Pub Date : 2024-09-30DOI: 10.1093/ageing/afae178.154
Claire Gallagher, Ruth Staunton, Nichola Boyle
Background Clinical Specialist Teams (CST) are a foundational component of the Integrated Care Programme for Older Persons (ICPOP) providing care for older adults with complex needs, completing Comprehensive Geriatric Assessments (CGA) and supporting goals until outcomes are optimised (HSE, 2021). WHO (2014) estimates 400 million individuals worldwide are affected by hearing loss, with prevalence increasing with age. The WHO in 2024 recommended targeted hearing screening and interventions in older age. NICE guidelines (2023) issued specific recommendations for adults with suspected or diagnosed dementia or mild cognitive impairment (MCI). The aim of this study was to review current practice of sensory assessment with respect to these recommendations. Methods This is a retrospective audit to evaluate current practice against established standards and to identify areas for improvement to achieve best practice. This will form part of an ongoing quality improvement initiative. Data was collected using a team designed tool gathering information on sensory assessment, interventions and onward referrals. A sample of 65 ICPOP clients was chosen from the last quarter of 2023. Results Preliminary results: Conclusion Screening rates for sensory impairment in the CST is high but needs improvement to reach the target of 100%. Referral onto appropriate services for specialised sensory intervention is actioned adequately, but there is need for the CST to advise timely hearing and vision testing to clients in order to adhere to international guidelines, especially those clients with dementia/MCI.
{"title":"“Addressing the Silent Need”","authors":"Claire Gallagher, Ruth Staunton, Nichola Boyle","doi":"10.1093/ageing/afae178.154","DOIUrl":"https://doi.org/10.1093/ageing/afae178.154","url":null,"abstract":"Background Clinical Specialist Teams (CST) are a foundational component of the Integrated Care Programme for Older Persons (ICPOP) providing care for older adults with complex needs, completing Comprehensive Geriatric Assessments (CGA) and supporting goals until outcomes are optimised (HSE, 2021). WHO (2014) estimates 400 million individuals worldwide are affected by hearing loss, with prevalence increasing with age. The WHO in 2024 recommended targeted hearing screening and interventions in older age. NICE guidelines (2023) issued specific recommendations for adults with suspected or diagnosed dementia or mild cognitive impairment (MCI). The aim of this study was to review current practice of sensory assessment with respect to these recommendations. Methods This is a retrospective audit to evaluate current practice against established standards and to identify areas for improvement to achieve best practice. This will form part of an ongoing quality improvement initiative. Data was collected using a team designed tool gathering information on sensory assessment, interventions and onward referrals. A sample of 65 ICPOP clients was chosen from the last quarter of 2023. Results Preliminary results: Conclusion Screening rates for sensory impairment in the CST is high but needs improvement to reach the target of 100%. Referral onto appropriate services for specialised sensory intervention is actioned adequately, but there is need for the CST to advise timely hearing and vision testing to clients in order to adhere to international guidelines, especially those clients with dementia/MCI.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"18 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1093/ageing/afae178.232
Mubashra Ashraf, Yvonne Boland, Sarah Mello
Background Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’. Methods Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded. Results Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases. Conclusion FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.
