ISSN 0002-0729 (PRINT) ISSN 1468-2834 (ONLINE) September 2016 Volume 45 Supplement 2 www.ageing.oxfordjournals.org and age ageing The Journal of the British Geriatrics Society 64th Annual and Scientific Meeting of the Irish Gerontological Society Developing Cultures of Excellence in Ageing and Exploring the Needs of Marginalised Groups The Malton Hotel, Killarney 30th September - 1st October 2016 age and ageing September 2016 Volume 45 Supplement 2 pp. ii1–ii61 AGEING_Supplement_2.indd 1 23-09-2016 17:00:33
Transcript
Issn 0002-0729 (prInt)Issn 1468-2834 (onlIne)
September 2016 Volume 45 Supplement 2www.ageing.oxfordjournals.org
andage
ageingThe Journal of the British Geriatrics Society
64th Annual and Scientific Meeting of the
Irish Gerontological Society
Developing Cultures of Excellence in Ageing and
Exploring the Needs of Marginalised Groups
The Malton Hotel, Killarney
30th September - 1st October 2016
age and ageing Septem
ber 2016 Volume 45 Supplem
ent 2 pp. ii1–ii61
AGEING_Supplement_2.indd 1 23-09-2016 17:00:33
AGEING_Supplement_2.indd 2 23-09-2016 17:00:33
ContentsVolume 45, Number S2, September 2016
AbstractsOral Presentations ii1
Poster Presentations ii13
Author Index ii57
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The Journal of the British Geriatrics Society
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Age and AgeingEditorProf David J. Stott, Glasgow
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012 INVESTIGATING COGNITIVE IMPAIRMENT IN THEEMERGENCY DEPARTMENT: THE ROLE OF THE INFORMANTHISTORY
Adam Dyer, Shamis Nabeel, Robert Briggs, Desmond O’Neill, Sean KennellyCentre for Ageing, Neuroscience and the Humanities, Tallaght Hospital, Dublin, Ireland
Background: The informant history is a crucial investigation in clarifying the nature,extent and appropriate follow-up of cognitive impairment in older adults presenting tothe Emergency Department (ED). However, very little research has been published on itsuse to date (1).Methods: A convenience sample of older adults (aged >70 years) underwent detailedcognitive assessment in the ED of a tertiary referral hospital. Cognitive assessment con-sisted of tools for delirium (CAM-ICU) and a general cognitive screener (sMMSE). Inindividuals where either of these were positive, an informant history was sought and theAD8 informant interview for dementia administered.Results: Two hundred and twenty patients were included (mean age: 78.8 ± 6.16). Of thosescreened positive on the CAM-ICU (11.8%, 26/220) or sMMSE (41.8%; 81/194), inform-ant histories were available in just under two-thirds (61.1%). In 39% (26/66), informant his-tories were consistent with previously undiagnosed dementia. The majority of informantswere immediate relatives (62/66; 94%) with a mean interview duration of 6.1 minutes. Thevast majority were rated very high in “informant confidence” (96.9%, 64/66) and “contribu-tion to patients’ care” (93/9%, 62/66). Following a review of the attending physicians’ notes,a reference to an informant history was only documented in 5.6% of cases.Conclusions: The informant history is a crucial investigation in the complete cognitiveassessment of older adults. The informant history provides a ready source of reliableinformation to the assessing physician warranting further emphasis on both undergradu-ate and postgraduate medical curricula.Reference:1. Briggs R, O’Neill D. The informant history: a neglected aspect of clinical education
and practice. QJM; pii: hcv145 [Epub ahead of print].
024 CAREGIVING CAPACITY AND FUTURE CARE PLANNING OFFAMILY CARERS FOR OLDER PEOPLE WITH ANINTELLECTUAL DISABILITY IN IRELAND
Damien Brennan1, Rebecca Murphy1, Philip McCallion2, Mary McCarron11Trinity College Dublin, Dublin, Ireland2University at Albany, State University of New York, USA
Background: Within contemporary Irish society, families within their homes are the pri-mary providers of caregiving support for people with an ID. However, as people with anID age so too do their families, making family caregiving more difficult and complex.This study examined the caregiving capacity and future care plans of parent and siblingcarers for their ageing family member with an ID.Methods: Situated with the parent study population of IDS TILDA (IntellectualDisability Supplement to The Irish Longitudinal Database on Ageing), a qualitative studydesign was employed with a purposive sample of parent and sibling carers (n = 17) ofolder people with an ID. Five focus groups and six semi-structured interviews were con-ducted and analysed.Results: Family caregiving capacity was compromised by limitations and anomalies incontemporary carer support systems, particularly the reduced and varied availability ofcarer’s allowance, day care and respite care.Few carers have definitively formulated future care plans with their family member
with an ID or the wider familial network, and where plans do exist these are predomin-antly aspirational in nature.Sibling caregivers in particular felt physically, psychologically, and intellectually
restricted and unsupported in their primary carer role. Furthermore, the majority of fam-ilies articulated that they represented the last remnant of family caregiving capacity exist-ing within the family.Families anticipated future crisis management and foresaw a strong possibility of their
family member with an ID requiring residential out-of-family home care provision atsome point in the future.Conclusion: Carers allowance, day services and respite care are key to improving thequality and sustainability of family caregiving for older people with an ID.Families’ future care planning and the future need for tailored residential service provi-
sion for the older cohort of people with an ID necessitates clarification, costing and pol-icy planning.
026 IMPROVING HIP FRACTURE CARE IN IRELAND: THE IRISHHIP FRACTURE DATABASE 3 YEAR DATA
Louise Brent1, Emer Ahern2, Conor Hurson31University Hospital Waterford, Waterford, Ireland2St. Luke’s Hospital, Kilkenny, Ireland3St. Vincent’s University Hospital, Dublin, Ireland
Background: In 2015, 3,578 patients over the age of sixty were hospitalised with a hipfracture in Ireland. The acute hospital care costs is approximately €45 million and grow-ing. This does not include the longer term costs of rehabilitation, convalescence, commu-nity care and long term care.
The IHFD has modeled itself in a similar way to the UK National Hip FractureDatabase (NHFD), which demonstrated that the synergy of care standards, audit andfeedback drive measurable improvements in hip fracture outcomes including mortality(NHFD 2011) and cost of care.Methods: The IHFD is a clinically led, web based audit of hip fracture casemix, care andoutcomes. It is backed by the Irish Gerontological Society (IGS) and the Irish Institute ofTrauma and Orthopaedics (IITOS). The IHFD has been recording data since 2012. Datais collected through the Hospital In-Patient Enquiry (HIPE) portal in collaboration withthe Healthcare Pricing Office (HPO). The National Office of Clinical Audit (NOCA)provides operational governance for the IHFD.Results: The most recent report (2014) is comprised of data from 2,664 hip fracturecases from 14 hospitals. The 2015 report will be published later this year and will com-prise of data from all 16 the trauma units and over 3000 cases in the Republic of Ireland.In 2014 the mean length of stay has decreased from 21 days to 19 days and the medianalso decreased from 14 days to 12.5 days. In 2015 the preliminary analysis shows furtherimprovements in a number of hip fracture standards including pre-operative review by ageriatrician, bone health assessment and pressure ulcer incidence and time to surgery.Conclusion: There has just been a national facilities audit underway in all 16 sites andsite visits ongoing since the start of the year. A three year view of the data will be pre-sented 2013-2015.
035 THE EVALUATION OF THE OLDER PEOPLE REMAINING ATHOME (OPRAH) PROJECT: A MIXED METHODS STUDY
Lorna Roe1, Aisling O’Halloran2, Charles Normand11Centre for Health Policy and Management, Dublin, Ireland2The Irish Longitudinal Study on Ageing, Dublin, Ireland
Background: The National Positive Ageing Strategy aims to enable older people to liveat home for as long as possible. However in 2013, over 21,000 older people resided inIrish nursing homes, 35% of whom were classified as low to medium dependency. TheOlder People Remaining At Home (OPRAH) project was established to support olderpeople at-risk of nursing home admission, to remain living at home. Best practice, pointsto the delivery of an integrated package of services and the components of the OPRAHproject to deliver this care included comprehensive geriatric assessment, a SupportCoordinator and a local planning committee within a one-year pilot, across four sites inIreland. This study evaluates the impact of the OPRAH project on participants’ serviceutilisation patterns and experiences within the project.Methods: A sequential explanatory mixed methods design was operationalised.Quantitative data for each participant (n = 146) was collected by trained nurses on eachsite using the InterRai-HC form and a survey. STATA v.13 was used to analyse the datafrom the ‘before’ and ‘after’ time-point using McNemar and repeated-measures ANOVAtests. Data from the Irish Longitudinal Study on Ageing (TILDA) were used to comparechanges in the OPRAH pilots to changes occurring nationally. Semi-structured qualitativeinterviews were used to explore the experiences of the OPRAH clients (n = 12), SupportCoordinators (n = 4) and the Project Manager (n = 1) within the OPRAH project.Results: A gap was identified in provision for the psychosocial needs and care planningneeds of older people. These needs can be addressed through the provision of a SupportCoordinator. However, inadequate supply of community services and inflexible budgetmodels, meant services could not be accessed at the right time.Conclusions: New ways to support older people to live at home which address aspectsof care planning, must be facilitated by financial supports.
039 FREQUENCY AND STABILITY OF MOTOR SUBTYPES INOLDER MEDICAL INPATIENTS WITH INCIDENT DELIRIUM
Niamh O’Regan1, James Fitzgerald2, Dimitrios Adamis3, David William Molloy1,David Meagher4, Suzanne Timmons11Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork,Ireland2Graduate Entry Medical School, University of Limerick, Limerick, Ireland3Sligo Mental Health Services, Sligo, Ireland4Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation &Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Background: Delirium is highly prevalent, and serious, yet remains under-recognised.Although patients presenting with hypoactivity have the worst prognosis, they are mostcommonly missed or misdiagnosed. Most studies of motor profile have been conductedusing cross-sectional methodology, however longitudinal studies are required to trulyunderstand motor course, given the dynamic nature of delirium. Older patients are par-ticularly vulnerable to delirium, however little is known about motor profile in this group.We aimed to investigate the frequency and stability of motor subtypes in incident deliriumin older medical inpatients.Methods: Medical inpatients of ≥70 years were assessed for delirium within 36 hours ofadmission, using the Revised Delirium Rating Scale (DRS-R98). Consenting patientswithout prevalent delirium then underwent daily assessment for the first week of admis-sion for the development of delirium. The Delirium Motor Subtype Scale-4 (DMSS-4)
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was used to establish the motor activity profile of incident delirium. Longitudinal sub-types (hypoactive throughout; hyperactive throughout; mixed subtype throughout; nosubtype throughout; variable subtype) were then ascertained by examining the daily pro-files for each patient with delirium, based on pre-determined definitions.Results: In 191 patients included the prospective study (i.e. non-delirious on admission;median age 80.1 years; 52.9% male), 1219 contemporaneous DRS-R98 and DMSS-4assessments were performed. There were 61 cases of incident delirium, with 113 deliriumdays with motor profile established (1-6 days per case). Motor profile was generally stable(n = 45/61, 73.8%; p < 0.001). Hypoactive subtype was most prevalent on any givendelirium day (n = 75/113, 66.4%) and was the most common longitudinal subtype(n = 38/61, 62.3%).Conclusions: This study highlights the prevalence of hypoactive delirium in older med-ical inpatients, which can be subtle to the untrained eye. Future delirium education pro-grammes should focus on improving awareness and understanding of hypoactivepresentations amongst undergraduate and postgraduate clinical staff.
042 USING QUALITY IMPROVEMENT METHODS TO IMPROVEMALNUTRITION SCREENING RATES ON AN ACUTE FRAILELDERLY WARD
Margaret O Donoghue1, Carol Lyons1, Paula O Connor1, Grace Corcoran1,Alan Moore1, Olivia Sinclair21Beaumont Hospital, Dublin 9, Ireland2HSE QI Division, Dublin, Ireland
Background: Malnutrition is associated with complications such as pressure ulcers andincreased lengths of stay amongst patients admitted to acute hospitals. Nutrition supportintervention is known to improve clinical outcomes and quality of life. To ensure patientsreceive the right intervention at the right time requires that systems are in place to:
• identify patients at risk of malnutrition• prevent patients from becoming malnourished
A key recommendation of current national guidelines for preventing malnutrition is touse the Malnutrition Universal Screening Tool (‘MUST’) 5 steps screening tool. The‘MUST’ is a method of identifying the patient at nutritional risk and assignment of a riskscore which leads to a subsequent plan of care.Methods: he multi-professional QI Project Team used the Model for Improvement(MFI) as an approach to improving rates of screening using the ‘MUST’ tool on an acuteward. Combined with the Plan, Do, Study, Act (PDSA) cycle the model is a simple, yetpowerful tool for accelerating improvement.
A baseline audit was undertaken showing the rate of ‘MUST’ completion was 20%.Over 8 weeks a number of PDSA’s were introduced including:
• Nurse education• introduction of an admission checklist• availability of equipment
Sampling methods were used to collect data weekly which was plotted on time seriesrun charts.Results: The team set a SMART aim to increase screening rates by 60% over 8 weeks.An actual increase of 80% was achieved.Conclusion: A significant improvement in screening rates for malnutrition using the‘MUST’ was achieved using the MFI and PDSA cycles. Screening is now embeddedinto the admissions process and dietetic intervention takes place earlier in thepatient’s journey. This lead to the development of a national guidance document:Malnutrition screening using “MUST”: A brief guide for improving. This is availableon the HSE website.
044 OUTCOMES OF A MEMORY STRATEGY EDUCATION GROUPINTERVENTION FOR CLIENTS WITH MILD COGNITIVEIMPAIRMENT AND EARLY DEMENTIA
Áine Coe1, Tadhg Stapleton1, Mary Martin21Trinity College Dublin, Dublin, Ireland2Naas General Hospital, Naas, Co. Kildare, Ireland
Background: An occupational therapy Memory Strategy Education Group was devel-oped to assist clients with MCI and their caregivers adopt strategies to manage memoryimpairment in everyday living. The study aimed to examine the impact of the programmeon the person’s everyday memory function, use of memory strategies, and quality of life,through a focus on setting and reviewing individualised memory goals over the course ofthe intervention.Methods: A quasi experimental one group pre-test post-test prospective clinical studydesign was utilised. Clients and caregivers attended a one-hour occupational therapy ledgroup session each week for six weeks. Outcome measures were taken at baseline, twoweeks post completion of the group, and at three month follow-up.Results: Over a 16 month period 60 clients participated in the programme, with 47 con-senting to participate in the research study. Results (n = 47) show statistically significantimprovements in Rivermead Behavioural Memory Test scores (P = 0.001), and overallDEMQoL scores (P = 0.02) upon completing of the programme. Clients reported tohave less concerns about their memory on the cognitive functioning subtest of theDEMQOL (P = 0.011), and all clients increased their use of external memory aids
(P<0.001). From the clients perspective there was a significant improvement in their self-ratings of their performance (P<0.001) and satisfaction (P<0.001) on their individualisedmemory goals on the COPM, that was maintained at follow-up.Conclusions: Results of this study indicate positive outcomes, that are maintained atthree month follow-up, for the clients engaging in the Memory Strategy Educationgroup intervention. This study provides evidence to support the role of occupationaltherapy in developing and delivering memory focused education programmes to enableclients to use memory strategies to lessen the impact of memory impairment in theireveryday lives.
048 DOING EXACTLY WHAT IT SAYS ON THE TIN: AN ACTION-LEARNING APPROACH TO SUPPORTING AUTONOMY ANDDECISION-MAKING IN THE OLDER ADULT
Anna-Marie Greaney1, Marie Kehoe-O’Sullivan21Institute of Technology, Tralee, Ireland2Health Information and Quality Authority, Dublin, Ireland
Background: This work presents the methodology and detail of a guidance documentcommissioned by the Health Information and Quality Authority (HIQA) to promote theautonomy of adults who engage with health and social care services. This is particularlysignificant in the older adult community; a group whose right to self-determination hasnot always been fully realised. Exploring issues with regard to autonomy is timely. TheAssisted Decision-Making (Capacity) Act (2015) has recently been enacted in Ireland.This significantly alters a previous focus on best-interests to a way of working that pro-motes individual will and preference. The aim of the paper is two-fold; (a) to examinehow action learning methodology can facilitate a meaningful consultation process, (b) tooutline how the guidance document can assist health and social care professionals to sup-port autonomy and decision-making in the older adult.Methods: Action-learning was the methodology chosen to guide the consultation pro-cess. This approach values experience over expertise and focuses on practical solutions tocomplex issues (Pedler and Abbot 2013). Three action-learning groups were convened insites where promoting autonomy presented different challenges and opportunities. Thisincluded a community nursing unit with older adult participation. This process was sup-ported by an advisory group and desktop research (literature review). The presenter’sPhD work on autonomy was used as the basis of initial interaction.Results: All data sets were collectively analysed to facilitate the development of a guidancedocument to support autonomy. Central to the guidance document is a Supporting AutonomyFramework which provides a six-step approach to supporting autonomy in an accountableway. The process also outlined the benefits of action-learning as a consultative methodology.Conclusions: This work highlights the value of action-learning to consultation in healthand social care, and the practical relevance of the Supporting Autonomy Framework inenacting assisted decision-making legislation.
049 AN AUDIT OF KNOWLEDGE OF ACUTE STROKE GUIDELINESAMONGST GENERAL AND EMERGENCY PHYSICIANS IN ACOMPREHENSIVE STROKE CENTRE
John McCabe1, Yvonne Lee1, Yoann O’Donoghue2, Michael Wall3, Aileen O’Shea4,John Thornton4, David Williams11Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin 9, Ireland2School of Medicine, Trinity College Dublin, Dublin, Ireland3Emergency Medicine Department, Beaumont Hospital, Dublin 9, Ireland4Department of Neuroradiology, Beaumont Hospital, Dublin 9, Ireland
Background: Acute stroke care has radically changed with the advent of novel time-dependent therapies, such as intravenous thrombolysis and mechanical thrombectomy.The American Stroke Association (ASA) has published guidelines on appropriate timewindows for managing patients with acute stroke. Knowledge of these guidelines is a keyperformance indicator for all stroke centres.Methods: An anonymous standardised questionnaire assessing knowledge of the ASAguidelines was distributed to all general and emergency department (ED) physicians fromSenior House Officer to Consultant grade in a single comprehensive stroke centre. Thosecompleting the survey were also asked whether they were NIHSS trained.Results: 47 completed questionnaires were returned (ED n = 24, general n = 23). 61%of ED and 96% of generalists reported that they were aware of at least 1 acute strokecare guideline. Knowledge of the correct time window for thrombolysis amongst ED andgeneralists was 83% and 78% respectively. Knowledge of the time window up until whichthrombectomy can be considered in anterior circulation strokes amongst ED and general-ists was 35% and 73% respectively. 25% of ED and 22% of generalists correctly identi-fied the recommended door to CT time of <25 minutes. 61% of ED and 35% ofgeneralists were aware of the target door to needle time of <60 minutes. 13% of ED phy-sicians and 43% of generalists reported that they were certified in conducting an NIHSSassessment.Conclusion: The awareness of the internationally recognised ASA guidelines amongstED and general physicians in our centre is sub-optimal. Furthermore the majority of phy-sicians are not certified in NIHSS assessment. Knowledge of best-practice guidelinesamongst health professionals who frequently encounter acute stroke patients is essential.A hospital-wide education programme to improve awareness is critical to improving stan-dards of care in our department.
abstracts Age and Ageing
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54 PROFILING COMMUNICATION ABILITY IN PEOPLE WITHDEMENTIA: DEVELOPMENT OF A NEW INSTRUMENT TOINFORM MANAGEMENT OF COGNITIVE COMMUNICATIONDIFFICULTIES
Margaret Walshe1, Suzanna Dooley1, Tammy Hopper3, Rachael Doyle2,Roisin McCabe2, Muriel Moore2, Des O’Neill11Trinity College Dublin, Dublin, Ireland2St Columcille’s Hospital, Dublin, Ireland3University of Alberta, Edmonton, Canada
Background: Communication difficulty is an integral part of dementia, a major age-related syndrome, leading to limitations in functioning and social isolation. Althoughmuch can be done to maximize communication abilities, no instrument focuses on thecommunication abilities of people with dementia that is sensitive to change across timeand linked with specific strategies to support communication. Profiling CommunicationAbility in Dementia (P-CAD) was devised in 2015 and shows promise in clinical practice.The aim is to validate the P-CAD to direct individualised advice, support and therapy forpeople with dementia and their carers. It will detect changes in communication and willbe a robust outcome measure to evaluate efficacy of current and new communicationinterventions in dementia.Method: There are two phases to this study. Phase 1 involved revising and amending theearlier version of the P-CAD based on feedback from carers, people with dementia, med-ical and nursing staff, health and social care professionals as well as speech and languagetherapists (SLTs). Nine SLTs used the P-CAD in clinical practice over a 6-week period.Results: Phase 1 is complete. Feedback was obtained through questionnaires and focusgroups. Overall, the response was positive. Participants suggested some amendments toface, content and ecological validity. Changes were made to the scoring system; an add-itional accessible profile summary form was also included. The new instrument comprises8 sections, which includes cognitive, linguistic and functional communication parameters. Itobjectively evaluates cognitive communication abilities and provides support strategies.Conclusion: The P-CAD has been extensively revised following feedback with the finalP-CAD ready for validation. The focus remains on the abilities of people with dementiaand carers across different stages of the condition. Phase 2 involves validation of the finalP-CAD with 100 people with dementia and carers across Ireland and Canada.
