risk factors for sexual abuse, barriers to recognising and reporting abuse and managing incidents. Conclusion The ‘trial and test’ will involve a feedback survey (N=50 respondents) and focus groups with participating healthcare professionals from the hospital site informing further refinement of the course content in preparation for wider rollout and implementation across Ireland's health and social care settings.","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":"142360174","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/afae178.067
Maeve Scanlan, Emer Harte, Evelyn Newell
Background The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations. Methods In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this. Results 9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received. Conclusion Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.
{"title":"Assessing Adherence to Acute Stroke Therapy Guidelines: An Audit Study","authors":"Maeve Scanlan, Emer Harte, Evelyn Newell","doi":"10.1093/ageing/afae178.067","DOIUrl":"https://doi.org/10.1093/ageing/afae178.067","url":null,"abstract":"Background The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations. Methods In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this. Results 9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received. Conclusion Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.","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":"142360169","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/afae178.088
Niamh Cleary, Andrew Davies, Roman Romero-Ortuno, Amanda Lavan
Background Frailty is common in older patients referred to specialist palliative care teams. Its prevalence is estimated at 18% [1]. It is regarded as a “state of vulnerability” [2] in which even a minor stressor may result in adverse health outcomes [3] and mortality [4] independently of chronological age [5]. Oral problems in older patients may also be associated with increased morbidity and mortality [6, 7]. There may be an indirect interplay between oral problems and frailty. Oral symptoms like xerostomia are common in older patients. There is a paucity of research examining oral symptoms specifically in older patients with frailty. Thus, the prevalence of many oral symptoms is not known in this patient group. Methods The aims of this study were to determine the prevalence of oral symptoms in older patients with frailty and to determine their clinical features using the Oral Symptom Assessment Scale (with the addition of the symptom of drooling). This prospective observational study was conducted at Our Lady’s Hospice and Care Services, Dublin, and St James’ Hospital, Dublin. Once informed consent was obtained, participants completed the OSAS. Clinical Frailty Scale score, medications, co-morbidities and basic demographics were also recorded. Results Data from the first 100 participants recruited to the study is presented. Ninety-one participants reported at least one oral symptom. Two symptoms was the most frequent number of oral symptoms experienced (19%, 19/100). The median number of symptoms present was 4 (range: 0–13 symptoms). Forty participants reported the “new” symptom of “drooling”. Conclusion Asking about oral symptoms is important in this patient group. Initial data analysis suggests that many oral symptoms are common (and often of high impact). This study provides a novel insight into the prevalence and clinical features of oral symptoms not previously investigated using a multi-dimensional symptom-specific assessment too.
{"title":"Oral Symptom Assessment In Older Patients with Frailty Using the Oral Symptom Assessment Scale","authors":"Niamh Cleary, Andrew Davies, Roman Romero-Ortuno, Amanda Lavan","doi":"10.1093/ageing/afae178.088","DOIUrl":"https://doi.org/10.1093/ageing/afae178.088","url":null,"abstract":"Background Frailty is common in older patients referred to specialist palliative care teams. Its prevalence is estimated at 18% [1]. It is regarded as a “state of vulnerability” [2] in which even a minor stressor may result in adverse health outcomes [3] and mortality [4] independently of chronological age [5]. Oral problems in older patients may also be associated with increased morbidity and mortality [6, 7]. There may be an indirect interplay between oral problems and frailty. Oral symptoms like xerostomia are common in older patients. There is a paucity of research examining oral symptoms specifically in older patients with frailty. Thus, the prevalence of many oral symptoms is not known in this patient group. Methods The aims of this study were to determine the prevalence of oral symptoms in older patients with frailty and to determine their clinical features using the Oral Symptom Assessment Scale (with the addition of the symptom of drooling). This prospective observational study was conducted at Our Lady’s Hospice and Care Services, Dublin, and St James’ Hospital, Dublin. Once informed consent was obtained, participants completed the OSAS. Clinical Frailty Scale score, medications, co-morbidities and basic demographics were also recorded. Results Data from the first 100 participants recruited to the study is presented. Ninety-one participants reported at least one oral symptom. Two symptoms was the most frequent number of oral symptoms experienced (19%, 19/100). The median number of symptoms present was 4 (range: 0–13 symptoms). Forty participants reported the “new” symptom of “drooling”. Conclusion Asking about oral symptoms is important in this patient group. Initial data analysis suggests that many oral symptoms are common (and often of high impact). This study provides a novel insight into the prevalence and clinical features of oral symptoms not previously investigated using a multi-dimensional symptom-specific assessment too.","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":"142360207","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/afae178.063