{"title":"Identification and Modification of Fall-Risk-Increasing-Drugs Following Fall-Related Hospitalization in Older Adults","authors":"Mubashra Ashraf, Yvonne Boland, Sarah Mello","doi":"10.1093/ageing/afae178.232","DOIUrl":"https://doi.org/10.1093/ageing/afae178.232","url":null,"abstract":"Background Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’. Methods Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded. Results Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases. Conclusion FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360168","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/afae178.052
Diane O Toole, Mary Berry, Marian Bracken, Alice Farrelly
Background The ‘What Matters to Me’ question has been used in many areas of the healthcare. In the context of older persons, the focus is typically on improving patient-centred care in long stay settings or in people living with dementia. It is also synonymous with end-of-life decisions. The question is contextual in itself and can elicit a wide range of responses. In this abstract, it was included in the Comprehensive Geriatric Assessment (CGA) in a section about future care and responses were anticipated to be relevant to that subject. Methods The Older Person Specialist Nursing Team developed a CGA document for use in acute care. The “What Matters To Me?” question was included with the intention of discovering and recording older persons’ end of life plans and wishes. The responses to this question were extracted from a random 30 completed CGAs. Results A total of 24 responses were gathered, some participants provided multiple answers. Not documented n=6, 3 themes were identified from the responses; Home; Free time and Worries/Concerns. Return home was the most frequently expressed response; n=13. Other responses identified were enjoyment, pass times and pets; n=9. Worries/Concerns were identified in broad terms; “I’m worried out the future” n=7. Conclusion “What matters” in this context was a broad query and responses may have been influenced by participants current health status, location and fear of the future and the subjectivity of the question and the practitioner. Participants did not mention dying a concern but did allude to the future in a broad context. The “What Matters To Me” question will now be in the social information section and the Older Person Specialist Nursing Team are considering a targeted question related to end-of-life plans and wishes.
{"title":"“What Matters To Me?” Responses from Older People in the Acute Setting","authors":"Diane O Toole, Mary Berry, Marian Bracken, Alice Farrelly","doi":"10.1093/ageing/afae178.052","DOIUrl":"https://doi.org/10.1093/ageing/afae178.052","url":null,"abstract":"Background The ‘What Matters to Me’ question has been used in many areas of the healthcare. In the context of older persons, the focus is typically on improving patient-centred care in long stay settings or in people living with dementia. It is also synonymous with end-of-life decisions. The question is contextual in itself and can elicit a wide range of responses. In this abstract, it was included in the Comprehensive Geriatric Assessment (CGA) in a section about future care and responses were anticipated to be relevant to that subject. Methods The Older Person Specialist Nursing Team developed a CGA document for use in acute care. The “What Matters To Me?” question was included with the intention of discovering and recording older persons’ end of life plans and wishes. The responses to this question were extracted from a random 30 completed CGAs. Results A total of 24 responses were gathered, some participants provided multiple answers. Not documented n=6, 3 themes were identified from the responses; Home; Free time and Worries/Concerns. Return home was the most frequently expressed response; n=13. Other responses identified were enjoyment, pass times and pets; n=9. Worries/Concerns were identified in broad terms; “I’m worried out the future” n=7. Conclusion “What matters” in this context was a broad query and responses may have been influenced by participants current health status, location and fear of the future and the subjectivity of the question and the practitioner. Participants did not mention dying a concern but did allude to the future in a broad context. The “What Matters To Me” question will now be in the social information section and the Older Person Specialist Nursing Team are considering a targeted question related to end-of-life plans and wishes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Ireland has the highest rates of loneliness of all EU countries. Those in the older old category (aged 80+) are at increased risk of developing loneliness, which is in turn a risk factor for many adverse health outcomes. Ireland has a strong tradition of Irish gerontological loneliness research, and it is critical to now know how best to focus research efforts to mitigate the impact of loneliness on older adults. Methods We held a roundtable discussion on priorities in Irish loneliness research at the Loneliness Taskforce Research Network inaugural event on 16th April 2024. 75 attendees were present, including those from non-governmental organisations, health and social care professionals, experts by lived experience, academic experts, researchers, and representatives from the private sector and governmental agencies. Of seven tables discussing loneliness research priorities, two tables were devoted to the discussion of priorities in research on loneliness in older people (with 18 participants in total). The priorities were noted, then amalgamated and organised. Results There was considerable heterogeneity in priorities raised, with little overlap across the two roundtable outputs. Of particular note was the need to evaluate the many services being delivered across Ireland to reduce loneliness, which operate without an evidence base. Other priorities included: Conclusion Results are informative for those planning future research on loneliness among older adults in Ireland and will form the basis for a report from the Loneliness Taskforce to the Irish Government, who have pledged funding for alleviation of loneliness.