065 STOPPFRAIL (SCREENING TOOL OF OLDER PERSONSPRESCRIPTIONS IN FRAIL ADULTS WITH LIMITED LIFEEXPECTANCY): CONSENSUS VALIDATION
Amanda Lavan2, Paul Gallagher1, Carole Parsons3, Denis O’Mahony11Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland2Department of Medicine, University College Cork, Cork, Ireland3School of Pharmacy, Queen’s University Belfast, Belfast, Ireland
Background: To validate STOPPFrail, a list of explicit criteria for potentially inappropriatemedications (PIMs) in frailer older adults with limited life expectancy. A Delphi consensussurvey of an expert panel (n = 17) comprising specialists in geriatric medicine, clinicalpharmacology, palliative care, psychiatry of old age, clinical pharmacy and general practice.Methods: STOPPFrail criteria was initially created by the authors based on clinicalexperience and appraisal of the available literature. Criteria were organised according tophysiological system. Each criterion was accompanied by an explanation. Panellistsranked their agreement with each criterion on a 5-point Likert scale and invited to pro-vide written feedback. Criteria with a median Likert response of 4/5 (agree/stronglyagree) and a 25th centile of ≥4 were included in the final criteria.Results: Three Delphi rounds were required. All panellists completed all rounds. Thirtycriteria were proposed for inclusion; 26 were accepted. No new criteria were added. Thefirst two criteria suggest deprescribing medications with no indication or where compli-ance is poor. The remaining 24 criteria include lipid-lowering therapies, alpha-blockers forhypertension, anti-platelets, neuroleptics, proton pump inhibitors, H-2 receptor antago-nists, anti-spasmodics, theophylline, leukotriene antagonists, calcium supplements, boneanti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal anti-inflammatories, corticosteroids, 5-alpha reductase inhibitors, alpha-1 selective blockers,muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor block-ers, systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibio-tics. Anticoagulants and anti-depressants were excluded. Despite incorporation ofpanellists’ suggestions, memantine and acetyl-cholinesterase inhibitors remainedinconclusive.Conclusion: STOPPFrail comprises 26 criteria, which have been judged by broad con-sensus, to be potentially inappropriate in frailer older patients with limited life expectancy.STOPPFrail may assist in deprescribing medications in these patients.
066 ANTIPSYCHOTIC PRESCRIBING RATES IN OLDER ADULTS: ACOMMUNITY NURSING UNIT SETTING POINT-PREVALENCEREVIEW
Pádraig Bambrick1, Mary Costigan2, Deirdre O’Halloran2, Ronan O’Toole1,Frances McCarthy21Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland2St. Mary’s Hospital, Phoenix Park, Dublin 8, Ireland
Background: Although there is evidence for modest efficacy for the use of atypical anti-psychotics in treating behavioural and psychological symptoms of dementia (BPSD),growing concern regarding the potential for harm has led to calls for more judicious use(Ballard et al. 2006). Recent practice guidelines published by the American PsychiatricAssociation further stress the need for targeted use, with prioritisation of non-pharmacological measures and routine review (Reus et al. 2016). Our study aimed toassess the prevalence of antipsychotic prescribing in an Irish urban older persons’ com-munity nursing unit.Methods: We reviewed medication prescriptions across four wards of a publicly-fundedolder persons’ community nursing unit, including one ward specifically designated forpeople with dementia. This facility has onsite Geriatrician-led medical cover, with all resi-dents receiving quarterly standardised review, including review of psychotropicmedications.Results: Prescriptions of 100 long-term residents were reviewed (69% female). Themean age was 84.7 years. 41% were prescribed either an acetyl-cholinesterase inhibitor,memantine, or both. 32% were prescribed a regular oral antipsychotic (97% of which(31/32) were atypical antipsychotics) with 40.6% (13/32) also prescribed additional PRNantipsychotics.Conclusion: These results indicate significant utilisation of antipsychotic prescribing inthis setting. The management of BPSD remains a particularly complex challenge, withshortcomings in the allocation of resources for non-pharmacological measures and aneed to balance quality-of-life considerations with known harmful effects on physicalhealth related outcomes. This is combined with increasing involvement of family andcarers in healthcare-related decision making for people with dementia, with a formalisa-tion of this advocacy role set out in the recent Assisted Decision-Making (Capacity) Act2015. Since completing this study, we have implemented a formal structure of regularmulti-disciplinary review of antipsychotic prescribing (involving senior medical registrarsand senior nursing staff) with a view to promoting cautious reduction where appropriate.
068 EXPLORING THE HOUSING NEEDS OF MARGINALISEDOLDER PEOPLE: A COMPARATIVE SURVEY OF THOSE LIVINGIN ‘MAINSTREAM’ OR ‘SHELTERED’ SOCIAL HOUSING
Siobhan Fox1, Lorna Kenny2, Mary Rose Day3, Cathal O’Connell3, Joe Finnerty3,Suzanne Timmons11Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland2School of Applied Social Studies, University College Cork, Cork, Ireland3School of Nursing, University College Cork, Cork, Ireland
Background: The house we live in and where we live has a major impact on our physicaland mental health; this is particularly true for people who tend to spend more time athome, including older adults. Older people living in social housing are even more vulner-able than their counterparts in the general population, and are at risk of experiencingpoorer health and lower life expectancy. With an ageing population, it is critical that themost suitable housing model is identified. However, it’s unclear whether supporting peo-ple in their own homes (‘ageing-in-place’) or in specially designed ‘sheltered’ accommoda-tion is the better method. This research aimed to explore the housing needs of olderpeople in social housing, comparing those in mainstream or sheltered schemes.Methods: The population studied was tenants of Clúid Housing aged 60 years and older.Two surveys were designed, for ‘mainstream’ or ‘sheltered’ social housing tenants. Astratified sampling method was used to reach a geographically representative sampleacross Ireland.Results: The response rate was 47.2% (n = 380/805). Older people across the schemeshad similar housing needs. Unsuitable homes led to fear and anxiety, especially aroundusing the bathroom and stairs. One-in-four experienced fuel poverty. Tenants in main-stream housing were less likely to have necessary adaptations in place. Sheltered housingtenants were happier with their home (90% ‘completely’ or ‘somewhat’ satisfied) and hadmore social contact than mainstream tenants.Conclusions: Tenants living in mainstream houses reported more disability/illnesses,worried more about the future, and felt less safe in their neighbourhood, than those insheltered housing. However, few wanted to move, and even of those who would considermoving, few viewed sheltered accommodation as an option. This suggests a lack ofknowledge about housing and support options.
082 IMPACT OF DEMENTIA CAREGIVING ON COGNITION,DEPRESSION AND STRESS BIOMARKERS: BENEFITS OFSTRESS REDUCTION TECHNIQUES
Andrew P Allen1, Eileen Curran2, Áine Duggan3, Aoife Ní Chorcoráin4, Judy Wall4,John F Cryan5, Timothy G Dinan1, Patricia Kearney2, D William Molloy4, Gerard Clarke11Department of Psychiatry and Neurobehavioural Science, and APC Microbiome Institute,University College Cork, Cork, Ireland2The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University CollegeCork, and Department of Epidemiology & Public Health, University College Cork, Cork, Ireland3School of Medicine, University College Cork, Cork, Ireland4Centre for Gerontology & Rehabilitation, University College Cork, Cork, Ireland5Department of Anatomy & Neuroscience, and APC Microbiome Institute, University CollegeCork, Cork, Ireland
Background: Caring for a relative with dementia is associated with heightened stress,anxiety and depression, and may impact upon central nervous system activity. The
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current study aimed to examine the cognitive neurobiology and mental well-being ofdementia caregivers.Methods: We conducted a systematic review to gauge the currently known biologicalimpact of family dementia caregiving. We examined mental well-being and cognitive per-formance in dementia caregivers and non-caregiving controls. Participants were recruitedthrough advertisements, and caregivers were recruited via clinics at St. Finbarr’s Hospital,Cork. Participants completed validated tests of stress, anxiety, and depression.Participants also completed cognitive tasks from the CANTAB battery. A sub-set of care-givers completed both a carer training program and mindfulness-based stress reduction(MBSR) program. Each program was delivered in a group setting by an experiencedinstructor and lasted 6-8 weeks.Results: Our systematic review indicates altered hypothalamic-pituitary-adrenal axisactivity and impaired attention in caregivers, and that interventions to attenuate stressmay improve cognition. Our preliminary study results suggest the presence of higherlevels of stress and depressive symptoms in caregivers (N = 31, mean age = 56.1, 20females, 11 males) compared to controls (N = 18, mean age = 55.8, 11 females, 7 males).Caregivers also made a higher number of errors on the paired associates learning task(PAL), which engages the hippocampus, suggesting poorer visuospatial memory, as wellas impaired performance on rapid visual information processing, suggesting poorer sus-tained attention. However, following both carer training and MBSR, caregivers’ perform-ance improved on both tests.Conclusions: Dementia caregiving is associated with heightened biomarkers of stress,high self-reported levels of stress and depression as well as impaired cognition. Carertraining and MBSR may be beneficial in improving cognitive performance. A comprehen-sive physiological phenotyping of dementia caregivers is required to better understand themechanisms of these effects.
086 EXPERIENCES OF PROVIDING FORMAL HOME ANDCOMMUNITY DEMENTIA CARE IN IRELAND: ADVOCATINGFOR A HOLISTIC SYSTEMIC APPROACH
Louise Hopper1, Rachael Joyce1, Anja Bieber2, Anja Broda2, Kate Irving1, Frans Verhey31Dublin City University, Dublin, Ireland2Martin-Luther University Halle-Wittenberg, Halle, Germany3Maastricht University, Maastricht, The Netherlands
Background: Access to formal dementia care services varies widely within and acrossEuropean countries. This paper presents Irish data from one study within the Access toTimely Formal Care (Actifcare) JPND-funded research project. This study explored theprofessional experiences, and perceived barriers and facilitators in accessing formalhome- and community-based health and social care from the perspectives of healthcareprofessionals and expert stakeholders in a unique position to influence dementia policy inIreland.Methods: An exploratory qualitative design with purposive sampling was used. Threefocus groups were conducted with healthcare professionals from a variety of back-grounds (n = 18; years experience M = 11.35, SD = 7.22). One group took place in a rur-al setting, one in south and one in north Dublin. Seven interviews with policy andpolitical decision makers also took place. Discussions followed an agreed structure, wereaudio-recorded, transcribed, and analysed using inductive content analysis.Results: Narratives revealed a wide range of themes describing barriers and facilitators forthe use of formal dementia care at (1) an individual level – relating to every personinvolved, such as needs-focused care, capacity and rights; (2) a system level – relating to theIrish health and social care systems, such as service design, service availability and casemanagement; and (3) overarching aspects that were important on both levels, such as edu-cation, awareness, influence and community engagement. Conflicting views emergedbetween healthcare professionals regarding the most appropriate time for care, and amongexperts regarding the definition and location of any case management support.Conclusions: These findings are interpreted in the context of the 2014 National DementiaStrategy and they support the increasing body of evidence that highlights the very clear gapsthat exist between the formal home- and community-based care that is available in Ireland,and the care advocated for by health professionals and policy makers alike.
091 EVALUATING A DAY HOSPITAL SUPPORT GROUP AT ANOLD AGE PSYCHIATRY SERVICE: PATIENT AND STAFFPERSPECTIVES
Aidan Conway1, Jessica O’Brien1, Fiona Kelly2, Aoife Ní Chorcoráin31School of Applied Psychology, University College Cork, Cork, Ireland2South Lee Mental Health Services, ISA South, Cork, Ireland3Department of Psychiatry, University College Cork, Cork, Ireland
Background: Elderly people suffering with mental illness are particularly marginaliseddue to a prevailing cohort stigma around mental health. This project aimed to evaluate asupport group service offered at an Old Age Psychiatry day hospital. In line with HSEadvocacy of service-user involvement in health service evaluations, participatory methodswere chosen to evaluate this service from patient and staff perspectives.Methods: Semi-structured interviews were conducted with two psychiatric nurses whofacilitate the group and a focus group was completed with eight patients attending thegroup. Resulting data was analysed using thematic analysis.Results: Three themes emerged from staff interviews: the service provides a ‘safe space’through facilitating social support and ongoing health monitoring; ‘unfulfilled potential’
captures how staff feel the service could be improved through implementing more activeanxiety- and depression-management psychoeducation; staff feel ‘implementing change’ isdifficult due to patients’ resistance to change, which can be a particular problem whendealing with elderly populations. The focus group with patients led to the identification offour themes: ‘provision of social support’, ‘respite,’ ‘monitoring mental health’, and ‘sug-gestions for improvement’.Conclusion: Synthesising findings, staff and patient perspectives of the support group areconsistent in terms of the group’s benefits (social support, monitoring patient mentalhealth) but differ with regards the ideal group format. While patients are satisfied with thegroup as a long-term support with their role being passive, staff consider this unsustainable.Instead, they envisage the ideal group as an active short-term programme which empowerspatients with self-management skills and is arguably a more effective use of HSE resources.Based on these findings a participatory consultation approach is recommended, wherebystaff and patients co-creatively shape the format of the support groups.
093 USING INTER-LEVEL DYNAMICS AS AN INTERPRETIVE LENSWHEN EMPLOYING THE RE-AIM FRAMEWORK TOEVALUATE THE DEVELOPMENT OF INTEGRATED DEMENTIACARE
Louise Daly1, Mairead Bracken-Scally1, Geralyn Hynes1, Aurelia Ciblis1, Brian Keogh1,Brendan Kennelly2, Mary McCarron1, Anne-Marie Brady11Trinity College Dublin, Dublin, Ireland2National University of Ireland Galway, Galway, Ireland
Background: Dementia care requires an integrated approach across services at individ-ual, team, inter-departmental/service and organisation levels. This reflects a systems-oriented approach drawing on organisation development (OD) and change literature(Coghlan et al. 2016). In organisation development, inter-level dynamics recognise theinterdependence of individual, team, department and organisation.Initiatives aimed at developing integrated care pathways are underway in three hospitals
and two community service areas funded by the HSE Genio Dementia Programme.While these are discrete projects, each is comprised of a series of activities intended tocollectively support the development of an integrated approach to dementia care. A paral-lel evaluation using the RE-AIM (Kessler et al. 2013) evaluation framework is underwayto examine the reach, effectiveness, adoption, implementation and maintenance (sustain-ability) of the projects.Methods: The evaluation is employing a mixed methods multi-component approachover the course of the projects including: audit, economic analysis, exploration of staffknowledge and awareness, and service provider and service user experience. Data analysisinvolves descriptive and inferential statistics, and thematic content analysis as appropriate.Ethical approval was obtained from all sites involved and the university from which theevaluation is being conducted.Results: Interim findings from phase 1 highlighted potential tensions with reach andadoption. This suggests that achieving maintenance (sustainability) may be a challenge.When viewed through the constructs of inter-level dynamics, lessons may be gleanedfrom the planning and implementation processes for each project that might informdementia service development more broadly in the future.Conclusions: Examining how project outputs and processes impact on the bonding ofthe individual, functioning of the team, coordination of the department and adaptation ofthe organisation provide important insights into the complexities of developing integrateddementia care.
095 CAN ADDENBROOKES ASSESSMENT SCORES PREDICTPERFORMANCE ON ROOKWOOD DRIVING ASSESSMENTBATTERY? AN AUDIT OF AN OUT PATIENT DRIVINGASSESSMENT SERVICE
Aisling DavisSt Vincent’s University Hospital, Dublin 4, Ireland
Background: Carew House Geriatric Day Hospital offers an off road assessment serviceto out patients within the community. The assessment process involves obtaining detailedcollateral regarding driving history/need for driving, formal cognitive assessment, com-pletion of the Adelaide Self Efficacy Scale (and a by proxy version if patient accompan-ied) and completion of the Rookwood Driving Assessment Battery (RDAB). The latterassesses the core neuropsychological skills needed to drive. It is used as a tool to aid amedical practitioner’s decision regarding fitness to drive.Methods: A retrospective chart audit was completed over a 6 month period. A total of21 patient’s charts were selected as they included an Addenbrookes Assessment (ACE-R)and RDAB completed.Patient’s results on the RDAB were grouped into three as per manual’s guidelines.
Group A (score of 1-5 on RDAB)- indicates nil significant concerns regarding drivingabilities. 3 patients.
Group B (score of 6-10 on RDAB)- suggests a level of impairment that may reduce driv-ing ability and on road assessment is advised. 8 patients.
Group C (score of 10 + on RDAB)- this is considered a fail and is associated with a 90%chance of failing an on road assessment. 10 patients
Results:Group A (score of 1-5 on RDAB)- average ACE-R: 88%Group B (score of 6-10 on RDAB)- average ACE-R: 76%
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Group C (score of 10 + on RDAB)-average ACE-R: 67%Discussion: It could be suggested that there is a correlation between ACE-R scoresand RDAB scores. This has implications for the cohort of patients that are suitable toengage in a RDAB. Further investigation and audit with larger numbers is stronglyindicated.