Siobhán Murphy, Kate Steele, Sheena Murphy
Background The aim of the interim evaluation report is to provide the Caru Programme team with information on the impact of the Programme to date and to highlight the outcomes and challenges, whilst reiterating the key aims and objectives of the Programme and the overall evaluation. Methods The evaluation utilities’ a combination of quantitative and qualitative methodologies. A pre-post design of baseline, mid-line and end-line primary data collection is used to measure the overall impact of the programme. Secondary data analysis of participant feedback, workshop evaluations and attendance was completed under the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Results The education sessions provided were highly valued, with the majority of participants indicating an increase in baseline knowledge after attending a session. There were very high levels of positive experience with 80-99% of participants strongly endorsing the activities and recommending the programme. Participants who attended the Project ECHO and the QI workshops, indicated an intention to change practice; however, at this stage of the evaluation, there is a lack of specific details on what practice or change would be introduced, or indeed, its timeline. This will be measured in the next phase of the evaluation. Conclusion Caru is an innovative continuous learning programme supporting nursing home staff in the delivery of palliative, end-of-life, and bereavement care to residents. The learning components are delivered using a range of approaches, Webinars, Project ECHO online learning, Regional Networks, Quality Improvement Workshops. The interim evaluation report outlines the outcomes from Phase I and the first year of the programme’s delivery. It provides insights into its impact, outcomes, and challenges as well as providing a basis for the next phase of the evaluation. This interim evaluation lays the groundwork for a comprehensive understanding of the Caru Programme model and impact and provides valuable insights into its effectiveness.
{"title":"Evaluation of Caru Programme: A National Programme Supporting Palliative, End of Life and Bereavement Care in Nursing Homes in Ireland","authors":"Siobhán Murphy, Kate Steele, Sheena Murphy","doi":"10.1093/ageing/afae178.063","DOIUrl":"https://doi.org/10.1093/ageing/afae178.063","url":null,"abstract":"Background The aim of the interim evaluation report is to provide the Caru Programme team with information on the impact of the Programme to date and to highlight the outcomes and challenges, whilst reiterating the key aims and objectives of the Programme and the overall evaluation. Methods The evaluation utilities’ a combination of quantitative and qualitative methodologies. A pre-post design of baseline, mid-line and end-line primary data collection is used to measure the overall impact of the programme. Secondary data analysis of participant feedback, workshop evaluations and attendance was completed under the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Results The education sessions provided were highly valued, with the majority of participants indicating an increase in baseline knowledge after attending a session. There were very high levels of positive experience with 80-99% of participants strongly endorsing the activities and recommending the programme. Participants who attended the Project ECHO and the QI workshops, indicated an intention to change practice; however, at this stage of the evaluation, there is a lack of specific details on what practice or change would be introduced, or indeed, its timeline. This will be measured in the next phase of the evaluation. Conclusion Caru is an innovative continuous learning programme supporting nursing home staff in the delivery of palliative, end-of-life, and bereavement care to residents. The learning components are delivered using a range of approaches, Webinars, Project ECHO online learning, Regional Networks, Quality Improvement Workshops. The interim evaluation report outlines the outcomes from Phase I and the first year of the programme’s delivery. It provides insights into its impact, outcomes, and challenges as well as providing a basis for the next phase of the evaluation. This interim evaluation lays the groundwork for a comprehensive understanding of the Caru Programme model and impact and provides valuable insights into its effectiveness.","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":"142360209","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/afae178.070