{"title":"Advancing Loneliness as a National Health Priority: Results of a Multisectoral Roundtable","authors":"Joanna McHugh Power, Aileen O'Reilly, Robyn Homeniuk","doi":"10.1093/ageing/afae178.044","DOIUrl":"https://doi.org/10.1093/ageing/afae178.044","url":null,"abstract":"Background Ireland has the highest rates of loneliness of all EU countries. Those in the older old category (aged 80+) are at increased risk of developing loneliness, which is in turn a risk factor for many adverse health outcomes. Ireland has a strong tradition of Irish gerontological loneliness research, and it is critical to now know how best to focus research efforts to mitigate the impact of loneliness on older adults. Methods We held a roundtable discussion on priorities in Irish loneliness research at the Loneliness Taskforce Research Network inaugural event on 16th April 2024. 75 attendees were present, including those from non-governmental organisations, health and social care professionals, experts by lived experience, academic experts, researchers, and representatives from the private sector and governmental agencies. Of seven tables discussing loneliness research priorities, two tables were devoted to the discussion of priorities in research on loneliness in older people (with 18 participants in total). The priorities were noted, then amalgamated and organised. Results There was considerable heterogeneity in priorities raised, with little overlap across the two roundtable outputs. Of particular note was the need to evaluate the many services being delivered across Ireland to reduce loneliness, which operate without an evidence base. Other priorities included: Conclusion Results are informative for those planning future research on loneliness among older adults in Ireland and will form the basis for a report from the Loneliness Taskforce to the Irish Government, who have pledged funding for alleviation of loneliness.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"43 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360172","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/afae178.055
Sara Feeney, Cathy Monahan, Archana Dsouza
Background The authors are part of the education and training (E&T) team in the older person directorate. They noted a large influx of new staff and also wanted to develop the learning needs of current staff. This highlighted a need for staff development. Simulation: Aims: Methods Results Conclusion
{"title":"Stepping Stones to Simulation","authors":"Sara Feeney, Cathy Monahan, Archana Dsouza","doi":"10.1093/ageing/afae178.055","DOIUrl":"https://doi.org/10.1093/ageing/afae178.055","url":null,"abstract":"Background The authors are part of the education and training (E&T) team in the older person directorate. They noted a large influx of new staff and also wanted to develop the learning needs of current staff. This highlighted a need for staff development. Simulation: Aims: Methods Results Conclusion","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"219 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360173","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/afae178.288
Aoife Cashen, Amy Lynch, Niamh Cormican, Kei Yen Chan, Kathy Devaney, Stephanie Robinson, Cliona Small
Background Delirium is a prevalent issue affecting older patients in acute hospitals. National guidelines mandate that all patients >65 years old admitted to an acute hospital setting are screened for delirium. Prompt assessment and management of delirium is vital in delivering optimal care to the older patient. In our institution, delirium can be under recognised and not assessed routinely as part of the medical admission. Our aim was to assess delirium documentation rates and utilising the 4AT as part of the acute medical admission in a service development project. Methods A retrospective assessment of patient demographics and documentation of delirium and 4AT in the medical admission was carried out for January, February and March 2023 and compared to the same 3-month period in 2024 post set up of a new specialist geriatric ward (SGW) as part of a service development project. This was in tandem to targeted interventions for improving delirium education and management. Results Mean age was 83 years in both groups. 11% (18/157) in the cohort pre SGW and 30% (40/134) post setup of the SGW had a diagnosis of dementia. 13% (20/157) in the pre SGW cohort had delirium documented in the admission note and 23% (31/134) post. 24% (32/134) had a 4AT documented in the admission note post SGW setup compared with 6% (10/157) previously. Conclusion There was suboptimal documentation of the 4AT and delirium in the acute medical admission note. An acute medical admission proforma is being developed and implemented in our institution which will include a 4AT delirium screening tool. We will reassess this in 6 months’ time to ascertain whether there is an improvement in delirium and 4AT documentation. We will also give education to the medical NCHD group carrying out the admissions to emphasise the importance of utilising the 4AT and delirium documentation.