101 SAD BONES: SEROTONIN REUPTAKE INHIBITORS ANDBONE HEALTH IN AN ELDERLY IRISH POPULATION
James Mahon, Richard Duffy, Clodagh Power, Nessa Fallon, Georgina Steen,Joseph Browne, MC Casey, JB Walsh, Kevin McCarrollSt James’s Hospital, Dublin 8, Ireland
Background: Depression and antidepressant medications (ADTs) negatively effect bonehealth, but little is known of the relative impact of different ADTs, nor has their effectbeen studied in an elderly Irish population. We aimed to establish the bone health impli-cations of ADTs for elderly patients attending our osteoporosis clinic.Methods: We identified patients prescribed ADTs: Venlafaxine, citalopram, escitalopram,fluoxetine, sertraline, paroxetine, mirtazapine, duloxetine, amitriptyline, clomipramine,lofepramine, dothiepin and trimipramine. We compared them with a random controlgroup not prescribed ADTs. We examined DXA bone mineral density (BMD) andT-scores, and fracture history.Results: 1578 individuals: 522 on ADTs; 1056 control. Mean age 66.93 (SD 14.56);79.2% female; mean BMD total hip 0.795 g/cm2 (SD 0.156); mean BMD spine0.908 g/cm2 (SD 0.189).Patients on ADTs had significantly lower hip BMD than controls: BMD hip
0.025 g/cm2 lower in ADT group (SE 0.010, 95% CI 0.011–0.048, p < 0.002), adjustedfor age, gender, BMI. BMD spine did not differ significantly between groups (p = 0.850).Those on ADTs had higher prevalence of hip fracture: OR 2.18 (95% CI 1.68-2.83, p
< 0.001). BMD hip was significantly lower in patients on ADTs who had never hadhip fracture: BMD mean difference 0.121 g/cm2 (SE 0.017, 95% CI 0.087–0.154,p < 0.001).There was significant variation in prevalence of hip osteoporosis between different
ADTs, p < 0.001, chi-squared test. Highest rates were in mirtazapine, 50% (n = 20); cita-lopram, 45.9% (n = 109); lowest rates in fluoxetine, 6.7% (n = 30). OR for hip osteopor-osis, comparing citalopram to fluoxetine was 11.86 (95% CI 2.69-52.29, Pearson’s chi-squared test p < 0.001).Conclusions: We confirmed in an elderly Irish population that ADTs are associated withlower BMD hip, and higher risk of hip fracture. While no single drug was clearly linkedwith reduced BMD or increased fracture, some evidence indicates that fluoxetine may beassociated with a less-negative impact on bone health compared with other ADTs.
104 VALIDATION OF SHORT SCREENING TOOLS FOR DELIRIUMDETECTION IN OLDER PATIENTS IN THE EMERGENCYDEPARTMENT: 4-AT IS SUPERIOR TO 6-CIT
Noeleen M. Brady1, Dawn O’Sullivan1, Edmund Manning1, Emma O’Shea1,Síle O’Grady2, Niamh A. O’Regan1, Suzanne Timmons11Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork,Ireland2Mercy University Hospital, Health Service Executive, Cork, Ireland
Background: Delirium is common but under-diagnosed in older people presenting tothe Emergency Department (ED). ED staff need fast, valid tools to identify potentialdelirium in older attendees. The 4-AT is recommended nationally for delirium screeningin ED, but has never been validated in an ED population.Method: A trained researcher assessed consecutive ED attendees ≥70 years for deliriumand dementia using the Delirium Rating Scale–Revised 98 (DRS-R98; cut-off 18) andInformant Questionnaire on Cognitive Decline in the Elderly (cut-off 3.5), respectively.An expert later reviewed the data and assigned diagnoses. A second researcher blindlyassessed the same patients in ED, using 4-AT and Six-Item Cognitive Impairment Test(6-CIT), with random order of short versus long test performance, within a three-hourwindow.Results: Of the 419 patients, 50.8% were female; median age 77 years (IQR 9); 21.5%had dementia and 15.2% delirium. Using the accepted 4-AT cut-off for delirium (≥4),possible delirium was indicated in 21% of patients, of whom 69.2% had delirium. 4-ATand DRS-R98 (reference standard) concordance for delirium categorisation was good(92.5% case agreement, p < 0.001). Compared to expert diagnosis, the positive predictivevalue (PPV) of 4-AT for delirium detection was good at 0.69 (CI 0.58-0.79) and negativepredictive value (NPV) excellent at 0.99 (0.97-1.00; AUC 0.97). Thus the 4-AT reliablyrules out delirium, with acceptably low false-positivity. The 6-CIT performed less well,with PPV 0.40 (0.31-0.50) and NPV 0.97 (0.95-0.99) using a pre-specified cut-off of 10/11 (AUC 0.91). The optimal cut-off was 13/14 (PPV 0.51 (CI 0.40 – 0.62); NPV 0.97(0.94 – 0.99)).Conclusions: This study validates the 4-AT for the first time in an ED population;4-AT out-performs the 6-CIT, a more generic short cognitive assessment. Further assess-ment is indicated when patients screen positive for delirium using 4-AT, as per thenational ED delirium algorithm.
107 IN THE HEEL OF THE HUNT: QUANTITATIVE ULTRASOUNDFOR OSTEOPOROSIS IN AN ELDERLY IRISH POPULATION
James Mahon, David Moloney, Angelina Farrelly, Deirdre Smith, Laura Mulkerrins,Maire Rafferty, Caoimhe McManus, Oisin Hannigan, Nessa Fallon, Georgina Steen,Niamh Maher, Rosaleen Lannon, MC Casey, JB Walsh, Kevin McCarrollOsteoporosis Unit, St James’s Hospital, Dublin 8, Ireland
Background: Quantitative heel ultrasound (QUS) is a low-cost, portable, quick, non-irradiating alternative to DXA in osteoporosis screening. However, correlation betweenQUS and DXA is ill-defined, especially in an elderly Irish population. We aimed to exam-ine the relationships of QUS with DXA, biochemical bone markers, and fracture historyin elderly patients attending our osteoporosis tertiary referral centre.Methods: We identified patients with contemporaneous QUS and DXA. We comparedQUS T-scores, Broadband Ultrasonic Attenuation (BUA) and Speed of Sound (SOS)with DXA results, fracture history and biochemical bone turnover markers.Results: 2294 patients; 83% female; mean age 67.13 years (SD 13.98). Mean BMDtotal hip 0.767 g/cm2 (SD 0.152); mean BMD spine 0.898 g/cm2 (SD 0.194). In linearregression analysis, both QUS SOS and BUA significantly correlated positively withBMD hip and spine; association was strongest at hip, where BUA accounted for a35.71% BMD variation (R-square adjusted, p < 0.0001). For patients whose QUST-score was ≤−2.5 (osteoporotic), odds ratio (adjusted for age, sex, BMI) for hip fracturewas 2.17 (95% CI 1.66-2.88, p < 0.0001); odds ratio for vertebral fracture 1.83 (95% CI1.44-2.30, p < 0.001). QUS sensitivity and specificity for diagnosing osteoporosis by T-score varied by site. When compared with DXA, a QUS heel T-score of ≤−2.5 had71.21% sensitivity and 69.78% specificity for diagnosis of hip osteoporosis; for spineosteoporosis, QUS sensitivity was 58.9%, specificity was 73.04%. No significant correl-ation of SOS and BUA to bone turnover markers.Conclusions: QUS heel is strongly predictive of BMD at hip and also of hip fractureand has high sensitivity for diagnosis of osteoporosis of hip. It is less accurate in predict-ing spine osteoporosis, BMD and fractures. Nor was it predictive of increased markers ofbone turnover. Further research may identify groups in whom QUS has highest accuracy,and establish T-score cut-off points to normalise its screening utility.
117 SINGLE HOSPITAL THROMBOLYSIS RATES IN CONSECUTIVEISCHAEMIC STROKE PATIENTS.
Brian Drumm2, Sean Murphy1, Patrick O’Donoghue3, Ronan O’Toole1, Tim Lynch1,Killian O’Rourke1, Shane Smyth1, Derek Hayden1, Peter Kelly11Mater Misericordiae University Hospital, Dublin, Ireland2University College Dublin, Dublin, Ireland3James Connolly Memorial Hospital, Dublin, Ireland
Background: Since its approval in 1996, recombinant tissue-type plasminogen activatorremains the only medication of proven benefit in the hyper-acute management of ischae-mic stroke (Demaerschalk et al., Stroke 2016;47:00-00). The 2015 national stroke auditshowed a national rate of thombolysis of 11%, which compares well internationally.Worldwide single hospital studies have shown rates of up to 30% (Meretoja et al.Neurology, 2012:79(4):306-313).
We examined the rates of thrombolysis in consecutive Ischaemic Strokes presenting toour Tertiary Referral Urban Hospital from January 1st to December 31st 2015.Methods: All patients discharged from the hospital are coded via the Hospital In-patientEnquiry System (HIPE). We reviewed all cases of strokes coded during 2015, as well asinpatients at the turn of year and crosschecked these against the patient’s medical records.We determined from this the total number of ischaemic strokes admitted in 2015 and thenumbers who received thrombolysis.Results: In 2015, there were 290 cases of ischaemic stroke. 73(25.2%) of these patientsreceived intravenous alteplase. The mean door to CT time was 19 minutes (+/− 14); themean door to needle was 41 minutes (+/− 19). Of note 23 patients also received endo-vascular treatment bringing the total number intervened in to 84 (29.0%).Conclusion: Our figures highlight that a significantly higher proportion of patientsreceiving thrombolysis than the national average. The hospitals urban location, allow-ing quicker access to treatment, and larger size, allowing for specialised review onarrival are possible reasons behind the increased rate. This raises important questionsabout resource allocation and how acute stroke services are structured going forwardto ensure equitable access for all patients, especially those in rural settings.
122 REHABILITATING THE REVOLVING DOOR: REDUCINGREADMISSIONS - A MULTI-DISCIPLINARY QUALITYIMPROVEMENT PROJECT
Keith McGrath, Karen Donovan, Ruth Holland, Margaret McKiernan, Kieran O’ConnorMercy University Hospital, Cork, Ireland
Background: Readmissions are costly for healthcare and undesirable for patients.Hospitals with low readmission rates ensure smooth care transitions as their patients aredischarged. Our aim was to reduce avoidable readmissions by improving the dischargeprocess at our hospital.
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Methods: We collected quantitative and qualitative data using a mixed methodsresearch approach. Information from patients, carers, and staff was gathered throughstructured and unstructured interviews. The factors influencing the achievement of ouraim were represented on a driver diagram. A fishbone diagram displayed the causes ofdeficiencies in the current discharge process. Quality improvement interventions basedon these models were tested and introduced by rapid Plan-Do-Study-Act cycles. Wedeveloped a measurement dashboard comprising of relevant run charts to assessimprovement.Results: Our results indicate that one third of 28 day readmissions are potentially avoid-able. Some reasons for avoidable readmissions were not within a hospital’s control.Nevertheless, the majority of reasons related to inadequate discharge planning. Duringour project a multidisciplinary discharge planning checklist, a pathway for frail olderpatient assessment and a complex discharge round were introduced. Individualised dis-charge plans and early telephone follow-up for complex discharges were commenced.Focused educational sessions on discharge planning were started in the hospital.Avoidable readmissions fell from 9.8% during the baseline period to 8.1% by the end ofthe project.Conclusions: Managing readmissions is a complex task. Multi-component interventions,with early multi-disciplinary review for complex discharges, focused patient education,and medication reconciliation can significantly reduce readmissions. Overall, a moreeffective pathway is developed for all patients and patient safety is improved. Reducingavoidable readmission has great potential to improve quality and lower spending through-out the healthcare service. A person-focused approach understanding the unique issuesof each high-risk individual admitted to the hospital is crucial.
127 AN INVESTIGATION OF THE CONTRIBUTING FACTORSTHAT INCREASE THE RISK OF OSTEOPOROSIS ANDOSTEOPENIA AMONG ADULTS WITH AN INTELLECTUALDISABILITY
Eilish Burke1, Rachael Carroll1, Philip McCallion2, JBernard Walsh1, Mary McCarron11University of Dublin Trinity College, Dublin, Ireland2University of Albany, New York, USA
Background: Osteoporosis is a significant health and socioeconomic threat to a largeproportion of the population. People with ID are at greater risk of experiencing overallpoor health. Many barriers exist from difficulty in expressing their own health need tolack of empirical evidence on health determinants.Methods: The sample was drawn from The Intellectual Disability Supplement to TheIrish Longitudinal Study on Ageing (IDS-TILDA). Bone quality was measured using aGE Lunar Achilles as part of an objective health suite of assessments. Assessment wassupported with accessible material. Ethics was granted by Trinity College Faculty Ethicscommittee and by the service providers involved in the study. All participants providedconsent prior to engaging in assessment. A decision tree-based statistical classificationalgorithm for identifying variables responsible for the occurrence of poor bone qualitywas utilised.Results: Overall 575 participants had QUS performed. The prevalence of osteoporosiswas identified at 41% among this cohort. For osteoporosis the model classified 70.8% ofthe sample with difficulty walking (p < 0.0001), antiepileptics (p = 0.004) and protonpump inhibitors (p = 0.043) as the strongest predictors to emerge.Conclusion: The findings supports a need for robust risk assessment and for clinicalpractitioners to not only consider the obvious risks but also specific concerns for peoplewith ID in order to better target preventative strategies.
133 TRENDS IN CASE FATALITY, ANTITHROMBOTIC USAGEAND LOCATION OF INTRACEREBRAL HAEMORRHAGE OVERA 12 YEAR PERIOD
Marie Therese Cooney, Stephen Murphy, Susan O’Callaghan, Patrick Moloney,Imelda Noone, Mary Kate Meagher, Morgan Crowe, Tim CassidySt Vincent’s University Hospital, Dublin, Ireland
Background: Intracerebral haemorrhage (ICH) is associated with worse outcomes thanischaemic stroke. Counter-intuitively this has not improved in recent years. We postulatedthat increasing age of the population and usage of anticoagulants represents a possibleexplanation.Methods: St. Vincent’s University hospital is a tertiary referral hospital serving a popula-tion of approximately 300,000 in Dublin, Ireland. We excluded ICH associated with traumaor other secondary causes. We analysed changes in age distribution, clinical characteristics,medication usage and case fatality (30 day mortality) over the 12 year period. Fisher’s exacttest was used to assess for significant differences between percentages.Results: 3,547 stroke patients presented between 2003 and 2014; 11.1% (394) weredue to ICH. Median age was 77.2 years. ICH patients aged ≥90 years increased from1.9% in 2003–2006 to 7.5% in 2010–2014. Anticoagulation use in this group increasedfrom 0% in 2003–2006, to 11% in 2007–2010 to 19% in 2011–2014, NS. There wasno change in case fatality or location of ICH over the 12 years. There was an increasein case fatality with increasing age; 11% in under 75 s, 24% in 75–89, 38% in over 90 s,p < 0.001. Lobar ICH was associated with higher case fatality than deep ICH; lobar40%, deep 14%.
Conclusion: We have shown no decrease in case fatality, despite advances in manage-ment of ICH over this period. This may be related to the increasing percentage of ICHoccurring in older people and the increasing association with anticoagulant usage. Furtherresearch will focus on identifying factors, both clinical and radiological, associated withboth short-term mortality and longer term functional outcome.
134 A SYSTEMATIC REVIEW OF THE EFFECTS OF ADVANCECARE PLANNING ON NURSING HOME RESIDENTS
Ruth Martin1,2, Barbara Hayes1, Kate Gregorevic1,2, Wen Kwang Lim1,2
1Northern Health, Melbourne, Victoria, Australia2University of Melbourne, Melbourne, Victoria, Australia
Background: Advance Care Planning (ACP) encompasses a process by which peoplemay express and record their values and preferences for care and treatment should theylose the capacity to communicate them in the future. Our aim was to identify the effectsof Advance Care Planning (ACP) interventions on nursing home residents.Methods: A comprehensive literature search was conducted using Embase, Medline,PsychINFO and CINAHL. Reference lists of all included articles were reviewed.Inclusion criteria included randomised controlled trials (RCT), controlled trials, pre/poststudy design trials and prospective studies. A narrative synthesis was compiled as the het-erogeneous nature of the interventions and results precluded meta-analysis.Results: Initial search yielded 4,654 articles, thirteen fitted inclusion criteria. ACP inter-ventions included: five evaluating educational programmes; five introducing/evaluating anew ACP; two introducing an ACP programme with a palliative care initiative; oneobserving effect of Do Not Resuscitate orders on respiratory infection treatments. ACPdecreased hospitalisation rates by a range of 9–43% without increased mortality. ACPincreased the number of residents dying in their nursing home by 29–40%. Medical treat-ments being consistent with wishes increased with ACP. ACP was associated withdecrease in overall health costs. ACP was associated with increase in community palliativecare use but not in-patient hospice referrals.Conclusions: ACP has beneficial effects in the nursing home population. The types ofACP interventions vary and it is difficult to identify superiority in effectiveness of oneintervention over another. Outcome measures also vary considerably between studiesalthough hospitalisation, place of death and actions being consistent with resident’s wishesare by far the most common. Very few studies with high quality methodology have beenundertaken in the area with a significant lack of RCT. More robust studies, especiallyRCT are required to support the findings.
135 IMPLEMENTATION OF “GOALS OF PATIENT CARE”MEDICAL TREATMENT ORDERS IN RESIDENTIAL AGED CAREFACILITIES: A RANDOMISED CONTROLLED TRIAL
Ruth Martin1,2, Barbara Hayes1,2, Anastasia Hutchinson1,2, Paul Yates3, WenKwang Lim1,2
1Northern Health, Melbourne, Victoria, Australia2University of Melbourne, Melbourne, Victoria, Australia3Austin Health, Melbourne, Victoria, Australia
Background: Systematic review shows that advance care planning has many effects onresidents of aged care facilities, including decreasing hospitalisation. (1) The ResidentialAged Care Facility (RACF) “Goals of Patient Care” (GOPC) form is a medical treatmentorder that incorporates aged care residents’ advance care plans or wishes. The form helpsguide healthcare decisions made on behalf residents in planned and emergency situations.Methods: We performed a cluster randomised controlled trial in three pairs of RACFs.Inclusion criteria were all residents from participating facilities for whom writteninformed consent could be obtained. We recorded baseline characteristics from all partici-pants. We completed the Goals of Patient Care form with participants in the interventionfacilities as compared with usual care in control facilities. Our primary outcome is theeffect on Emergency Department reviews and admissions at 6 months. Secondary out-comes include change in hospitalisation rates at 3 months amongst others.Results: We selected 6 RACFs from 45 invited to take part. We recruited 337 partici-pants across 6 sites of which 72% were female. The mean age was 86.5 years. 61% hadan existing advance care plan. The three month event rates for Control facilities were (1)0.23, (2) 0.15 and (3) 0.45 versus Intervention facilities (1) 0.21 (2) 0.11 (3) 0.25. The sixmonth event rates for Control facilities were (1) 0.53, (2) 0.3, (3) 0.73 versus Interventionfacilities (1) 0.46, (2) 0.28, (3) 0.46 with the event rate being the number of admissionsper total residents per time period.Conclusions: Within each cluster pair, Intervention facilities show reduced event ratesversus Control. The Goals of Patient Care medical treatment order showed positivetrends towards reducing Emergency Department reviews and admissions at both threeand six months. We feel this and further analysis will support the use of our GOPC formin RACFs.
142 PERSONHOOD AND PUBLIC POLICY FOR DEMENTIA INIRELAND
Niamh Hennelly, Eamon O’SheaNational University of Ireland, Galway, Galway, Ireland
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Background: Personhood in dementia refers to treating the individual with dementia asa person, in a manner which supports and promotes their sense of self, role and socialconnectedness. An overarching principle of the Irish National Dementia Strategy is toprogress personhood by enabling people with dementia to maintain their dignity, identityand resilience when faced with the disease (Department of Health, 2014).Methods: This paper explores the origins and implications of personhood as an over-arching principle for dementia policy in Ireland. It examines the impact of personhoodon dementia care services, outcome measurement and regulatory frameworks withindementia. A content analysis of submissions made by stakeholders in developing theNational Dementia Strategy examines the rhetoric and substance of personhood withinthe public discourse and its relevance to priority setting within dementia care. An examin-ation of the use and status of personhood models in international dementia strategiesprovides a comparative framework for the Irish Strategy.Results: Differing concepts of personhood appear in national and international dementiastrategies. This does not always lead to personhood-led action in care provision, outcomemeasurement and regulation. The extent to which the personhood principle is reflected inservice delivery, outcome measurement and regulatory instruments in Ireland is varied,resulting in ambiguity and disappointment when assessing how the Strategy hasresponded to one of its overarching principles.Conclusions: If the principle of personhood is to have meaning in dementia care inIreland much more work is needed on operationalising the concept in relation to the con-tent of dementia care programmes, outcome measurement and the development ofappropriate regulatory instruments.Reference:Department of Health The Irish National Dementia Strategy. Dublin: Department ofHealth, 2014.