Christine Condon, Colin Mason, Luke Phillips, Vinny Ramiah, John Duddy, Paolo Rizzo, Sorcha Burns
Background We observed variation in timing of CT brain imaging in patients presenting with a history of trauma. The objective of this audit was to determine adherence to local ED CT Head Criteria in patients with a confirmed traumatic ICH. Methods Retrospective point prevalence audit of patients with a confirmed intracranial haemorrhage over a five-month period using our neurotrauma work-stream data. Exploration of CT timing between Criteria A (within 60 minutes) and Criteria B (within 8 hours). Characteristics reviewed included Gender, Age, Time of presentation to ED, Day of Arrival, GCS on presentation, Mechanism of Injury and Time of CT completion. Results 68 patients over the five-month period had a confirmed ICH: 48 male, 20 female. The median age was 62 years (range 17-97). Falls of less than 2 metres were the most frequent cause of injury (n=44, 65%), with 60% of these occurring in patients aged over 65 years of age. 67% (n=31) of patients meeting Criteria A did not have a CT Brain completed within 60 minutes. 14% (n=3) of patients meeting Criteria B did not have a CT Brain completed within 8 hours. Of patients meeting criteria who did not have a timely CT, 11 patients presented out of hours. Patients aged less than 65 years of age were less likely to meet target CT timing; 71% (n=24). Conclusion This audit highlights that only 33% of patients meeting Criteria A had brain imaging within one hour. Older adults were more likely to meet target CT timing than younger adults. Lack of ED access to radiology out of hours was deemed to be the main barrier to meeting target CT timing. We are working alongside our radiology department to secure no discussion trauma CT scans in ED out of hours. We plan to re-audit following the implementation of this change.
{"title":"Time of Brain Imaging In Patients With An Acute Traumatic Intracranial Haemorrhage","authors":"Christine Condon, Colin Mason, Luke Phillips, Vinny Ramiah, John Duddy, Paolo Rizzo, Sorcha Burns","doi":"10.1093/ageing/afae178.070","DOIUrl":"https://doi.org/10.1093/ageing/afae178.070","url":null,"abstract":"Background We observed variation in timing of CT brain imaging in patients presenting with a history of trauma. The objective of this audit was to determine adherence to local ED CT Head Criteria in patients with a confirmed traumatic ICH. Methods Retrospective point prevalence audit of patients with a confirmed intracranial haemorrhage over a five-month period using our neurotrauma work-stream data. Exploration of CT timing between Criteria A (within 60 minutes) and Criteria B (within 8 hours). Characteristics reviewed included Gender, Age, Time of presentation to ED, Day of Arrival, GCS on presentation, Mechanism of Injury and Time of CT completion. Results 68 patients over the five-month period had a confirmed ICH: 48 male, 20 female. The median age was 62 years (range 17-97). Falls of less than 2 metres were the most frequent cause of injury (n=44, 65%), with 60% of these occurring in patients aged over 65 years of age. 67% (n=31) of patients meeting Criteria A did not have a CT Brain completed within 60 minutes. 14% (n=3) of patients meeting Criteria B did not have a CT Brain completed within 8 hours. Of patients meeting criteria who did not have a timely CT, 11 patients presented out of hours. Patients aged less than 65 years of age were less likely to meet target CT timing; 71% (n=24). Conclusion This audit highlights that only 33% of patients meeting Criteria A had brain imaging within one hour. Older adults were more likely to meet target CT timing than younger adults. Lack of ED access to radiology out of hours was deemed to be the main barrier to meeting target CT timing. We are working alongside our radiology department to secure no discussion trauma CT scans in ED out of hours. We plan to re-audit following the implementation of this change.","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":"142360210","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/afae178.068
Aislinn Higgins
Background The Community Connector (CC) uses a social prescribing model to work with Older Persons who have recently engaged with ICPOP, complementing the multidisciplinary interventions they receive. A holistic approach is used to support the patient to access a range of community supports to benefit their health and wellbeing and address the social determinants of their health. Reviews show the impact that social prescribing has on the cost implications and healthcare demands. Studies have shown a reduction in GP services, ED attendances and referrals to hospital among those linked with a social prescribing project. Methods Results Conclusion