{"title":"Delirium Assessment And Documentation As Part Of An Acute Medical Admission","authors":"Aoife Cashen, Amy Lynch, Niamh Cormican, Kei Yen Chan, Kathy Devaney, Stephanie Robinson, Cliona Small","doi":"10.1093/ageing/afae178.288","DOIUrl":"https://doi.org/10.1093/ageing/afae178.288","url":null,"abstract":"Background Delirium is a prevalent issue affecting older patients in acute hospitals. National guidelines mandate that all patients >65 years old admitted to an acute hospital setting are screened for delirium. Prompt assessment and management of delirium is vital in delivering optimal care to the older patient. In our institution, delirium can be under recognised and not assessed routinely as part of the medical admission. Our aim was to assess delirium documentation rates and utilising the 4AT as part of the acute medical admission in a service development project. Methods A retrospective assessment of patient demographics and documentation of delirium and 4AT in the medical admission was carried out for January, February and March 2023 and compared to the same 3-month period in 2024 post set up of a new specialist geriatric ward (SGW) as part of a service development project. This was in tandem to targeted interventions for improving delirium education and management. Results Mean age was 83 years in both groups. 11% (18/157) in the cohort pre SGW and 30% (40/134) post setup of the SGW had a diagnosis of dementia. 13% (20/157) in the pre SGW cohort had delirium documented in the admission note and 23% (31/134) post. 24% (32/134) had a 4AT documented in the admission note post SGW setup compared with 6% (10/157) previously. Conclusion There was suboptimal documentation of the 4AT and delirium in the acute medical admission note. An acute medical admission proforma is being developed and implemented in our institution which will include a 4AT delirium screening tool. We will reassess this in 6 months’ time to ascertain whether there is an improvement in delirium and 4AT documentation. We will also give education to the medical NCHD group carrying out the admissions to emphasise the importance of utilising the 4AT and delirium documentation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"8 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360091","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/afae178.299
Padraig Scully, Sarah Altayyari, Ali Alnajjar, Mohamed Elhassan, Katherine Finan
Background Frailty is a treatable trait of relevance to people with various chronic respiratory diseases, especially those with severe COPD and/or lung transplantation. This has been recognised in the 2024 GOLD (Global initiative for chronic Obstructive Lung Disease) report and within recent European Respiratory Society guidelines. Central to optimisation of frailty management in those with chronic respiratory conditions is the identification of frail patients in the respiratory OPD (outpatients department) setting. This study aims to assess the prevalence of frailty among patients attending the respiratory OPD in our hospital. Methods A cross-sectional study was conducted over two respiratory clinics over a two-week period. Patients aged 65 and above were screened for frailty using the Clinical Frailty Scale (CFS). A CFS score was assigned to each patient by an assessing NCHD/consultant on the respiratory team. Statistical analysis was then performed to determine the prevalence of frailty amongst such patients. Frailty was defined as those having a CFS score of >5. Results A total of 25 patients were included in the study. Frailty (CFS score of >5) was identified in 56% of patients assessed, with 12% of patients being identified as having a CFS score of 7 (severely frail) or higher. Frailty had not previously been diagnosed by the respiratory team in those patients. Conclusion This study highlights a high prevalence of frailty among patients aged 65 or over in the respiratory OPD. Implementing systematic frailty screening in the respiratory OPD using the CFS can improve early identification of such patients, potentially enhancing management and clinical outcomes. The CFS is a quick and effective tool in identifying frailty. Integrating frailty assessments into routine clinical practice may help to ensure comprehensive care for this vulnerable population. We are currently looking at options for referral pathways to develop to improve management of frailty in this population.