147 FRAILTY IN AN EMERGENCY DEPARTMENT: PREDICTORSAND POINT PREVALENCE OF FRAILTY AND PRE-FRAILTY INAN IRISH COHORT
Cliona Small1, Lynn Spooner2, Maria Costello1, Antoinette Flannery1, Liam O’Reilly2,Laura Heffernan2, Edel Mannion3, Orla Sheil3, Sinéad Bruen3, Pauline Burke3,Nora Kyne3, Mary McMahon3, D. William Molloy4, Anna Maughan5, Alma Joyce5,Helen Hanrahan2, Georgina Stallard2, John O’Donnell2, Rónán O’Caoimh11Department of Geriatric Medicine, University Hospital Galway, Newcastle Rd, and HealthResearch Board Clinical Research Facility Galway, National University of Ireland, Galway,Geata an Eolais, Galway City, Ireland2Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, GalwayCity, Ireland3Frail Elderly Assessment Team, University Hospital Galway, Newcastle Rd, Galway City,Ireland4Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital,Douglas Rd, Cork City, Ireland5PCCC, Shantalla Health Centre, Costello rd, Galway City, Ireland
Background: Although frailty is common among older adults presenting to theEmergency Department (ED), its prevalence is not well described. Likewise, little isknown about the characteristics and prevalence of vulnerable ‘pre-frail’ patients attendingED who may benefit from early identification and intervention to prevent transition toestablished frailty.Methods: We assessed consecutive older adults, aged >70 years, attending a large univer-sity hospital ED, 24-hours/day for a two week period in March 2016, for frailty using abattery of frailty measures including the FRAIL Scale, Clinical Frailty Scale, GroningenFrailty Indicator, Mini-Nutritional Assessment (MNA), body mass index (BMI),Alzheimer’s disease 8 (AD8) cognitive test, the Euroqol-5D and the Caregiver BurdenScore (CBS). Instruments were administered by trained clinician raters. Frailty status (frail,pre-frail and robust) was determined by a consultant geriatrician.Results: In all, 307 patients were available. Of these, 280 were included with a median(interquartile) age of 78 (83−73 = +/− 10) years. Most, 148/280 (53.6%) were female.The number considered globally frail by physician assessment was 161, a point prevalenceof 58%. Using the FRAIL scale alone, the point prevalence of frailty (cut-off ≥3/5) andpre-frailty (cut-off <3/5 but ≥1/5), was 29% and 41% respectively. Frail patients weresignificantly more likely to be older (p = 0.003), have lower MNA (p < 0.001), higherAD8 (p < 0.001), poorer Euroqol-5D scores (p < 0.001), and a higher CBS (p = 0.01)compared to those scoring as non-frail (pre-frail or robust). There were no differences ingender or BMI. Pre-frail patients had significantly better MNA, AD8, Euroqol-5D andCBS scores than frail patients but were similar in age, sex and BMI.Conclusions: The point prevalence of frailty and pre-frailty in an Irish university hospitalED is high. Frail and pre-frail older patients report more cognitive impairment, are morelikely to screen positive for malnutrition, report lower quality of life and have higher care-giver burden scores.
152 THE IMPACT OF FUNCTIONAL LIMITATION ON SOCIALPARTICIPATION FOR OLDER PEOPLE WITH ANINTELLECTUAL DISABILITY IN IRELAND
Darren McCausland1, Philip McCallion2, Damien Brennan1, Mary McCarron11Trinity College Dublin, Dublin, Ireland2University of Albany, New York, USA
Background: Limitation to aspects of functioning, including ADLs and IADLs, is asso-ciated with ageing and has been used to assess disability in later life. Functional limitationhas been found to impact negatively on quality of life in the general older population(McCrory et al. 2014), while much higher rates of functional limitation have beenreported amongst older people with an intellectual disability (ID) (McCarron et al. 2011).Methods: Cross-sectional data from wave 2 of the Intellectual Disability Supplement toThe Irish Longitudinal Study on Ageing (IDS-TILDA) explored associations betweenfunctional limitation and social participation amongst a nationally representative sampleof 701 adults with ID aged 43 and above. Functioning in relation to ADLs, IADLs, phys-ical ability, communication and literacy was examined. The World Health Organisation’s(WHO) International Classification of Functioning, Disability and Health (ICF) was usedas a theoretical framework to examine social participation.Results: Large majorities (between 70.3% and 97.9%) of older people with ID reportedlimitation in each of the functional areas examined. Higher rates of limitation were asso-ciated with more severe ID, worse health, institutional residence and being older.Functional limitation was associated with lower rates of social participation, including par-ticipation in human rights and citizenship, education and occupation, social activities, localcommunity and interpersonal relationships.Conclusions: Older people with intellectual disabilities in Ireland have much higher ratesof functional limitation than the general older population, and this may impact negativelyon their social participation. Policy aimed at social and community participation for olderpeople with ID must provide the individualised supports required for improved function-ing, as the basis for participation.
158 QUALITY IMPROVEMENT INITIATIVE IN FALLS ANDFRACTURE PREVENTION IN CONTINUING CARE SETTINGS
Rosemary Murphy1, David Wong2, Eileen Moriarty1, Sheena McHugh2, Finola Cronin1,Kieran O’Connor1, Olivia Wall11Health Service Executive - Community Healthcare Organisation Area 4, Cork, Ireland2University College Cork, Cork, Ireland
Background: Accidental falls are the most common safety concern affecting long-termresidents in community hospitals. Education, training, peer support and targetedresources are essential to enable the application of evidence based best practice and todevelop a systematic approach to risk assessment and management. This study describesthe use of falls data as part of a quality improvement initiative for falls prevention beingimplemented in continuing care settings.Methods: This is a quantitative study consisting of older residents in continuing care set-tings, aged between 65–95 yrs. Falls data were extracted from incident reports taken from8 Community Hospitals and entered into a statistical software package for analysis. Thedata extracted included the number of falls, location of falls, time of day and injuries sus-tained. Data were collected, analysed and reviewed using pie charts, bar charts, run chartsand Pareto charts.Results: Of the 8 Community Hospitals that took part in the study all underwent add-itional education sessions on falls prevention and correct data collection techniques, toensure best practice for the future. Following an analysis of each individual communityhospital, an environment and residents profile was completed. Data were collected andfeedback given to hospital staff, to support their awareness of falls prevention and theimportance of patient safety.Conclusions: The patterns and trends of falls at each of the Community Hospitals havebeen highlighted to team leaders and interventions that can be carried out to reduce fallsrates have been identified. This standardised approach to reviewing falls data in thesecommunity hospitals enables targeted future planning in each hospital and ensures theincorporation of data when reviewing environments, staffing, resources, services, activitiesand trends in long term versus short stay patients who fall.
163 AN EVIDENCE SYNTHESIS OF RESILIENCE IN DEMENTIACAREGIVING: A SYSTEMATIC REVIEW
1University College Dublin, Dublin, Ireland2Care Alliance Ireland, Dublin, Ireland3St Vincent’s University Hospital, Dublin, Ireland
Background: The majority of people with dementia live in the community and receivecare from family members or other informal carers. Family caregivers experience caregiv-ing differently and have varying levels of personal resilience when acting in the caregivingrole. Defined as a set of personal qualities, resources and factors which allow an individ-ual to maintain normal or enhanced functioning during times of adversity (Windle, 2011),resilience, contributes to the carer’s well-being and the quality of care provided to the per-son with dementia. The aim of this systematic review is to examine the concepts attribut-ing to resilience in dementia caregiving and to outline interventions that enhanceresilience in dementia caregivers.Methods: A systematic literature review was conducted to examine resilience, as itapplies to caregiving, and to identify non-pharmacological intervention studies examiningdementia caregivers published between 2006 and 2016. The systematic review was con-ducted using six databases (Cochrane, PubMed, CINAHL, EMBASE, PsycInfo, ASSIA).Two reviewers pre-screened search results and conducted data abstraction and qualityappraisal.
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Results: A total of 13,863 studies were identified from the initial search and, followingscreening, 92 studies were included in the systematic review. Based on narrative synthesisof the literature, the study reports a model of resilience for dementia caregivers whichfocuses on social and cultural factors, aspects of the carer-care recipient relationship andthe carer’s psychological resources.Conclusions: While many studies focus on the area of caregiving, very few examineresilience as an independent construct. As well as outlining a framework of resilience, thisreview highlights interventions which enhance resilience. The findings can be used bypractitioners in the design and development of interventions aimed at enhancing resili-ence in family carers of people with dementia.
177 PRELIMINARY RESULTS OF THE FRAIL ELDERLY PILOTPROGRAMME IN CONNOLLY HOSPITALBLANCHARDSTOWN 2016
Background: The Specialist Geriatric Services (SGS) Model of Care aims to improvequality and efficiency of care for older people with complex health care needs. The FrailElderly Pilot Programme commenced in Connolly Hospital Blanchardstown (CHB) inJanuary 2016 to achieve these aims. It involves the early identification of the ‘frail olderperson’ with confusion, falls, poor mobility, poly-pharmacy and social factors which maywarrant a comprehensive geriatric assessment (CGA).Methods: The Frail Elderly Team was established within the emergency department(ED) and the acute medical assessment unit (AMAU) in CHB. Patients over 75 yearswere screened for frailty indicators during core hours. Frail Elderly care pathways andguidelines were implemented to improve quality, efficiency and outcomes for this cohort.To facilitate ED discharge, a rapid access pathway to the Day Hospital was established.Results: 307 patients received input from the Frail Elderly Team while in ED. Referralreasons included functional, cognitive, social, dysphagia and nutritional assessment, fallsand poly-pharmacy. Patients were categorised on average as moderately frail (RockwoodClinical Frailty Scale). 60% of patients screened scored positively for delirium and/or cog-nitive impairment on the 4AT. 31% of patients were discharged on the same day fromthe ED or AMAU. The length of stay of patients seen by the Frail Elderly Team was onaverage 40% shorter than those who had not received input.Conclusions: The Frail Elderly Team aims to improve the quality and efficiency of careand outcomes for the frail elderly presenting to CHB. The SGS will continue to provideeducation and leadership in relation to the identification of the frail older person, CGAand early discharge planning where possible of identified frail older people.References:HSE and RCPI (2012) National Clinical Programme for Older People; Specialist
Geriatric Services Model of Care. Dublin.
179 CHARACTERIZATION OF MOTORIC COGNITIVE RISKSYNDROME FROM A NATIONALLY REPRESENTATIVESAMPLE
Fiachra Maguire, Isabelle Killane, Andrew Creagh, Gavin Bennett, Orna Donoghue, RoseAnne Kenny, Richard ReillyTrinity College Dublin, Dublin, Ireland
Background: Challenges of an aging population include an increasing prevalence ofdementia and need for prognostic indicators of pathology. Slow gait speed has shown sig-nificant associations with poor cognitive function. [1] Motoric Cognitive Risk syndrome(MCR) combines gait speed and subjective cognitive complaints to yield a pre-clinicalmarker of dementia. [2] This paper explores MCR using data from The IrishLongitudinal Study on Ageing.Methods: The mean age of the population over 50 years old (n = 4925, 54% women,)was 61.2 years (SD 8.3). Prevalence of MCR is estimated using criteria applied previouslyto the Health & Retirement Study (HRS). [2] Slow gait speed defined as 1 SD below theage and sex adjusted means. Subjective cognitive complaints are derived from self-ratingmemory as fair or poor. Risk factors are examined using logistic regression methodsadjusting for age, sex and education. Sampling weights are applied to all analysis.Results: The estimated prevalence of MCR is 2.3% (CI: 1.84 - 2.75), with no gender orage effects present. Physical inactivity (OR: 1.87, p < 0.05), polypharmacy (OR: 2.36, p <0.001), current smoker (OR: 2.02, p < 0.05) and obesity (OR: 2.47, p < 0.001) were asso-ciated with an increased risk of MCR.Conclusions: The prevalence of MCR in this cohort is lower than estimates from theHRS (1.74% vs 8% for participants over 65 years). [2] Polypharmacy is a potential riskfactor not previously identified in MCR cohorts and may contribute to prevalence inyounger patients.References:1. Mielke M. M. et al. Assessing the Temporal Relationship Between Cognition and Gait:
Slow Gait Predicts Cognitive Decline in the Mayo Clinic Study of Aging. J GerontolSer A 2013; 68: 929–937.
2. Ayers E., Verghese J. Motoric cognitive risk syndrome and risk of mortality in olderadults. Alzheimer’s & Dementia, 2015.
182 HOSPITALIZATION AND SURGERY: ARE THERE HIDDENCOGNITIVE CONSEQUENCES? EVIDENCE FROM THE IRISHLONGITUDINAL STUDY ON AGEING (TILDA)
Helen O’Brien1,2, Neil O’Leary1, Siobhan Scarlett1, Celia O’Hare1, Rose Anne Kenny1,21The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland2Mercer’s Institute for Successful Ageing (MISA), St. James’s Hospital, Dublin 8, Ireland
Background: The dramatic shift in the global population demographic has led toincreasing numbers of older people undergoing hospitalisation and surgical procedures.Objectives: To determine whether hospitalisation or hospitalisation with surgery undergeneral anaesthesia is associated with poorer cognitive performance in adults over the ageof 50.Methods: Cognitive function in the domains of global cognition (Mini-Mental StateExam (MMSE)), memory (immediate and delayed word recall tests, prospective memorytasks, subjective memory) and executive function (verbal fluency test) was assessed in8,023 individuals at waves 1 and 2 of TILDA two years apart. Mixed-effects models wereused to investigate the hypothesis after adjustment for risk factors for cognitive declineand potential confounders.Results: During the 12 months preceding wave 1, 458 participants were hospitalised(mean age 67.0, 55.2% female) and a further 548 participants (mean age 64.6, 51.8%female) were hospitalised and underwent surgery with general anaesthesia; 6,847 (meanage 63.4, 54.4% female) were not hospitalised. There was a 14% higher error rate (IRR[95% CI] = 1.14[1.07, 1.23]) in the MMSE in the hospitalisation group and a 5% highererror rate (IRR [95% CI] = 1.05[0.98, 1.13]) in the surgery group compared to those withno hospitalisation. Poorer cognitive performance in the memory tasks was evident inboth the hospitalisation group and the surgery group (immediate recall: [95% CI] =–0.12 words [–0.21, –0.03] versus −0.10 words [–0.19,–0.02] and delayed recall: –0.19words [–0.33,–0.05] versus −0.18 words [−0.31, −0.05]) compared to those with no hos-pitalisation. Increased error in the time-based prospective memory task was also observedin both groups (OR [95% CI] = 1.33[1.09, 1.62] versus 1.28[1.06, 1.55]).Conclusion: Hospitalisation and hospitalisation with surgery and general anaesthesia areassociated with poorer global and domain specific cognitive performance. This is the firsttime a longitudinal population-representative study has demonstrated this relationship forboth exposures simultaneously.
185 ENABLING OLDER PEOPLE TO ACCESS THEIR EXPRESSEDPREFERENCE FOR CARE AND SUPPORT: A SOCIAL WORKPERSPECTIVE
Sarah Donnelly1, Marita O’Brien2, Emer Begley3, John Brennan41University College Dublin, Dublin, Ireland2Age Action, Dublin, Ireland3Alzheimer Society of Ireland, Dublin, Ireland4Irish Association of Social Workers, Dublin, Ireland
Background: Research indicates that most older people would prefer to live in theirown homes and have support services provided to enable them to do so for as long aspossible (Barry, 2010). However, there is an evident tension between this objective andthe promotion of ‘ageing in place’, with the consequent heavy reliance on the NursingHome Support Scheme (NHSS) in the Irish context (Donnelly and O’Loughlin, 2015).This study set out to explore the perspectives and experiences of social workers inRepublic of Ireland working with older people to identify issues/barriers in accessingcommunity supports and to examine older people’s involvement in decision-making,including those with a cognitive impairment/dementia.Methods: A mixed methods study design was adapted and the study consisted of twophases: Phase 1 consisted of an on-line survey of social workers using Survey Monkey.Phase 2 consisted of in-depth semi-structured telephone interviews with at least twosocial workers from each Community Health Office area.Results: Geographical inconsistencies were revealed in social workers ability to accesscommunity supports and clear tensions were found as home supports are only deliveredwithin the framework of what is available. A growing emphasis on responding only tothose with the most severe level of need, coupled with increased budgetary constraints,means that little or no support can be accessed through home help services to assist olderpeople with domestic tasks.Social workers also reported that many older people with acognitive impairment and/or dementia were excluded from decision-making processesrelated to their care.Conclusions: Older people’s preference for receiving care and support in their homeand community is not being realised often resulting in unnecessary or premature admis-sion to nursing home care.
186 RESOURCE ALLOCATION ON THE BOUNDARY OF CARE FORPEOPLE WITH DEMENTIA IN IRELAND
Background: Dementia poses a significant cost burden to health and social care systems.Providing the most cost-effective mix of services is, therefore, becoming a priority for
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policy-makers in many countries. Evidence suggests that shifting the balance of resourceallocation towards more personalised community-based supports can reduce the risk ofinstitutionalisation for some older people on the boundary of care.The objective of this study is to estimate resource utilisation, cost of care and out-
comes for people with dementia on the boundary of community and residential care inIreland, within an innovative, personalised, community-based programme of care forpeople with dementia.Methods: A balance of care approach was used to examine how investment in persona-lised community care can impact on costs, outcomes and admission to long-stay carefacilities for people with dementia. The study examines resource use, costs and outcomesfor people with dementia, whose needs can potentially be met in alternative settings, overa three year period. Formal and informal resource use is assessed, as well as housing, per-sonal consumption and residential care costs.Results: 181 people with dementia on the boundary of care were supported to remainliving in the community, receiving a total of 34,635 personalised support hours at a costof €953,533. The total cost of formal community care was €4,804,563, while the cost ofinformal care was €8,586,096. In contributing to potentially keeping people living athome for longer, the estimated public expenditure saving associated with the programmewas €3,169,561.Conclusions: Personalised supports are likely to support family carers to continue caringfor longer, thus postponing expensive admission to long-stay care facilities. The study hasshown that it is possible to increase the availability of personalised supports for peoplewith dementia to augment existing formal care provision and still not exceed residentialcare costs.
188 SEXUAL ACTIVITY AND RELATIONSHIP QUALITY IN IRISHOLDER ADULTS
Joanna Orr1, Richard Layte2, Neil O’Leary1, Rose Anne Kenny11The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland2Department of Sociology, School of Social Sciences and Philosophy, Trinity College Dublin,Dublin, Ireland
Background: Sexual activity in later life is a growing area of research. Existing evidencesuggests sexual activity is an important source of satisfaction in older couples but that itcan also be a source of conflict. The study aimed to assess whether sexual activity andcouple mismatches in the importance attributed to sex are associated with relationshipquality in older Irish adults.Methods: Data from 2,398 married/cohabiting respondents in Wave 2 of The IrishLongitudinal Study on Ageing (TILDA) was used. A scale of relationship quality, rangingfrom 0 to 24, was derived. Frequency of sexual activity, measured categorically, theimportance each couple attributed to sex (1–5 scale) and mismatch between members ofthe couple in this importance (0–4 scale) were estimated. Associations were assessedusing negative binomial regression.Results: The majority of respondents in this partnered sample were sexually active(79.2%), with over half reporting sexual activity at least once a month (57.8%).Frequency of sexual activity was positively associated with relationship quality for menand women, while couple importance of sex was positively associated with relationshipquality for women only. Over half of couples (59.2%) experienced some mismatch inimportance attributed to sex (≥1), and this was associated with worse relationshipquality for both men (Incidence Rate Ratio (IRR) per unit increase in mismatch = 1.1695% CI:1.11–1.22) and women (IRR = 1.17 95% CI:1.11–1.23). When accounting forimportance of sex and couple mismatch, overall frequency of sex remained importantfor men (p < 0.00), but lost some of its association with relationship quality forwomen (p < 0.05).Conclusion: Results showed that frequent sexual activity and attributing importance to sexwere associated with better relationship quality within spousal relationships. Associationsappear to work differently for men and women. Mismatch between partners was consist-ently related to worse relationship quality. Continued research in this area is needed.