{"title":"A Novel Service: The Role of the Community Connector for Older Persons within ICPOP","authors":"Aislinn Higgins","doi":"10.1093/ageing/afae178.068","DOIUrl":"https://doi.org/10.1093/ageing/afae178.068","url":null,"abstract":"Background The Community Connector (CC) uses a social prescribing model to work with Older Persons who have recently engaged with ICPOP, complementing the multidisciplinary interventions they receive. A holistic approach is used to support the patient to access a range of community supports to benefit their health and wellbeing and address the social determinants of their health. Reviews show the impact that social prescribing has on the cost implications and healthcare demands. Studies have shown a reduction in GP services, ED attendances and referrals to hospital among those linked with a social prescribing project. Methods Results Conclusion","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":"142360211","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/afae178.248
Yvonne Allen, Suzanne Timmons, Noreen Galvin
Background Dementia care in acute hospital settings requires targeted quality improvement initiatives based on national standards. This poster highlights key interventions to enhance care, aligning with local hospital group key performance indicators (KPIs), in one large teaching hospital. Methods Delirium screening (4AT) was implemented in the Emergency Department and geriatric ward, with education to increase staff awareness of delirium screening, prevention, and management. Audits assessed compliance with the 4AT tool. An audit evaluated the geriatric ward environment, including dementia-friendly painting, decorating, and signage, at baseline. Psychotropic prescribing practices were audited in 20 inpatient charts. A Life story Information tool (Sunflower Tool) was implemented to display personalized patient information at the end of the bed. Semi-annual audits assessed usage and effectiveness in the geriatric ward. Results The initial audit showed 85% compliance with the 4AT tool, dropping to 40% in a repeat audit after 6 months. Initially, 17 of 20 charts had complete 4AT scores; in the re-audit, 11 of 20 had scores recorded, with only 8 fully completed. The first environmental audit revealed poor compliance with dementia-friendly standards, especially in signage, clutter, and bedroom colour contrasts. Best compliance was seen with colour contrast in bathroom toilets and handrails. A quality improvement plan was developed to address gaps. The adoption and impact of the Sunflower tool improved patient-staff interactions and personalized care. All ward staff were trained in using the Sunflower tool. Conclusion A robust quality improvement plan, with measurable, achievable, relevant, and time-defined actions, aligned with national standards and local KPIs, is crucial to achieve and sustain positive audit results. Continuous education, resource allocation, and regular audits are required to ensure high-quality care for patients with dementia. Future efforts will focus on addressing identified challenges, refining interventions based on audit feedback, and maintaining care improvements.
{"title":"Quality Improvements in Dementia Care in an Acute Hospital Setting","authors":"Yvonne Allen, Suzanne Timmons, Noreen Galvin","doi":"10.1093/ageing/afae178.248","DOIUrl":"https://doi.org/10.1093/ageing/afae178.248","url":null,"abstract":"Background Dementia care in acute hospital settings requires targeted quality improvement initiatives based on national standards. This poster highlights key interventions to enhance care, aligning with local hospital group key performance indicators (KPIs), in one large teaching hospital. Methods Delirium screening (4AT) was implemented in the Emergency Department and geriatric ward, with education to increase staff awareness of delirium screening, prevention, and management. Audits assessed compliance with the 4AT tool. An audit evaluated the geriatric ward environment, including dementia-friendly painting, decorating, and signage, at baseline. Psychotropic prescribing practices were audited in 20 inpatient charts. A Life story Information tool (Sunflower Tool) was implemented to display personalized patient information at the end of the bed. Semi-annual audits assessed usage and effectiveness in the geriatric ward. Results The initial audit showed 85% compliance with the 4AT tool, dropping to 40% in a repeat audit after 6 months. Initially, 17 of 20 charts had complete 4AT scores; in the re-audit, 11 of 20 had scores recorded, with only 8 fully completed. The first environmental audit revealed poor compliance with dementia-friendly standards, especially in signage, clutter, and bedroom colour contrasts. Best compliance was seen with colour contrast in bathroom toilets and handrails. A quality improvement plan was developed to address gaps. The adoption and impact of the Sunflower tool improved patient-staff interactions and personalized care. All ward staff were trained in using the Sunflower tool. Conclusion A robust quality improvement plan, with measurable, achievable, relevant, and time-defined actions, aligned with national standards and local KPIs, is crucial to achieve and sustain positive audit results. Continuous education, resource allocation, and regular audits are required to ensure high-quality care for patients with dementia. Future efforts will focus on addressing identified challenges, refining interventions based on audit feedback, and maintaining care improvements.","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":"142360136","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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