{"title":"Optimising Outcomes For Those With Chronic Respiratory Disease: Detecting Frailty In The Respiratory OPD","authors":"Padraig Scully, Sarah Altayyari, Ali Alnajjar, Mohamed Elhassan, Katherine Finan","doi":"10.1093/ageing/afae178.299","DOIUrl":"https://doi.org/10.1093/ageing/afae178.299","url":null,"abstract":"Background Frailty is a treatable trait of relevance to people with various chronic respiratory diseases, especially those with severe COPD and/or lung transplantation. This has been recognised in the 2024 GOLD (Global initiative for chronic Obstructive Lung Disease) report and within recent European Respiratory Society guidelines. Central to optimisation of frailty management in those with chronic respiratory conditions is the identification of frail patients in the respiratory OPD (outpatients department) setting. This study aims to assess the prevalence of frailty among patients attending the respiratory OPD in our hospital. Methods A cross-sectional study was conducted over two respiratory clinics over a two-week period. Patients aged 65 and above were screened for frailty using the Clinical Frailty Scale (CFS). A CFS score was assigned to each patient by an assessing NCHD/consultant on the respiratory team. Statistical analysis was then performed to determine the prevalence of frailty amongst such patients. Frailty was defined as those having a CFS score of >5. Results A total of 25 patients were included in the study. Frailty (CFS score of >5) was identified in 56% of patients assessed, with 12% of patients being identified as having a CFS score of 7 (severely frail) or higher. Frailty had not previously been diagnosed by the respiratory team in those patients. Conclusion This study highlights a high prevalence of frailty among patients aged 65 or over in the respiratory OPD. Implementing systematic frailty screening in the respiratory OPD using the CFS can improve early identification of such patients, potentially enhancing management and clinical outcomes. The CFS is a quick and effective tool in identifying frailty. Integrating frailty assessments into routine clinical practice may help to ensure comprehensive care for this vulnerable population. We are currently looking at options for referral pathways to develop to improve management of frailty in this population.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"3 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360113","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/afae178.336
Michael Dowling, Ryan Garcia, Denis Saric, SM Kennelly, Kowshika Thavarajah
Background Nursing home residents may present inappropriately to the Emergency Department at the end of life (EOL). Appropriate advance care planning (ACP) may reduce these presentations. Inpatient teams are in a position to discuss, document and support these ACPs for nursing home residents admitted under their care. Methods Building on existing inpatient and outreach specialist pathways in a model three hospital, formal ACPs were introduced for all inpatients from Jan 2024 admitted from a nursing home where it was deemed clinically appropriate. The completed advance care plan included decisions re cardiopulmonary resuscitation, level of intervention (including hospital transfer), antibiotics, fluids, nutrition plan and medications to support EOL care. ACP discussions took place with the consultant geriatrician, patient, nominated family/patient support and director of nursing. Data on discharged patients (including presence of ACP on discharge) was collected and analysed for emergency re-presentations. Results Of 137 patients discharged back to their nursing homes in the first 4 months of 2024, 41 (30%) had an ACP in place while 96 (70%) did not. Of those with ACP in place, 6/41 re-presented to Emergency Department within this timeframe vs 17/96 who were discharged without an ACP (15% vs 18%, p=0.66). However, only 3/41 with ACP were re-admitted to hospital from the emergency department vs 15/96 without an ACP (7% vs 16%, p=0.19). No patients discharged with an ACP re-presented and subsequently died in hospital, while 1/96 (1%) of those discharged without an ACP died in hospital after re-presentation. Conclusion ACP discussion did not reduce re-presentations to hospital but there was a non-significant trend towards a reduction in re-admissions. Overall, there was an extremely low rate (1/137, 0.7%) of patients re-presenting to hospital and dying during that admission. Further work is ongoing to examine the criteria that would prompt ACP discussion in nursing home residents admitted to hospital.