201 EARLY SUPPORTED DISCHARGE FOR STROKE: COMPARINGTHE CHARACTERISTICS AND OUTCOMES OF URBAN ANDRURAL PATIENTS
Ciara Breen, Eithne Waldron, Thomas WalshGalway University Hospitals, Galway, Ireland
Background: Early Supported Discharge (ESD) services after stroke have demonstratedtheir efficacy in reducing length of stay and improving outcomes for a select cohort ofpatients. The evidence to date is strongest in relation to domiciliary-based rehabilitationin urban areas, as the only study carried out among a rural population did not find a sig-nificant benefit for ESD when compared with in-patient rehabilitation (Fisher et al).In response to the high numbers of rural dwellers within our catchment area, an alter-
native ESD service model was developed, which combines domiciliary and out-patientrehabilitation. This model is provided to approximately one-third of the ESD cohort.Methods: A total of 51 patients participated in ESD from Jan 2014 to May 2016. Aretrospective audit was completed comparing urban and rural participants for the follow-ing variables: demographic profile, length of hospital stay, length of time on ESD, bedday savings and functional outcome.Results: A full dataset was available for 37 patients. The urban/rural demographics wereas follows: 23/14 participants, mean age 64/69.7 years, female gender 48%/29%.
The groups did not differ in number of bed days saved or length of stay on the ESDprogramme. There was a trend towards a shorter hospital length of stay among the ruralpopulation (mean of 20.9 compared to 29.8 days) but this did not reach statisticalsignificance.
The Functional Independence Measure was used to measure functional status and out-come. We found no statistical difference between the groups at baseline, at discharge orfor overall gains.Conclusions: Rural dwellers in our ESD service had equivalent functional outcomes tothose within the traditional ESD population. Our findings suggest that further explor-ation of this service model should be considered within the Irish context.Reference:Fisher et al. A consensus on stroke: early supported discharge. Stroke 2011 May; 42(5):
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215 THE PATTERNS AND PREDICTORS OF PHYSICAL ACTIVITYCHANGE IN IRISH OLDER ADULTS: TILDA
Sean KilroyTrinity College Dublin, Dublin, Ireland
Introduction: Physical activity (PA) in older adults is extremely important in the main-tenance of independence, improvement of quality of life and the prevention and protec-tion of many non-communicable diseases. Older adults are recommended to do at least150 minutes of moderate-intensity PA; however over 60% of the worlds population failto meet current guidelines with age considered a major factor for reduced PA. Althoughpredictors of PA behaviour in older adults have been well researched and documented incross sectional studies, longitudinal research exploring the predictors of PA change hasrarely been examined, particularly in the old.Methods: Data presented are from 2782 community dwelling older adults aged 65 andover who participated in both wave 1 & 2 of the Irish Longitudinal Study of Ageing(TILDA). PA was assessed using the IPAQ and dichotomized at baseline and follow-upbased on activity levels according to the WHO guidelines: “active” (≥150 mins) and“inactive” (<150 mins). Detailed information on demographic, social and health circum-stances were collected. Four multiple logistic regression models were run to examine thepredictors of PA change.Results: Four patterns of PA were identified. Active maintainers (AM) (46.7%), suffi-ciently active at both time points; Inactive maintainers (IM) (23.1%) inactive at both timepoints; Adopters (adopt) (13.2%) becoming active and Relapser (rel) (17%), becominginactive. Older age, female gender, reporting a disability and fear of falling were less likelyto be AM. Higher education, better quality of life and endocrine, nutritional or metabolicdisease was associated with AM. Over 80, female gender, reporting a disability, fear offalling and respiratory disease were associated with IM. Retired, female gender and anx-iety were associated with rel.Conclusion: Policies and practice need to be aware of the factors associated with PAchange to help maintain PA and protect this vulnerable population from chronic disease.
223 SELF-REPORTED UNSTEADINESS PREDICTS FEAR OFFALLING AND ACTIVITY RESTRICTION AT TWO YEARSFOLLOW-UP
Orna Donoghue1, Annalisa Setti2, Neil O’Leary1, Rose Anne Kenny11The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland2School of Applied Psychology, University College Cork, Cork, Ireland
Background: Fear of falling (FOF) is common in older adults and can lead to restrictionof everyday activities. A recent conceptual model proposes that FOF may result from arealistic self-appraisal of one’s own balance abilities (Hadjistavropoulos et al. 2011). Inthis study, we examine if self-reported unsteadiness during walking is independently asso-ciated with the development of FOF and/or activity restriction at two years follow-up.Methods: Data were obtained from the first two waves of The Irish Longitudinal Studyon Ageing (TILDA). Community-dwelling adults aged ≥65 years, with Mini-Mental StateExamination score ≥18, who participated in a health assessment and who did not reportFOF at baseline were included in this analysis (n = 1,659). Unsteadiness was based onreports of feeling slightly steady, slightly unsteady or very unsteady (as opposed to verysteady) during walking. Participants were asked if they were afraid of falling and to whatextent (no FOF, somewhat afraid, very much afraid). Participants were then asked if theyrestricted their activities as a result of this fear (yes/no). Ordinal logistic regression andpoisson regression analyses were used to obtain the relative risk of reporting FOF oractivity restriction at follow-up after adjusting for socio-demographics, physical and men-tal health, self-reported sensory function and gait speed.Results: 24.6% of this sample (mean age 71.4 years; range 65–93) reported unsteadiness.Unsteadiness was independently associated with an increased risk of developing FOF(IRR = 1.53 [1.19–2.08], p = 0.008) and fear-related activity restriction (IRR = 1.98 [1.26–3.11], p = 0.003) after adjusting for variables listed above.Conclusion: Self-reported unsteadiness is easily obtained and may be a useful indicatorof existing or future balance dysfunction. It’s inclusion in a clinical assessment presentsan opportunity to target individuals for interventions aimed at improving balance andthus, reduce the development of FOF.References:1. Hadjistavropoulos et al. J Aging Health 2011; 23(1):3–23.
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225 ACUTE HOSPITAL ADMISSIONS IN NURSING HOMERESIDENTS: A TRIGGER TO THINK AHEAD!
Josephine Soh, Jonathon O’Keeffe, Diarmuid O’Shea, Graham HughesSt Vincent’s University Hospital, Dublin, Ireland
Background: Nursing Home Residents (NHRs) have complex healthcare needs due toadvanced age, multiple comorbidities and high levels of dependency. Acute hospitaladmissions of older people are associated with risks and complications. Despite this,transfer of NHRs to hospitals remains common. This study aims to examine the relation-ship between acute hospital admissions and survival benefits among NHRs.Methods: Retrospective analysis of NHRs with unscheduled admissions to a tertiary hos-pital over a 2 year period, from 2014 to 2015.Results: There were a total of 1219 unscheduled admissions from 929 residents. Thisrepresented 4.8% of 25,336 unscheduled admissions in the time period. 62% werewomen and mean age was 85 years. Of all admissions, 36% were recurrent admissions.293 residents had more than 1 admission.
The overall 6 month mortality of NHRs after hospital admissions was 34%. 18%(n =167) died during their hospital stay, with 81% of deaths occurred within the first 15 days.Following hospital discharge, a further 16%(n = 124) died in nursing homes within 6months. 40% of this cohort died within 1 month of hospital discharge.
NHRs with more than 1 admission had poorer outcomes. Their overall 6 month mor-tality was significantly higher at 37.5% vs 28.5% in residents with single admission (p =0.006). In-hospital mortality among re-attenders was 20.5%, compared to 16.8% in thosewith 1 admission (p = 0.17). Following hospital discharge, NHRs with more than 1admission had significantly higher nursing home mortality at 6 months, compared tothose with single admission (21% vs 13%,p = 0.009).
Among re-attenders who died in hospital, 73%(n = 45) died on their second admission.Of re-attenders who died in their nursing homes, 69%(n = 43) died after their secondadmission.Conclusion: Acute hospital admissions are associated with poor survival outcomesamong NHRs. Hospital admissions, in particular recurrent admissions, should promptearly discussions regarding appropriate end of life care.
229 INCIDENCE AND COURSE OF DEMENTIA IN PEOPLE WITHDOWN SYNDROME: FINDINGS FROM 20 YEARLONGITUDINAL FOLLOW UP
Mary McCarron1, Pamela Dunne2, Niamh Mulryan2, Rachael Carroll1, Philip McCallion3,Evelyn Reilly21Trinity College Dublin, Dublin, Ireland2Daughters of Charity, Dublin, Ireland3University of Albany, Albany, USA
Background: The prevalence of Alzheimer’s Dementia (AD) in people with Down syn-drome (DS) increases dramatically with age. However the early clinical presentation,nature and course of decline and risk factors for mortality are poorly understood. Aim:To investigate the characteristics of age related clinical changes, risk factors for dementiaand mortality in adults with DS.Method: Seventy-seven people with DS aged 35 years and older were followed over a 20year period in a specialist memory clinic for people with an Intellectual Disability. Thediagnosis of dementia was established using the modified International Classification ofDiseases, Tenth Revision (ICD-10) criteria, comprehensive diagnostic work up and acombination of objective and informant-based tests instruments.Results: Over the 20 year period, 97.4% (75 of 77) people developed dementia. The riskfor dementia was established, at 23% at age 50 years; 45% at age 55 years and 88% riskat age 65 years. The average age of diagnosis of dementia was at 55 years (median = 56years). Of the 56 people who died with a diagnosis of dementia, they had a mean dur-ation of dementia of 6.589 years.
The presence of dementia was strongly associated with new onset epilepsy. Withintwo years after dementia diagnosis, 72% (54 of 75) had a diagnosis of epilepsy. A sub-ject with epilepsy was over 11 times (95% CI = 2.0, 41.9) more likely to have died thana subject without diagnosed epilepsy when adjusted for age of onset of dementia andlevel of ID.Conclusion: The previously reported high risk levels for dementia among people withDS was confirmed. The memory clinic approach utilised here proved capable of trackingchange suggestive of dementia and potentially supported earlier diagnosis thus helping toensure earlier access to appropriate treatments and programme redesign.
232 CREATING LIFE STORIES THROUGH DIGITAL TECHNOLOGYAS A MEANS OF SUPPORTING PERSON-CENTRED,RELATIONSHIP BASED CARE ACROSS THE CONTINUUM OFDEMENTIA
S Lynch2, Evelyn Reilly2, F Lowe2, J Rhoda2, Mary McCarron11The University of Dublin Trinity College, Dublin, Ireland2Daughters of Charity, Dublin, Ireland
Background: Life story is a powerful tool for providing meaningful communication andfacilitating genuine person centred, relationship based care across the continuum of
dementia. Aim: The aim of this project was to build life story through digital technologyto support people with an intellectual disability across the continuum of dementia.Method: A multi-step approach was taken. First, a comprehensive survey in an easy toread format was distributed throughout the Dublin Service of the Daughters of CharityDisability Support Service to gather information and gauge interest among 380 peopleaged 40 years and over. A sub-cohort of people with Down syndrome who are atincreased risk of dementia and/or had a diagnosis of dementia were purposefullyincluded. Next, an exploration was undertaken of currently available Life Story and musicapps and a suite of easy to use apps were identified and then pilot tested. A tailored suiteof apps was sourced and supplemented with a ‘Train the Trainer’ manual. Instructions onthe use of these apps and information on assistive technology options was introducedand evaluated in terms of their accessibility and user friendliness. An easy read instructionmanual was developed to assist persons with limited literary skills. With the support ofthe person’s family and close carers a personalised digitalised life story was created foreach person using a combination of chapters which included personal photos, narrationas well as favourite songs and video clips.Conclusions: Digital life stories have been shown to be a very powerful means of facili-tating meaningful communication and supporting relationship based, person centred careacross the continuum of dementia. They have been shown to be very acceptable both tothe individual, their family and staff carers. Structured training and easy read supportmaterial as well as organisational commitment are critical for sustainability.
251 AN EVALUATION OF SWALLOW SCREENING IN ACUTESTROKE CARE
Nora Cunningham1, Monica Clancy2, Elaine Shanahan1, Catherine Peters1,Margaret O’Connor1, Declan Lyons1, Peter Boers31Department of Therapeutics and Ageing, University Hospital Limerick, Limerick, Ireland2Department of Speech and Language, University Hospital Limerick, Limerick, Ireland3Department of Neurology, University Hospital Limerick, Limerick, Ireland
Background: Recommendations from the Irish Clinical Program for Stroke include thatevery stroke patient should have a validated swallow screen completed within the first 24hours of admission. In 2015 The Irish National Audit of Stroke Care showed screeningrates of 36%. We introduced in The Massachusetts General Hospital-Swallow ScreeningTool (MGH-SST) screening tool in 2014. The aim of this study was to assess if swallowscreening took place in those patients who subsequently developed aspiration pneumonia.Methods: Medical records of consecutive patients admitted with stroke over a onemonth period were reviewed. We assessed if swallow screening was carried out, if a vali-dated screening tool was used, referral rates to Speech and Language Therapy (SALT),timing of SALT review, aspiration pneumonia rates and death rates.Results: 21 patients were admitted with stroke. The mean age was 71.6 years (SD 13.7).19% (4) were diagnosed with aspiration pneumonia. 28.6% (8) had a swallow screeningcarried out within 24 hours of admission. 9.6% (2) had a validated screening tool used.47.6% (10) were referred to SALT. Of these 80% (8) were seen within 48 hours of admis-sion. Of the patients with aspiration pneumonia 50% (2) did not have a swallow screen-ing test carried out within 24 hours and 25% (1) were not seen by SALT.Conclusion: Swallow screening levels are well below national levels of 36%, which arethemselves significantly below the optimum, which would involve all patients receivingscreening. Only 2 patients were screened using a validated tool. This has the potential tolead to aspiration pneumonia. Staff involved in acute care are now undertaking training inuse of the MGH-SST to ensure all patients are screened within the recommended 24 hours.
252 A PROFILE OF MALE PATIENTS ATTENDING A SPECIALISTBONE HEALTH CLINIC
Patrick O’Donoghue, Ronan O’Toole, Ann Gallagher, Seán Murphy, Cora McGreevyMater Misericordiae University Hospital, Dublin, Ireland
Background: Osteoporosis and fragility fractures are not exclusive to post menopausalwomen. Osteoporosis is a common but often under recognised problem in older men.This study aimed to profile men attending a bone health clinic.Methods: We conducted a retrospective chart analysis of all male patients attending aspeciality bone health clinic between 2012 and 2015. DXA results, Vitamin D level andsecondary work up for osteoporosis were all noted.Results: Over the 4 year period, 17/157 (10.83%) patients attending the clinic were malewith a mean age of 64.2 years (range 30-81 yrs). Of the male subjects, mean T score was−2.16 at total hip and −2.37 at Lumbar spine. In terms of risk factors for osteoporosis,8/17 (47.06%) of male subjects had a history of vertebral fracture. Secondary risk factorwork up for osteoporosis identified 1 subject with hypogonadism, 1 had a history of longterm phenytoin use, 1 was a long term vegan and 1 had hypercalciuria. 5/17 subjects hadno identifiable risk factor for osteoporosis. 10 subjects had a Vitamin D level check witha mean level of 79.8 nmol/l.Conclusion: Our results indicate that male patients are certainly under represented fordiagnosis, screening and treatment of osteoporosis. The reasons for this need to be evalu-ated further and increased awareness amongst physicians of the importance of bonehealth in the male population need to be emphasised. However, the small sample samplesize limits the generalisation of this study. In addition, the wide variety of risk factorsidentified for osteoporosis in men is illustrated in our results highlighting the importanceof secondary work up. Interestingly, nearly half of the male subjects had a history of ver-tebral fracture.
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265 FIVE YEAR MORTALITY RATE AND ASSOCIATED FACTORSPOST HIP FRACTURE IN OLDER ADULTS
Background: Hip fractures are associated with high risk of death during the immediatepost fracture years. We investigated if a Nurse-led care package, incorporating early bonehealth clinic access at 3 months, with a multidisciplinary approach to falls risk and bonehealth, reduced post fracture mortality.Methods: Hip fracture patients were followed for 5 years and invited to a RCT. 226patients were included and randomised into intervention (114) and control (112) groups.Inclusion criteria were ≥60 years and MMSE ≥18. Mortality information was obtainedfrom; hospital’s electronic patient’s records system (EPR); Registrars Office of BirthsDeaths and Marriages and online death notice site(rip.ie). Randomisation carried out bycomputerised minimisation programme. Data analysed using SPSS.Results: 396 patients attended study site. Mean age; 77 years, (40–96 years). 69% female.Overall mortality rates were 14%, 22%, 29%, 37% and 44% at 1,2,3,4 and 5 yearsrespectively.Study population(Intervention and Control groups) mean age 81 years(+/−8 years),
female and 76 years(+/−8 years) male. Mortality rates were 8%, 14%, 25%, 33% and40% at 1,2,3,4 and 5 years respectively. Significant difference noted at 1 and 2 years.Intervention group mortality rates were 5%, 9%, 23%, 30%, 37% and in Control
group 10%, 20%, 27%, 36% and 43% at 1,2,3,4, and 5 years respectively. Significant dif-ference noted at 2 years(p = .02).Risk factors for increased mortality were male gender(p = .02), older age(p = .04),
reduced cognition (p = .001), admission from nursing homes(p = .001), delay of >24 hrsto surgery (p = .008), increased length of stay (p = 0.001), discharge to LTC (p = 0.001),reduced pre-fracture mobility (p = .001), reduced ability to self care (p = 001), reducedAmended Barthel Score at 15 months (p = 001), HADS depression at 15 months (p =001), at risk of malnutrition at 15 months (p = 003).Conclusion: Intervention improved mortality rates in year 1 and 2 post fracture.Mortality was dependent on; pre and post fracture physical and psychological health sta-tus; and time to surgery.
267 EXPERIENCES OF STAFF AND FAMILIES OF INPATIENTSWITH DEMENTIA USING PERSONAL PASSPORTS TOSUPPORT CARE IN AN ACUTE SETTING
Susan O’Reilly1, Declan Patton2, Siobhan Kennelly1, Zena Moore21Connolly Hospital, Dublin, Ireland2Royal College Of Surgeons In Ireland, Dublin, Ireland
Background: The National Dementia Strategy indicates that people with dementiarepresent up to 29% of acute hospital admissions. With the prevalence of dementia pre-dicted to rise significantly, it is reasonable to assume that the number of people withdementia presenting at acute hospital services will also increase. Yet, the National Auditof Dementia Care in Acute Hospitals identified that inpatients with dementia had notablypoorer care outcomes than inpatients without dementia. The effective use of personalpassports for inpatients with dementia leads to more positive care outcomes and the pro-motion of person centred care. Despite this, their introduction into Irish acute hospitalsettings is at best ad hoc. There is also a dearth of research evidence into their use, par-ticularly the experiences of staff and families of inpatients with dementia using personalpassports to support care.Method: Using a qualitative descriptive approach, this study consisted of two parts:Part 1: Six individual semi structured interviews with family members.Part 2: Two focus group interviews with staff members.Interviews were transcribed verbatim and thematic analysis was used to identify key
themes.Results: Part 1: Two themes emerged from the family interviews: Guardianship andAdvocacy. Personal passports allowed families to give staff an insight into the personwith dementia and highlight what is important to the person. Part 2: Two themesemerged from the staff focus groups: Care and Knowing the Person. Personal passportswere important for communication, management of responsive behaviours and recognis-ing the humanness of the person.Conclusions: Using personal passports enhances the provision of quality person centreddementia care. Families and staff differentiated this care from the delivery of clinical caretasks. Challenges, such as the acute care environment and lack of dementia awarenessand education, inhibit using personal passports in acute hospital settings.
268 DEVELOPMENT OF AN ELECTRONIC FRAILTY INDEX USINGELECTRONIC HEALTH RECORD DATA AS A PREDICTOR OFOUTCOMES IN ACUTE ADMISSIONS
Eimear O Brien, Cliona Ní Cheallaigh, Nadim Akasheh, Declan Byrne, Barry Kennedy,Jennifer Kieran, Rachel Kidney, Joseph BrowneDepartment of General Internal Medicine, St James’s Hospital, Dublin 8, Ireland
Background: Frailty is an emerging geriatric syndrome, and its associations include falls,disability, morbidity, mortality and excess healthcare costs from consultations,
polypharmacy, hospitalisations and institutionalisations. Numerous frailty assessmenttools have been developed in clinical practice and research. Frailty index (FI) of deficitaccumulation has been used widely to measure frailty in the elderly. FI relies on indivi-duals with more health deficits are more likely to be frail. The concept of a FI has beenincreasingly accepted, reporting significant associations with risk of fractures, falls, disabil-ity, and mortality. Prolonged wait times in ED are associated with poorer outcomes forolder adults.Methods: Retrospective review of patients admitted to the medical assessment unit overa 42-day period. Data collected co-morbidities and functional status (21 measurements)and also included type of ED presentation, length of time in ED, length of stay, and dis-charge outcomes (including long term care (LTC).Results: 197 patients were assessed (Female: 50.8%). Mean length of stay (LOS) was12.4 (+/− 3.05) days. Mean time in ED was 350 (+/− 27) minutes, with 60.9% ofpatients seen in <6 hours. Older adults presented later in day hours (p = 0.36), had pro-longed stays in the ED (p = 0.242). Those with a prolonged ED stay were more likelyrequire LTC (0.156). Patients with higher FI scores were observed in older adults(p < 0.001), had prolonged wait times in ED (p = 0.164), had longer LOS (p < 0.001)and likely to be discharged to LTC (p < 0.017).Conclusion: The eFI uses routine data to identify older adults with increasingly levels offrailty. The frailty index does not capture socioeconomic factors and care supports andthus a modification of this prospective model may enhance its predictive effectiveness.Routine implementation of the eFI could target vulnerable frail adults in the ED and mayimprove their outcomes.
272 PERCEPTIONS OF SAFE FUNCTIONING WITHIN THECONTEXT OF PEOPLE ATTENDING A MULTIDISCIPLINARYMEMORY ASSESSMENT SERVICE
C McHale, R Briggs, D Fitzhenry, D O’Neill, T Coughlan, R Collins, A Connolly,N Austin, J Freeman, E Duignan, C Mooney, S KennellyTallaght Hospital, Dublin, Ireland
Background: Driving is an important aspect for the well-being of older people but maybe affected by age related syndromes such as dementia. Earlier studies of memory clinicsindicated relatively low levels of current drivers (26% in a 2005 Irish study (1)), however,the increased interest in the assessment at earlier stages of memory disorders may resultin more current drivers attending and require a more focused approach to assessmentand management. We assessed current driving practice in a cohort attending a multidis-ciplinary memory assessment clinic from 2014 to 2016 with an emphasis on earlier stagesof memory impairment.Method: Prospective study of a cohort attending a multidisciplinary memory assessmentclinic in a university teaching hospital. Data was collected on current driving status,recommendations for driving assessment, presence, diagnostic formulation, and func-tional and psychometric tests.Results: There were 31 men and 39 women, mean age 76.2 years (range 6191). The diag-nostic formulation was 40% (28/70) MCI, 42.9% (30/70) dementia, 12.9% (9/70) sub-jective memory complaints and 4.3% (3/70) other issues e.g. mood. Continued drivingwas reported by 58.6% (41/70), never driven by 17.1% (12/70), and prior driving cessa-tion by 24.3% (17/70). Accidents since the onset of memory problems were reported by7% in the informant history. On-road driving assessments were recommended to 18participants.Conclusion: Continued driving is considerably more prevalent in contemporary memoryservices compared to earlier estimates. Healthcare staff involved in the assessment andmanagement of memory disorders need to develop assessment skills and pathways toensure continued safe mobility for older people with memory disorders.Reference:1. Talbot A et al. Age Ageing 2005; 34: 3638.
287 TIME TO INITIAL DETECTION OF ATRIAL FIBRILLATION [AF]WITH IMPLANTABLE CARDIAC MONITOR [ICM] INCRYPTOGENIC STROKE
Nkechi Uzomefuna1, Frederick Okpoko1, Hafiz Hussein2, David Williams2,Brendan McAdam2
1Department of Geriatrics and Stroke Medicine, Beaumont Hospital, Dublin, Ireland2Royal College of Surgeons [RCSI], Dublin, Ireland
Background: An ICM is a small thin device inserted under the skin of the chest torecord the activity of the heart. A number of studies have shown that Electrocardiogram[ECG] monitoring with ICM is superior for detecting AF in the investigation of crypto-genic stroke. However, the optimum monitoring duration remains unknown. The pur-pose of this study is to evaluate the use of ICMs at a tertiary referral hospital and thetime to initial AF detection in patients with cryptogenic stroke using ICM.Methods: This is a study of 212 Patients who had ICM inserted for long term cardiacmonitoring between 04/08/2012 and 29/02/2016 in this Hospital. We were particularlyinterested in the proportion of these patients who had ICM inserted for evaluation ofcryptogenic stroke. Cryptogenic stroke is brain infarction not attributable to a source ofdefinite cardioembolism, large artery atherosclerosis or small artery disease despite exten-sive vascular, cardiac and serologic evaluation. Prior ECG monitoring failed to detect AF.Results: The commonest clinical use of ICMs in this hospital were unexplained syncope[n = 117], palpitations [n = 51], presyncope [n = 23] and evaluation of cryptogenic stroke
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[n = 20] and the further evaluation of an arrhythmia identified on prior ECG monitoring[n = 4]. 90%[n = 19] of the patients evaluated for cryptogenic stroke had prior ECGmonitoring. Duration of prior ECG monitoring ranged from 24hr to 6 day monitoring.In patients with ICM for evaluation of cryptogenic stroke, AF was detected by one week14% [n = 3], by five weeks 33% [n = 7], by eleven weeks 43% [n = 9], by seventy-fiveweeks 52% [n = 11]. AF remained undetected in 47% [n = 10].Conclusion: Prolonged ICM monitoring results in increased diagnostic yield of AF incarefully selected patients with cryptogenic stroke. However a significant number ofpatients remain undiagnosed after 75 weeks of monitoring.
298 ASSOCIATIONS BETWEEN MEDICATION USE AND FALLSAMONG OLDER ADULTS WITH INTELLECTUAL DISABILITYIN IRELAND
Sinead Foran2, Maire O Dwyer1, Mary McCarron1, Martin Henman1, Philip McCallion31Trinity College Dublin, Dublin, Ireland2Waterford Institute of Technology, Waterford, Ireland3University at Albany, New York, USA
Background: Despite a considerable body of evidence noting the link between medica-tion use and falls in older adults, data is limited in studies of intellectual disability (ID)regarding the association between medication use and increased risk for falling. The pre-sent study set out (1) to investigate the association between the use of different medica-tion types and falls in older adults with ID; (2) to identify the association betweenpolypharmacy and falls in older adults with ID.Methods: Data from The Intellectual Disability Supplement to The Irish LongitudinalStudy on Ageing are reported. Data from 753 participants across all levels of ID areincluded. Data comprised of sociodemographic, medication type and use and a numberof falls items. Medications were coded using the World Health Organisation AnatomicalTherapeutic Chemical Classification (ATC) classification code. Ethics was granted byTrinity College Faculty Ethics committee and by all service providers involved in thestudy.Results: 26.7% (n = 200) of the participants reported falling in the previous 12 months,14.5% (n = 94) experienced one fall, with 16.3% (n = 107) reporting 2 or more falls.Medication use was very high among the sample with high rates of polypharmacy andexcessive polypharmacy reported. Use of anti-epileptic drugs (AEDs) (p = .012), laxatives(p = .027) and analgesics (p = .049) were significantly associated with any fall in the previ-ous 12 months. The use of AEDs (p = .003) and laxatives (p = .014) were significantlyassociated with multiple fallers. Individuals reporting excessive polypharmacy were signifi-cantly associated with any fall (p = .010) and multiple falls (p = .004).Conclusion: These findings are critically important for older adults with ID, service pro-viders and healthcare practitioners. Medication review must be routinely and robustly
included in the development of person centred care. Appropriate alternatives for themanagement of health conditions must be sought.
306 CEREBRAL WHITE MATTER INSULT CORRELATES WITHBLOOD PRESSURE VARIABILITY
Dan Ryan1, Soren Christensen2, Rose Anne Kenny1, James F Meaney3, Ruth McDonagh1,Hassan Haswadi1, Georgia Richard1, Joseph A Harbison11Geriatrics Department, St. James’s Hospital, Dublin, Ireland2Stanford University, California, USA3Centre of Advanced Medical Imaging, St. James’s Hospital, Dublin, Ireland
Background: Cerebral associations with blood pressure variability (BPV) include inci-dent stroke and white matter disease, however, it is unclear whether these are associationsor manifestations of BPV. We explored a causal relationship by interrogating regions ofthe brain susceptible to sudden fluctuations in BP, known as borderzone regions, inpatients with high BPV.Methods: Cases were compared with age and gender-matched controls using standarddeviation (SD) of daytime systolic blood pressure (BP) from ambulatory 24-hr BP read-ings, and dichotomised based on values greater than or less than 22 mmHg. All under-went Diffusion Tensor MRI with interrogation of one white matter borderzone region(centrum semiovale) and of two white matter non-borderzone regions (internal and exter-nal capsule) according to fractional anisotropy (FA) values, which reflect white matterintegrity.Results: Forty-six patients were recruited in 1:1 case-control ratio. The mean age was68.5 years (SD 10.8) and 22 (48%) were female. The mean SD of systolic BP in casesand controls was 27 mmHg and 17 mmHg respectively. Use of anti-hypertensive medica-tion and the prevalence of stroke and diabetes was similar in both groups. The integrityof borderzone white matter region was significantly more damaged in cases than in con-trols; FA values 0.43 (SD 0.06) and 0.47 (SD 0.03) respectively, p = 0.01. Conversely onenon-borderzone white matter region was more intact in cases than in controls and in theother both were equally intact; internal capsule FA in cases 0.54 (SD 0.05) and in controls0.51 (SD 0.05), p = 0.03; External capsule FA in cases 0.41 (SD 0.04) and in controls 0.4(SD 0.05), p = 0.44.Conclusion: High BPV correlates with selective insult to regions of the brain vulnerableto flow change. Consequently BPV may directly damage white matter tracts, which maymanifest clinically as vascular cognitive impairment, gait disorders and possibly incidentlacunar stroke.
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Age and Ageing 2016; 45: ii13–ii56doi: 10.1093/ageing/afw159
Background: The mini-mental state examination (MMSE) is a widely used screening testfor cognitive impairment in older adults. During observation in clinical practice, a signifi-cant proportion of patients were found to have difficulty with the constructional abilityquestion despite being intact in other cognitive domains. The aim of this study was toassess whether the impaired constructional ability noted in routine cognitive screeningwas reproducible in a formal analysis of older people living independently in the commu-nity with no documented dementia history.Methods: 370 patient records of the Health Inequalities and Aging in the CommunityEvaluation (HIACE) Study were reviewed after excluding patients with documenteddementia. Basic demographics, original MMSE form and score were reviewed and scoredaccording to Folstein guidelines. This was compared to the testers score and if any dis-crepancies were noted a new MMSE score was calculated. 295 had a completed andscored MMSE.Results: 62% female, age range 60-92 years, 97% with a Barthel >18. 85% (294) had adocumented score of 30. Discrepancies were founds between the scoring of the construc-tion question by the tester compared to the MMSE scoring guidelines in 11% (40) cases.16% (59) incorrectly drew the pentagon. In 10% (37) this was the only incorrect question.Following adjustment for all discrepancies in scoring, 72% (213) actually scored 30/30.Therefore the major source of incorrect scoring was with pentagon analysis.Conclusion: A significant proportion of older people living independently in the com-munity have impaired constructional ability in the absence of documented cognitive def-icit. Does this predict early cognitive decline, is it representative of normal ageing orcould visual impairment account for this? A significant number of errors in MMSEpentagon scoring highlight a requirement for training of health care professionals tostandardise MMSE scoring and improve inter-observer variability.
004 PREDICTING ACUTE POST-OPERATIVE OUTCOMESFOLLOWING HIP FRACTURES
Background: Hip fractures place a significant burden on both patients and health sys-tems. Pre-operative morbidity has been shown to reliably predict 30 day1 and 1 year2mortality among these patients. However little research has been done on predictingmore acute outcomes such as post-operative complications or length of stay.Methods: We conducted a prospective observational study on a trauma ward in an urbanteaching hospital to assess which factors are useful in predicting acute, in-patient post-operative outcomes.Patient demographics and standard of care were collected via a chart based review and
included age, medications, comorbidities, time to admission to ward, time to surgery andtime in surgery.Premorbid status was assessed via questionnaire based tools in an interview conducted
within 48 hours of admission. Cognition was assessed using the Mini Mental State Exam(MMSE), frailty was determined using the SHARE-Frailty Index (SHARE-FI), nutritionwas evaluated using the Mini nutritional Assessment (MNA) and co-morbidities wereclassified using the Charlson Comorbidity Index (CCI).Results: 60 patients were enrolled in this trial.Increased length of stay was associated with poorer cognition (r = 0.441, p = 0.001),
frailty (r = 0.674, p < 0.001), malnutrition (r = 0.0.694, p < 0.001), increased number ofcomorbidities (r = 0.453, p < 0.001) and increased CCI (r = 0.532, p < 0.001).Complication rate was influenced by cognition (p = 0.047), frailty (r = 0.564, p =
0.002), grip strength (p = 0.016), nutrition (r = 0.571, p < 0.001), CCI score (r = 0.588,p < 0.001) and medications (r = 0.293, p = 0.023).Both time to ward and time to surgery impacted on length of stay (p = 0.034 and p =
0.039 respectively) whereas time in surgery affected complication rate (r = 0.313, p =0.018).Conclusion: Acute post-operative complications and length of stay following hip frac-tures can be predicted based on pre-fracture morbidity and standard of care received.Nutritional status, frailty and co-morbidities are the in all hip fracture patients in order toflag those who are at a higher risk of poor post-operative outcomes.
006 AGE DEPENDENT MORTALITY RATES IN WEXFORDGENERAL HOSPITAL
Omerole MacDonald, Siobhan Walsh, Michael Reardon, Eithne HarkinWexford General Hospital, Wexford, Ireland
Background: We examined age related discharges from the department of medicine atWexford General Hospital from June 2014 to June 2015. We examined the mortality ratesof various age groups in the hospital and compared our results to a similar audit we car-ried out in 2008-2009.Methods: We wished to see if more older patients were being admitted and if their mor-tality rates had changed.
We obtained our data from HIPE data in the hospital. We examined mortality rates ofthe age groups <65yrs, >65yrs and <75, >75yrs and <85yrs and those >85 yrs. We alsoexamined length of stay prior to death in these age groups.Results: Our catchment population for adults >17years had increased from 2008 to2014 by 10%. The 85+ age group make up 2% of the population but make up 11% ofthe discharges compared to 6.9 % of discharges in 2008. The overall mortality rate for allage groups was 3% but for the 85+ age group it was 8.4%. This mortality rate is 0.35%less than what it was in 2008. The length of stay before death was 9.13 days for those<65 years and significantly longer at 16.4 days in those >85 years.Conclusion: While our catchment population has increased, the very elderly make up aconsiderable percentage of our discharges. Our mortality rate for this age group hasremained steady. Health planners need to take into account the substantial burden anddemand that the very elderly are making in our acute hospitals.
009 DELIRIUM: DIAGNOSIS, EDUCATION & COMMUNICATION
Sandra Phillips, Gail Nicholson, Amanda CrawfordBelfast Health & Social Care Trust, Belfast, UK
Background: We recognised delirium as a problem on our Care of the Elderly (COE)wards. We aimed to determine how accurately it was being recorded on discharge letters.Those with previous cognitive impairment are at increased risk of delirium. Inclusion ofdelirium on discharge letters would support early identification and intervention for pre-vention of delirium in this high risk group. It is also essential that primary care isinformed about episodes of delirium given the increased risk of dementia.Methods: We randomly selected 61 discharge letters from our COE wards in September2014. We recorded the number of discharge letters with a diagnosis of delirium. If delir-ium had not been diagnosed, we reviewed the chart for evidence of delirium. After thisaudit, we provided two teaching sessions detailing delirium and the importance of accur-ate discharge letters. We then re-audited 54 discharge letters in May/June 2015.Results: The September 2014 audit found a 29% prevalence of delirium, with the inclu-sion of delirium on the discharge letter in 66% of cases. The May/June 2015 audit founda 28% prevalence of delirium, with the inclusion of delirium on the discharge letter in66% of cases.Conclusions: This audit has shown that our prevalence of delirium aligns with publishedrates, but its inclusion on discharge letters could be improved. We considered the reasonswhy there was no apparent improvement following our educational intervention. Firstly,even though all the junior doctors who completed discharge letters received a teachingsession, there were two different sets of junior doctors between audits. Secondly, ourteaching intervention largely targeted junior doctors, but senior clinicians are more likelyto be responsible for documenting diagnosis in the clinical notes. Lastly, in some cases,‘acute confusion’ was recorded, when perhaps delirium should have been used. Furthereducational work is needed before re-audit.
013 DETECTING COGNITIVE IMPAIRMENT IN THE EMERGENCYDEPARTMENT: UTILITY OF THE AMT4?
Adam Dyer, Robert Briggs, Shamis Nabeel, Desmond O’Neill, Sean KennellyCentre for Ageing, Neuroscience and the Humanities, Tallaght Hospital, Dublin, Ireland
Background: The Abbreviated Mental Test Score 4 (AMT4) is a brief tool recom-mended for cognitive screening of older adults in the Emergency Department. Whilst ithas been validated against the longer AMT10 and sMMSE in isolation, its exact ability tohighlight clinically significant cognitive impairment in the ED is yet to be determined.Methods: A convenience sample of older adults (aged >70 years) presenting the EDunderwent detailed cognitive assessment including screening for delirium (CAM-ICU)and dementia (sMMSE and AD8) using well validated tools in addition to the AMT4.Results: One hundred and ninety-six patients were assessed (mean age: 78.5 ± 5.9). TheAMT4 had a sensitivity of 0.53 (0.42−0.63) and specificity of 0.96 (0.89−0.99) in thedetection of altered cognitive status (dementia/delirium). The AMT4 identified nearly allpatients screening positive for delirium (92%, 24/26). In those with probable dementia,the AMT4 identified less than half (47.8%, 22/46). In those with probable cognitiveimpairment (not dementia), less than a quarter were correctly identified (22.2%, 6/27).Overall, in those patients screening negative for delirium with assessment suggestive ofsome form of cognitive impairment, the AMT4 identified less than one-third of thosewithout a pre-existing diagnosis (32.2% 19/59).Conclusions: Despite its high specificity, the poor sensitivity of the AMT4 restricts itsuse as a general cognitive screener in the ED. It appears its identification of altered men-tal status is limited to those with already clinically significant dementia (most of whomalready have a diagnosis) or in those with an acute disturbance in cognitive status(delirium).