{"title":"Assessing the Impact of the Introduction Of Advance Care Planning In Nursing Home Residents Admitted to Hospital","authors":"Michael Dowling, Ryan Garcia, Denis Saric, SM Kennelly, Kowshika Thavarajah","doi":"10.1093/ageing/afae178.336","DOIUrl":"https://doi.org/10.1093/ageing/afae178.336","url":null,"abstract":"Background Nursing home residents may present inappropriately to the Emergency Department at the end of life (EOL). Appropriate advance care planning (ACP) may reduce these presentations. Inpatient teams are in a position to discuss, document and support these ACPs for nursing home residents admitted under their care. Methods Building on existing inpatient and outreach specialist pathways in a model three hospital, formal ACPs were introduced for all inpatients from Jan 2024 admitted from a nursing home where it was deemed clinically appropriate. The completed advance care plan included decisions re cardiopulmonary resuscitation, level of intervention (including hospital transfer), antibiotics, fluids, nutrition plan and medications to support EOL care. ACP discussions took place with the consultant geriatrician, patient, nominated family/patient support and director of nursing. Data on discharged patients (including presence of ACP on discharge) was collected and analysed for emergency re-presentations. Results Of 137 patients discharged back to their nursing homes in the first 4 months of 2024, 41 (30%) had an ACP in place while 96 (70%) did not. Of those with ACP in place, 6/41 re-presented to Emergency Department within this timeframe vs 17/96 who were discharged without an ACP (15% vs 18%, p=0.66). However, only 3/41 with ACP were re-admitted to hospital from the emergency department vs 15/96 without an ACP (7% vs 16%, p=0.19). No patients discharged with an ACP re-presented and subsequently died in hospital, while 1/96 (1%) of those discharged without an ACP died in hospital after re-presentation. Conclusion ACP discussion did not reduce re-presentations to hospital but there was a non-significant trend towards a reduction in re-admissions. Overall, there was an extremely low rate (1/137, 0.7%) of patients re-presenting to hospital and dying during that admission. Further work is ongoing to examine the criteria that would prompt ACP discussion in nursing home residents admitted to hospital.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"14 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360115","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/afae178.127
Aideen McGuinness
Background All clients referred to Integrated Care for Older Persons (ICOP) for falls, frailty or functional decline have a Comprehensive Geriatric Assessment (CGA) including nutrition screening, which may trigger dietetic referral. Methods Retrospective analysis of initial year of a Senior Dietitian (0.5WTE). Results 172 referrals - representing 28% of ICOP clients. 14 did not engage. Age 56-95, Clinical Frailty Scale 3-8 (median 5). 304 consults: 40% one consultation, 40% 1-2 reviews, 20% 3-6 reviews. Nutrition screening Mini Nutritional Assessment-Short Form (MNA-SF)1 score ≤ 7 16% malnourished, 8-11 55% at risk of malnutrition, 12-14 29% not nutritionally at risk. So, 71% categorised as either malnourished or nutritionally at risk. While not assessed in all cases, probable sarcopenia2 was documented in 42% clients using grip strength. Individually tailored advice included (n=158): 141 discharged after individualised dietetic advice. Seven clients deceased. Remainder (nine) ongoing. Conclusion Those attending ICOP have a high prevalence of nutrition concerns, nutrition screening is important, and expert dietetic advice is essential to ensure guidance is evidence-based and resources are appropriate.
{"title":"ICOP Dietetics – The First Year","authors":"Aideen McGuinness","doi":"10.1093/ageing/afae178.127","DOIUrl":"https://doi.org/10.1093/ageing/afae178.127","url":null,"abstract":"Background All clients referred to Integrated Care for Older Persons (ICOP) for falls, frailty or functional decline have a Comprehensive Geriatric Assessment (CGA) including nutrition screening, which may trigger dietetic referral. Methods Retrospective analysis of initial year of a Senior Dietitian (0.5WTE). Results 172 referrals - representing 28% of ICOP clients. 14 did not engage. Age 56-95, Clinical Frailty Scale 3-8 (median 5). 304 consults: 40% one consultation, 40% 1-2 reviews, 20% 3-6 reviews. Nutrition screening Mini Nutritional Assessment-Short Form (MNA-SF)1 score ≤ 7 16% malnourished, 8-11 55% at risk of malnutrition, 12-14 29% not nutritionally at risk. So, 71% categorised as either malnourished or nutritionally at risk. While not assessed in all cases, probable sarcopenia2 was documented in 42% clients using grip strength. Individually tailored advice included (n=158): 141 discharged after individualised dietetic advice. Seven clients deceased. Remainder (nine) ongoing. Conclusion Those attending ICOP have a high prevalence of nutrition concerns, nutrition screening is important, and expert dietetic advice is essential to ensure guidance is evidence-based and resources are appropriate.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"8 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360281","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":"56 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"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}
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