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015 WALKING IN HOSPITAL IS ASSOCIATED WITH A SHORTERLENGTH OF STAY IN OLDER MEDICAL INPATIENTS
Ruth McCullagh1, Christina Dillon2, Darren Dahly4, N. Frances Horgan3,Suzanne Timmons11Centre for Gerontology and Rehabilitation, College of Medicine, University College Cork, Cork,Ireland2Department of Epidemiology & Public Health, Cork, Ireland3School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland4Clinical Research Facility, Cork, Cork, Ireland
Background: Evidence suggests that inactivity during a hospital stay is associated withpoor health outcomes in older medical inpatients. We aimed to estimate the associationsof in-hospital physical activity with physical performance and length of stay in a sampleof older inpatients.Methods: Medical in-patients aged ≥65 years, premorbidly mobile, with an anticipatedlength of stay ≥3 days, were recruited to this observational study. Measurements includedphysical activity, continuously recorded by a Stepwatch Activity Monitor until dischargeor for a maximum of five weekdays; co-morbidity (CIRS-G); frailty (SHARE F-I); andbaseline and end of study physical performance (Short Physical Performance Battery).Linear regression models were used to estimate associations between physical activity(average daily step-count over 5 weekdays) and end of study physical performance orlength of stay. Length of stay was log transformed in the first model, and average dailystep count was log transformed in both models. Similar multivariable linear regressionmodels were used to adjust for potential confounders.Results: Data from 154 patients (mean 77 years, SD 7.4) were analysed. Based on theunadjusted linear regression estimates, for each unit increase in the natural log of averagedaily step count, the natural log of length of stay decreased by 0.18 (95% CI −0.27 to−0.09). After adjustment of potential confounders, the strength of the inverse associationwas attenuated, but the 95% CI still excluded the null hypothesis (βlog(steps) = −0.15,95%CI −0.26 to −0.04). Interpreted in absolute terms, a 50% increase in average dailystep count was associated with a 6% shorter length of stay. There was no apparent associ-ation between average daily step count and end of study physical performance once base-line physical performance was adjusted for.Conclusions: The results indicate that physical activity is independently associated withhospital length of stay, and merits further investigation.
016 PRURITUS IN OLDER HOSPITALIZED PATIENTS:PREVALENCE AND EFFECT ON SELF REPORTED QUALITY OFLIFE
Sarah Mello1, Ken Mulpeter21St James Hospital, Dublin, Ireland2Letterkenny Hospital, Letterkenny, Ireland
Background: Pruritic skin conditions are common in the older population. It is wellknown that itching impacts negatively on quality of life resulting in greater psychosocialmorbidity. Our aim is to define the prevalence of pruritus in a cohort of hospitalised old-er adults and to determine the effect of pruritus on self reported quality of life.Methods: A prospective chart review was carried out on 50 consecutive patients over 75years old admitted acutely under the geriatric medicine service. Data was collected onpatient demographics and chronic disease burden. The total number of medications wasexamined including the use of drugs known to be associated with pruritus. We also notedwhether the the issue of pruritus was recorded in the patient’s notes and if they receivedany treatment. Patients reporting itch completed the 5-D pruritus scale to quantify theimpact on quality of life.Results: Of the 50 patients interviewed, (mean age 85, 42% male) 34% reported itch.The level of chronic disease burden was high in our population, with 75% of patientshaving chronic disease affecting one or more organ system. Patients were on an averageof seven medications each and 50% of patients were on at least one drug known to causepruritus. Only 17% of patients reporting itch were on a treatment for pruritus, and noneof these patients had the diagnosis recorded in the medical notes.
On the 5-D pruritus scale, patients described their itch severity from mild to severe.They generally spent less than six hours a day itching, but over half of patients with itchreported that it adversely affects their sleep.Conclusion: Pruritus is a common, but often under recognised problem in hospitalisedolder adults. Itch can adversely affect quality of life, so clinicians must increase their dili-gence in identifying and treating pruritus.
017 VITAMIN D DEFICIENCY AND INSUFFICIENCY RATES IN THEWEST OF IRELAND: BETTER TARGETING OF AT RISKPOPULATION REQUIRED?
Juliana Delos Reyes, Andrew Smyth, Paula O’Shea, Damian Griffin, Shaun O’Keeffe,Edward Colman MulkerrinUniversity Hospital Galway, Galway, Ireland
Background: A previous study (n = 149) reported high rates of vitamin D deficiencyand insufficiency in females aged over 65 years residing in long-term care or admitted to
University Hospital Galway (1). In this cross-sectional study, we evaluate age-related ratesof vitamin D deficiency and insufficiency in patients attending general practice.Methods: Vitamin D levels were measured from consecutive samples received at theUHG clinical biochemistry laboratory between January 2013 and December 2014.Vitamin D deficiency was defined as level <25 nmol/L and insufficiency as level between25 and 50 nmol/L. Samples were compared across four age groups (18–40 years, 41–60,61–80 and >80years). We report median and interquartile range as Vitamin D levels werenot normally distributed. Descriptive statistics were performed using STATA/MP 13.1for Mac.Results: Of 15,078 included samples, 73.0% were from females (n = 11,002), mean age52.6 (16.5) years. Overall median Vitamin D level was 54 (IQR 35-74) nmol/L. By agegroup, median Vitamin D level was 50 (32–71) nmol/L for 18–40years, 53 (36–72)nmol/L for 41–60years, 61 (40–79) nmol/L for 61–80years and 55 (29–79) nmol/L for>80years (p < 0.01). Sufficient Vitamin D level was most common in age 61-80 years(64.0%, n = 2,795), deficiency was most common in age >80years (19.4%, n = 136) andinsufficiency was most common in age 41–60 years (35.5%, n = 2,156)(p < 0.01).Conclusions: In this large, community-based study of patients attending general practicein the West of Ireland, sufficient Vitamin D levels were noted in almost two thirds ofthose aged 61–80 years. However, it is likely that those most vulnerable to Vitamin Ddeficiency (e.g. not attending GP for Vitamin D level check), were underrepresented inthis cohort. Further study is required to increase the identification of affected individualswith better utilization of laboratory resources.Reference:1. Dinizulu T. et al. J Nutr Health Ageing 2011; 15: 605–608.
019 AGE AND THE ECONOMICS OF AN EMERGENCY MEDICALADMISSION - WHAT FACTORS DETERMINE COST?
John Joseph McCabe1, Declan Byrne2, Deirdre O’Riordan2, Richard Conway2,Sean Cournane2, Bernard Silke21Department of Geriatric Medicine, Beaumont Hospital, Dublin 9, Ireland2Department of Internal Medicine, St. James’s Hospital, Dublin 8, Ireland
Background: The ageing of the population may be anticipated to increase demand onhospital resources. We have investigated the relationship between hospital episode costsand age profile in a single centre.Methods: All Emergency Medical admissions (33,732 episodes) to an Irish hospital overa 6-year period, categorised into three age groups, were evaluated against total hospitalepisode costs. Univariate and adjusted incidence rate ratios (IRR) were calculated usingzero truncated Poisson regression.Results: The total hospital episode cost increased with age (p < 0.001). The multi-variable Poisson regression model demonstrated that the most important drivers of over-all costs were Acute Illness Severity – IRR 1.36 (95% CI: 1.30, 1.41), Sepsis Status −1.46(95% CI: 1.42, 1.51) and Chronic Disabling Disease Score −1.25 (95% CI: 1.22, 1.27)and the Age Group as exemplified for those > 85 yr IRR 1.23 (95% CI: 1.15, 1.32).Conclusion: Total hospital episode costs are a product of clinical complexity with contri-butions from the Acute Illness Severity, Co-Morbidity, Chronic Disabling Disease Scoreand Sepsis Status. However age is also an important contributor and an increasing patientage profile will have a predictable impact on total hospital episode costs.
020 DETECTION AND MANAGEMENT OF DELIRIUM IN NEWMEDICINE FOR THE ELDERLY ADMISSIONS: AN AUDIT
Caitriona Breathnach, Aisling Farrell, Sarah MelloSt James’s Hospital, Dublin, Ireland
Background: Delirium is a common but under-recognised occurrence in older hospita-lised patients. It is associated with significant morbidity and mortality. This audit was con-ducted to assess the detection and management of delirium in Medicine for the Elderlyadmissions to St James’s Hospital as compared to current NICE guidelines. Our aim wasto increase delirium recognition by implementation of the 4AT screening tool.Methods: Data was collected on 50 consecutive patients admitted through Medicine forthe Elderly. Patients were screened for delirium by being asked to say the months of theyear backwards. Risk factors and subsequent diagnosis or treatment were establishedfrom admission notes in patient charts and the percentage of patients with delirium goingundetected was calculated.After the first audit, we introduced the 4AT screening tool and provided an informa-
tion session on its use. The 4AT allows for rapid assessment of delirium and cognitiveimpairment by examining a patient’s orientation, concentration, alertness and acute fluctu-ation in behaviour. A re-audit was then completed.Results: The first audit showed poor screening for and detection of delirium, with only12% being screened on admission. The audit revealed 60% of patients with deliriumwere going undiagnosed on admission.Following implementation of the 4AT screening tool re-audit results showed a signifi-
cant increase, to 52%, in the number of patients being screened. The number of cases ofdelirium undiagnosed at admission also dropped to 36%.All cases of diagnosed delirium were treated appropriately.
Conclusions: This audit showed that delirium was going largely under-diagnosed in theMedicine for the Elderly population in St. James’s Hospital. Following implementation ofthe 4AT screening tool, significant improvements were made. This audit concluded that
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the 4AT was an effective tool, in combination with regular education sessions raisingawareness, in improving the detection of delirium in the elderly.
021 THE PREVALENCE OF POLYPHARMACY AND THEAPPROPRIATENESS OF PRESCRIBING IN ADMISSIONS FROMA MEDICAL ASSESSMENT UNIT
James Ryan, Deniz Demirdal, Cormac McCarthy, Caoilfhionn O’DonoghueSt Columcille’s Hospital, Loughlinstown, Co Dublin, Ireland
Background: Polypharmacy is highly prevalent among the older population with signifi-cant consequences for patient safety. Polypharmacy and inappropriate prescribing havebeen associated with an increased cost in healthcare and an increased risk of drug-interactions, adverse drug events, falls, decreased cognition and reduced functional cap-acity. The aim of this study was to examine the prevalence of polypharmacy in patientsadmitted through a level 2 hospital Medical Assessment Unit (MAU) and to evaluate theappropriateness of prescribing for each class of medication.Methods: This is a cross sectional study. Patients over the age of 18 who were admittedvia the MAU over a 2 week period were included in the study. Polypharmacy was definedas patients receiving 6 or more medications regularly. The patient’s drug chart wasreviewed on day 0 and day 2 of admission for total number of medications and theappropriateness of prescribing for each class of medication.Results: A total of 55 patients were included in the study and the mean age was 69.7 yearsold (SD= 15.7). A total of 361 prescriptions were reviewed. The mean number of medica-tions on admission was 6.6 (SD = 4.2), with patients over the age of 65 on significantly moremedications than those under 65 (7.43 vs. 4.26, P = 0.009). Of the 16 common drug classesa total of 241 prescriptions were identified with 50 prescriptions (20.7%) meeting criteria forinappropriate prescribing. In 61.5% of proton pump inhibitor prescriptions and in 87.5% ofsedative/anxiolytic prescriptions there was no clear indication.Conclusions: The results from this study suggest that elderly patients presenting to the MAUare more likely to suffer from polypharmacy. There were also a high number of potentiallyinappropriate medications identified in this study. Future studies should evaluate the benefit ofusing a screening tool to identify potentially inappropriate medications in the hospital.
022 CORTICAL SUPERFICIAL SIDEROSIS PRESENTING AS TIAMIMIC
Aymn Babiker, Colin Quinn, Kevin MurphyLetterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
Background: Although rare, cortical superficial siderosis (CSS) is thought to be asso-ciated with an increased risk of future intracerebral haemorrhage and may be a markerfor latter development of cerebral amyloid angiopathy [1]. Transient focal neurologicalepisodes or amyloid spells are associated with CSS and may represent focal seizure activ-ity [2]. A 74 year-old female without significant vascular risk factors or cognitive impair-ment presented with migratory left sided face, arm and leg motor/sensory symptomswhilst driving. This episode lasted 30 minutes with full resolution. She was admitted andmanaged initially as TIA and commenced antiplatelet therapy and statin.Methods: CT Brain showed small linear area of hyperdensity high up in the right parietalarea which was suspicious for small area of cortical infarction with subsequent minorhaemorrhage. MRI brain with gradient echo sequence demonstrated small right parietalcortical/sub-cortical hemosiderin deposit most consistent with cortical superficial sidero-sis (CSS) involving two adjacent sulci. CTA of intra and extra cranial vessels was normal,with otherwise unremarkable stroke work up. EEG confirmed focal disturbance of cere-bral function in the right fronto-temporal region without definite epileptiform features.Results: In the subsequent few months, recurrent stereotyped events as describedincreased in frequency to 3-4 per day requiring readmission. Repeat MRI demonstratedstable appearances. Following counselling, antiplatelet therapy was discontinued withfocus on blood pressure optimisation. In view of symptom burden levitiracetam wascommenced and titrated with some improvement in symptom frequency. Advice was alsogiven to cease driving.Conclusion: The recurrent nature of our patient’s symptoms and correlation withimaging led to a change in usual practice of TIA management. This included a risk/bene-fit consideration of future cerebral ischemia/ haemorrhage burden with discontinuationof antiplatelet therapy and optimisation of blood pressure control. Treatment with antic-onvulsants may be a consideration, although efficacy is currently unproven.
023 PREVALENCE AND OUTCOMES OF COGNITIVE SPECTRUMDISORDERS IN OLDER PEOPLE ADMITTED TO AN ACUTEMEDICAL ADMISSIONS UNIT
Bruce Guthrie1, Simona Hapca1, Peter Donnan1, Vera Cvoro2, Emma Reynish31University of Dundee, Dundee, UK2NHS Fife, Kirkcaldy, UK3University of Stirling, Stirling, UK
Background: Many older people admitted to hospital have cognitive impairment of somekind, but previous research has usually focused on single conditions (usually dementia, delir-ium, and delirium superimposed on dementia), and has often been carried out in highlyselected groups. As a result, estimated prevalences in inpatients vary from 3-63% for
dementia, and from 10-31% for delirium. Few studies have measured outcomes, with in-hospital mortality the most commonly studied. The aim of this study was to examine theprevalence and outcomes of cognitive spectrum disorders (CSD) in an unselected cohort ofpeople aged 65+ admitted to a general hospital acute medical admissions unit (AMAU).Methods: Between 01/01/12 and 30/06/13, 5603/7131 (78.5%) people aged 65+admitted to a single general hospital AMAU had a specialist nurse structured assessmentincluding delirium assessment, ascertainment of a previous dementia diagnosis, andadministration of an Abbreviated Mental Test (AMT). This data was linked to routinehospital admission and mortality data to evaluate associations between cognitive spectrumdisorder and length of stay, mortality and readmission.Results: 1862/5603 (33.2%) had a cognitive spectrum disorder, 1041 (18.6%) had delir-ium alone, 248 (4.4%) delirium superimposed on dementia, 271 (4.8%) dementia alone,and 302 (5.4%) AMT score <8 but no delirium or diagnosed dementia. Outcomes wereworse in those with a CSD compared to those without: length of stay 25.4 days vs 11.7days, in-hospital mortality 15.4% vs 9.4%, one year mortality 39.7% vs 27.1%, one yeardeath or readmission 56.3% vs 45.7% (all differences significant p < 0.01), with little dif-ference by CSD type.Conclusions: This study of an unselected AMAU population includes more older peoplethan the total in all studies included in recent systematic reviews. Cognitive spectrum dis-order is common in medical inpatients, and is associated with considerably worse out-comes. Healthcare systems need to manage this vulnerable population better.
027 DECREASING BLOOD PRESSURE AND ANTI-HYPERTENSIVEMEDICATIONS IN VERY OLD PATIENTS WITH ADVANCEDFRAILTY
Ciara Mc Gann1, Sheela Perumal1, Denis Donohue1, Catriona Tiernan2, Lisa Cogan2,Morgan Crowe21Our Lady’s Hospice & Care Services, Harold’s Cross, Dublin (OLH), Ireland2Royal Hospital, Donnybrook, Dublin (RHD), Ireland
Background: Decreasing blood pressure is associated with increased mortality andstroke risk in very old patients with physical and mental disability (1,2). We examined theprevalence of mean systolic blood pressure (mSBP) less than 140 mmHg and 130 mmHgrespectively and anti-hypertensive (aHT) medications in very elderly patients in 2extended nursing care (ENC) facilities.Methods: mSBP derived from BP values recorded routinely over the previous 3 monthsin patients 80 years and over in ENC wards in OLH and RHD. In addition, barthel index(BI), clinical frailty scale (CFS), vascular risk factors and aHT medication were obtainedfrom medical records.Results: There were 59 patients aged 80-97 years. Most were severely disabled (BI score0-5; OLH 75%, RHD 74%) with advanced frailty (CFS 7, 8, 9; OLH 94%, RHD 93%).Hypertension (OLH 47%, RHD 37%) and history of stroke (OLH 44%, RHD 67%)were most common risk factors whilst 25% had atrial fibrillation (AF).
mSBP was <140 mmHg and <130 mmHg in 85% (50/59) and 64% (38/59) ofpatients, respectively. Of the latter group, 29% (11/38) were on aHT meds excludingdiuretics and alpha blockers (beta blockers 4, CCB 6, ACE/ARB 6) alone or in combin-ation. Most of these patients (82%) had other potential indications for aHT meds (AF 4,ischaemic stroke 4, diabetes mellitus 1).Conclusion: mSBP in the majority of very old frail patients is less than 130 mmHgwhich is within the range associated with increased mortality and stroke compared topatients with higher SBP. Most of this group of patients on aHT medications had otherpotential indications for treatment.Reference:1. Ogliari G. et al. Blood pressure and 10-year mortality risk in the Milan Geriatrics 75+
Cohort Study: role of functional and cognitive status. Age Ageing 2015; 44: 932–937.2. Sabayan B et al. High blood pressure, physical and cognitive function and risk of
stroke in the oldest old: the Leiden 85-plus Study. Stroke 2013; 44: 15–20.
028 ARE THE WARDS IN ST. VINCENT’S HOSPITAL DEMENTIAFRIENDLY? AN AUDIT
Aisling DavisSt Vincent’s University Hospital, Dublin, Ireland
Background: A significant proportion of the inpatients in SVUH have a dementia diag-nosis. These individuals have complex care needs and require a specialised environmentthat is tailored to their dementia needs. The term “environment” refers not only to thephysical aspects within the environment but also to the social, cultural and institutionalelements that are important aspects of a person environment.Aims/Objectives: To assess how “dementia friendly” the wards in SVUH are.Methods: The “Is your ward Dementia Friendly” Enhanced Healing EnvironmentAssessment Tool (developed by the King’s Fund NHS) was used to audit 8 wards and 1out patient setting in SVUH. This tool assesses the ward under 7 sections (Safe mobility,continence/ personal hygiene, Eating and Drinking, Meaningful interaction, Well-Being,Orientation, Calmness and security). This tool allows the user to “score” how dementiafriendly the ward is against and ideal ward. It also highlights areas for improvement andacknowledges any initiatives already in situ.Results: A total of 8 wards and 1 out patient setting were included in this audit. An“Ideal Ward” was also included, this represented a hypothetical ward that is completelydementia friendly and would receive full marks on audit. This was used for comparisonpurposes for percentages.
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Overall Results in Percentages: (average 42%)Ideal ward-100%TCU-61%Carew-56%OLW-52%Monica’s-42%Michael’s-40%Agnes-36%Lucy’s-35%Laurence’s-35%ED- 25%
Conclusion: Several recommendations have been made to improve the “dementiafriendliness” of the wards in SVUH. These range from simple and low cost modificationssuch as appropriate signage on toilets (pictures and words), orientation boards, clocks,calendars etc. Other modifications that can improve the dementia friendliness include-use of contrasting colours, dimmer switches on lights, handrails along length of corridors,remove additional clutter, use of day room for meals, activities etc.
029 THE IMPACT OF A STRUCTURED EDUCATION PROGRAM ONTHE KNOWLEDGE OF EVIDENCE BASED SECONDARYSTROKE PREVENTION STRATEGIES: PRELIMINARY STUDY
Ijeoma Tonia Obi1, Raymond Carson1, Mary Teeling2, Jacinta McElligott11National Rehabilitation Hospital, Dun Laoghaire, Co. Dublin, Ireland2Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8, Ireland
Background: People who have had a stroke are at increased risk of stroke recurrence,which is as high as 30% and can be more devastating. Secondary stroke prevention prac-tices according to evidence based researches if fully and rightly implemented can reducethe risk of stroke recurrence. This preliminary study aimed to explore the knowledge andthe impact of a structured education program on current evidence based secondarystroke prevention strategies by the doctors working in a stroke unit.Methods: The doctors in the National Rehabilitation Hospital (NRH) Ireland, weresurveyed using paper based anonymised questionnaires before and after the deliveryof a brief structured educational program on current secondary stroke preventionstrategies.With the approval of the ethics committee, both surveys were carried out onall eligible doctors in the NRH. A brief structured educational program on secondarystroke prevention strategies was given over three sessions and the electronic copies ofthe teaching materials made available on the hospital intranet prior to the repeatsurvey.Results: Although the doctors in the NRH showed appreciable knowledge of currentsecondary stroke prevention strategies in the first survey, the repeat survey showed anoverall improved knowledge post the structured educational program.Conclusion: Future studies are relevant to ascertain if the doctors’ improved knowledgeand its sustenance ultimately translates to improved stroke management and secondaryprevention practices. It was beneficial to leave the education materials for future intakesof doctors on the hospital intranet.
030 MAKING OUR COMMUNITY MORE ACCESSIBLE: ANOCCUPATIONAL THERAPY INITIATIVE TO INCREASEAWARENESS OF COMMUNITY MOBILITY IN SOUTH-EASTDUBLIN
Joanne Murphy, Aisling DavisSt Vincent’s University Hospital, Dublin, Ireland
Background: Following multi-disciplinary assessment in Carew House Geriatric DayHospital, many elderly people were advised to cease driving. As a result, this populationis at risk of becoming socially isolated owing to a lack of accessibility in their local areasto facilitate engagement in activities. Aims/Objectives: to develop a user-friendly, com-prehensive information pack detailing public and private transport options for older peo-ple residing in the South-East Dublin and North Wicklow region. It is hoped that theinformation booklet will be used as a tool to improve older peoples’ accessibility in theirlocal communities.Methods: An internet search was completed to source information regarding variousmodes of transport available within the area. Information regarding transport routes,timetables, fare prices, ticket information and customer services contact details wereretrieved from online sources.Results: A comprehensive and user-friendly information pack was developed to provideolder persons’ with information regarding DART, Dublin Bus, LUAS and taxi services inthe region.Conclusion: The information booklet was piloted with a small number of elderlypatients and positive feedback was received. It is envisioned that the information packwill increase the users’ awareness and knowledge of transport links and therefore facilitateengagement in social activities. This information booklet is available in Carew House DayHospital and is provided to patients as appropriate.
032 CIRCULATING BLOOD BIOMARKERS IN OLDER ADULTSWITH FRAILTY: THE IRISH LONGITUDINAL STUDY ONAGEING (TILDA)
Aisling O’Halloran1, Eamon Laird1, Martin Healy2, Rachel Moran3, John Nolan3,Stephen Beatty3, Anne Molloy1, Rose Anne Kenny11Trinity College, Dublin, Ireland2St. James’s Hospital, Dublin, Ireland3Waterford Institute of Technology, Waterford, Ireland
Background: Several circulating blood biomarkers have been linked to phenotype frailtyin cross-sectional studies and in longitudinal studies in women or the oldest old. In thisstudy we examined the relationships between three frailty instruments and plasma bio-markers in older adults in Ireland.Methods: Cross-sectional analyses were performed using data from community-livingadults aged ≥50 years (n = 4548) from Wave 1 of Irish Longitudinal Study on Ageing(TILDA). Circulating blood biomarkers of micronutrient status (vitamin B12, vitamin D,lutein and zeaxanthin), inflammatory stress (CRP), metabolic function (HbA1c, total,HDL and LDL cholesterol) and renal function (creatinine and cystatin c) were trans-formed and standardized. For each biomarker, one unit increase represented an increaseof 1 SD from the mean, this allowed comparability of associations across biomarkers.Frailty was assessed using Phenotype Frailty (PF), Frailty Index (FI) and FRAIL Scale(FS) instruments. Multinomial logistic regression determined associations between frailtyand each biomarker adjusted for age, sex, education, smoking status, BMI, and the num-ber of medications and supplements taken regularly.Results: Adjusting for covariates, a unit increase in lutein was negatively associated with allthree frailty measures: PF (RR = 0.59), FI (RR = 0.86) and FS (RR= 0.53). Higher levels ofzeaxanthin were negatively associated with two of the frailty measures: PF (RR= 0.62) andFS (RR= 0.65). A unit increase in cystatin c was positively associated with frailty: PF (RR=1.52), FI (RR= 1.16) and FS (RR= 1.34). Finally higher vitamin D was negatively associatedwith one frailty measure: PF (RR= 0.83), as was HDL cholesterol: FI (RR= 0.87).Conclusions: Considerable variability exists in relation to associations between bloodbiomarkers and frailty, depending on the frailty instrument used. The identification ofconsistent cross-sectional associations with more than one frailty instrument strengthensthe evidence that a biomarker may be correlated with frailty over time. However, caus-ation cannot be inferred using cross-sectional data.
034 PREVALENCE OF MICRONUTRIENT, INFLAMMATORYSTRESS, METABOLIC AND RENAL CONDITIONS IN FRAILOLDER ADULTS: THE IRISH LONGITUDINAL STUDY ONAGEING (TILDA)
Aisling O’Halloran1, Eamon Laird1, Martin Healy2, Rachel Moran3, John Nolan3,Stephen Beatty3, Anne Molloy1, Rose Anne Kenny11Trinity College, Dublin, Ireland2St James’s Hospital, Dublin, Ireland3Waterford Institute of Technology, Waterford, Ireland
Background: Circulating blood biomarkers have been linked to phenotype frailty incross-sectional studies and in longitudinal studies in women or the oldest old. In thisstudy we examined the prevalence of several health conditions among the frail using clin-ical reference values of circulating plasma biomarkers in older adults in Ireland.Methods: Cross-sectional analyses were performed using data from community-livingadults aged ≥50 years (n = 5463) from Wave 1 of Irish Longitudinal Study on Ageing(TILDA). The clinical reference values for circulating blood biomarkers of micronutrientstatus (vitamin B12, vitamin D, lutein and zeaxanthin), inflammatory stress (CRP), meta-bolic function (HbA1c, total, HDL and LDL cholesterol) and renal function (creatinineand cystatin c) were applied. Prevalence estimates of diabetes/pre-diabetes, chronic kid-ney disease, hypercholesterolemia, inflammatory stress and micronutrient status werethen calculated by phenotype frailty status. Significant differences in prevalence estimatesby frailty status were measured by multinomial logistic regression.Results: The estimated prevalence of pre-frailty and frailty was 33% and 4% respectively.Among the frail there was a higher prevalence of diabetes (5.9%; p < 0.01), pre-diabetes(18.1%; p < 0.01), chronic kidney disease (39.1%; p < 0.01) and inflammatory stress(70.4%; p < 0.01) compared to the pre-frail or non-frail. The frail also showed significantdeficiencies in micronutrients: lutein (51%; p < 0.01), zeaxanthin (50%; p < 0.01), andvitamin D (27%; p < 0.01), but not vitamin B12 (7%; p = 0.23). Hypercholesterolemiawas significantly lower among the frail (32%; p < 0.01). The pre-frail exhibited intermedi-ate prevalence estimates of these conditions compared to the non-frail.Conclusions: There are significant levels of several treatable chronic conditions amongpre-frail and frail older adults in the community. This illustrates the loss of physiologicalreserve and complexity of need that exists, and emphasises the requirement for multidis-ciplinary and integrated care approaches to treatment among those at risk of frailty.
038 PERCEPTIONS OF RISK OF HOSPITAL ADMISSION AMONGCAREGIVERS AND DOCTORS
Aisling Betts2, Ruth Devlin2, Anna McDonough1, David Robinson11St. James’s Hospital, Dublin, Ireland2Trinity College Dublin, Dublin, Ireland
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Background: For elderly patients, an inpatient hospital stay is associated with 31% riskof functional decline, 17.6% risk of infection, 24.8% risk of falls and 20.7% risk of death.What is not known is the perception of this risk among patients, caregivers or staff,which can vary depending on their experiences in a hospital setting. Our aims were tocompare these perceptions of risk.Methods: We conducted a face-to-face interview with both doctors and caregivers, usinga structured survey, in an outpatient setting in St. James’s Hospital. Data was analysedwith SPSS Statistics Data Editor. The primary outcome was the proportion of doctors orcaregivers who agreed with the statements: (i) In general, the hospital is a good place forolder people to get better and (ii) In general, the hospital is a good place for an older per-son to wait while awaiting arrangements to go home or to a nursing home.Results: We surveyed 51 doctors and 52 caregivers. There was no statistically significantdifference between the two populations in the primary outcome. However, both groupsover-estimated the actual risk for each outcome, except for death within 30 days, whichwas underestimated by 10%. Medians for both populations’ perception of risk were 45%for fall, 50% for infection, 40% for functional decline and 10% for death within 30 days.The number of doctors who disagreed with the hospital being a good place to wait whilearrangements are made to allow a person go home or to a nursing home compared tothe number of caregivers was highly significant (P = 0.0001).Conclusions: While both populations over-estimated the risk of hospital admissions forelderly patients, it was clear from both their descriptions and their answers to Likert ques-tions that caregivers had a more positive overall view of hospital compared to the doctorswho work there.
040 DIAGNOSTIC ACCURACY OF SIX BEDSIDE COGNITIVETESTS FOR DELIRIUM SCREENING
Niamh O’Regan1, Katrina Maughan2, James Fitzgerald3, Dimitrios Adamis4, DavidWilliam Molloy1, David Meagher5, Suzanne Timmons11Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork,Ireland2School of Applied Psychology, University College Cork, Cork, Ireland3Graduate Entry Medical School, University of Limerick, Limerick, Ireland4Sligo Mental Health Services, Sligo, Ireland5Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation &Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Background: Delirium is prevalent and serious, yet remains poorly detected. Systematicscreening could facilitate detection, however there remains no consensus as to the bestapproach. Our aim was to examine the diagnostic accuracy of six bedside cognitive testsin screening for delirium in older medical inpatients on admission: the six-item cognitiveimpairment test (6-CIT); clock-drawing test; spatial span forwards; months of the yearbackwards (MOTYB); intersecting pentagons (IPT); and a verbal test of visuospatialfunction.Methods: We conducted a cross-sectional study of prevalent delirium in older medicalinpatients in two hospitals in Cork city, Ireland. Eligible patients were assessed for delir-ium using the Revised Delirium Rating Scale within 36 hours of admission. They concur-rently underwent testing using the six cognitive tests outlined above. Sensitivity,specificity, positive and negative predictive values (PPV; NPV) were calculated for eachmethod. Where appropriate, area under the receiver operating characteristic curve (AUC)was also calculated.Results: Of 555 patients approached, 470 patients were included, and 184 had delirium.Of the tests scored on a scale, the 6-CIT performed best with an AUC of 0.876 (95%CI0.84-0.91), the optimum cut-off for delirium screening being 8/9 (sensitivity 89.9%, NPV91.2%). Of the binary tests, both MOTYB and IPT also performed well: MOTYB (sensi-tivity 84.6%, NPV 87.4%); IPT (sensitivity 92.7%, NPV 92.1%). Using stepwise discrim-inant analysis, 6-CIT was the only test to differentiate between those with delirium andthose with dementia only, Wilks’ Lambda=0.748, F=62.15, df1:1, df2:1, df3:184, p <0.001.Conclusions: The 6-CIT measures attention, temporal orientation and short-term mem-ory and shows promise as a screening test for prevalent delirium, particularly as it maydifferentiate between the cognitive impairment of delirium and that of dementia in oldermedical patients. For daily delirium screening on the ward however, a shorter, simplertest such as MOTYB may be more appropriate.
041 GUIDANCE FOR HEALTHCARE STAFF: ADVANCE CAREPLANNING AND ADVANCE HEALTHCARE DIRECTIVES WITHPEOPLE WITH DEMENTIA
Deirdre Shanagher1, Marie Lynch1, John Weafer1, Willie Molloy2, Sharon Beatty3, PatriciaRickard Clarke1, Emer Begley5, Esther Beck4, Geraldine McCarthy6, Sarah Murphy11Irish Hospice Foundation, Dublin, Ireland2University College Cork, Cork, Ireland3University College Hospital Galway, Galway, Ireland4University of Ulster, Belfast, UK5Alzheimer Society of Ireland, Dublin, Ireland6Sligo/Leitrim Mental Health Services, Sligo, Ireland
Background: Dementia is a progressive life limiting illness. People with dementia valueplanning ahead. It allows them to express wishes and preferences and reduces anxiety.With the enactment of The Assisted Decision Making (Capacity) Act 2015 guidance in
relation to advance care planning and advance healthcare directives with people withdementia is required by health and social care professionals.Methods: An expert advisory group was established. A systematic literature review,searching online databases, CINAHL and PubMed was carried out. Grey literature wasalso accessed. The themes were presided on by the expert advisory group. Identified lit-erature review themes directed the scope of the guidance.Results: 288 articles were deemed appropriate. The themes from the literature include:
(1) Advance Care Planning & Advance Healthcare Directives with People withDementia(a) Advance care planning is difficult to engage in due to fluctuating capacity.
(2) Family members:(a) Uncertain about roles in advance care planning and having conversations.
(3) Professional Uncertainty(a) Time constraints, lack of knowledge and understanding of dementia, advance
care planning and legal responsibilities are factors.
Guidance is offered on each on each of the above areas.Conclusion: A guidance document has been prepared for health and social care staff toprovide palliative care to people with dementia. The document will be published andmade available online.
043 INVESTIGATING THE FINANCIAL IMPACT OF HIPE CODINGFOR LIAISON OLD AGE PSYCHIATRY ASSESSMENTS
Leo Yoshida, Aoife Ní Chorcorain, Angela McSweeneyCork University Hospital, Cork, Ireland
Background: Health care authorities are now assigning patients a code in relation toDiagnosis-Related Groups (DRGs) on review of charts following discharge. DRGs aredetermined by the complexity of each case – a more complex case draws a higher reim-bursement for the hospital. Previous studies have found that psychiatric co-morbiditieshave not been correctly coded. This can have a financial impact for the service provideror hospital. To date, there have been no investigations at this centre to determine theaccuracy of HIPE coding for cases assessed by the Liaison Old Age Psychiatry team.Methods: Referrals to the service in the month of March 2015 were used for this investi-gation. Using the Health In-patient Enquiry Scheme (HIPE) program we determined ifdiagnosis codes were in agreement with the diagnosis given by the Liaison Psychiatryteam. We recorded whether or not a Procedure Code, “Mental/BehaviouralAssessment,” (MBA) was given for each of these cases. Cases with errors/omissionswere re-integrated through the HIPE program to determine if correction would changethe DRG.Results: Of the 30 cases referred, 3 cases (10%) did not have an appropriate psychiatricdiagnostic code. Only 10/30 (33%) cases had the MBA code documented. With reassign-ing of DRGs we found no change to the overall financial impact of these cases. The add-ition of missing MBA procedural codes did not have an impact.Conclusion: We were unable to detect financial differences when diagnostic/procedurecodes were reassigned. This was due to the complexity of these cases whereby the add-ition of a procedure or diagnosis had a proportionally small impact on the final cost ofthe inpatient stay. It is clear that liaison service input in geriatric cases is being missed byHIPE coding and should be addressed as it may have an impact on planning for serviceprovision going forward.
045 AN UNUSUAL CAUSE OF PUO IN AN ELDERLY PATIENT
Aileen McSorleyUlster Hospital Dundonald, Belfast, UK
Background: An 87-year-old man was admitted for investigation of a four week historyof weight loss, anorexia and night sweats. He had no past medical history of note.Methods: Other than pyrexia of unknown origin, clinical examination was unremarkable.Initial investigations revealed mild pancytopenia, normal biochemistry and normal chestX-ray. Serial blood and urine cultures were negative for growth. Mr. M was treated forsepsis of unclear source with broad spectrum antibiotics. He developed widespread gen-eralised pain, minimally responsive to opiods. Liver function tests became deranged, in amixed pattern. Subsequent CT chest, abdomen and pelvis revealed splenomegaly andwidespread lymphadenopathy. Further haematological investigations were: elevated LDH> 1600, elevated ferritin > 50,000. Bone marrow biopsy confirmed haemophagocyticlymphohistiocytosis.Results: After review by haematology team, treatment was commenced with high dosedexamethasone. Mr. M made a dramatic improvement, with improved pain control, reso-lution of pyrexia and a concomitant normalisation of liver function. Ferritin rapidly fell to1190. He was well enough to be discharged to his own home one month post admission.Conclusion: Haemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fataldisease of normal but overactive histiocytes and lymphocytes. This results in activation ofmacrophages, leading to hyperferritinaemia. Fever, hepatosplenomegaly, pancytopenia,lymphadenopathy and rash are often the presenting clinical features. HLH has familialand acquired forms. Acquired HLH in adults is usually triggered by infection (commonlyEBV), cancer or autoimmune disease. In Mr. M’s case EBV serology confirmed pastinfection. Various approaches to treatment exist:chemotherapy or immunosuppression.The aim is to achieve clinical stability. Cure is with bone marrow transplantation.
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Prognosis varies, and in the case of Mr. M was unclear, as HLH is rarely seen in the eld-erly. Sadly, less than one month post hospital discharge, Mr. M died of profound sepsissecondary to bowel perforation.
046 BEYOND THE STARS
Noreen Lynch, Cynthia Bennett, Brian CareyBantry General Hospital, County Cork, Ireland
Background: The Stroke Training and Awareness Resources (STARS) is an e-learningprogramme, devised by NHS Education for Scotland to help enhance the knowledge,skills and confidence of all healthcare staff when responding to the needs of strokepatients and to facilitate a patient centred approach with enhanced quality of care. In2013, an educational programme combining e-learning with an interactive study day wasestablished to engender specific core competencies in all staff working with acute strokepatients. We aimed to assess the effectiveness of this programme.Methods: Staff who successfully completed the STARS e-learning programme were allo-cated a place at a planned interactive multidisciplinary study day. The study day contentwas devised to reinforce the STARS programme and included lectures, practical demon-strations and interactive sessions. Representatives of multiple disciplines (physiotherapy,speech & language, occupational therapy, clinical nutrition, nursing and counselling)developed a comprehensive agenda addressing the 20 core competencies of the STARSprogramme. The training was approved by An Bord Altranais. Tests were devised toassess participants’ knowledge pre and post training. Tests comprised of 20 questions, 1from each core competency.Results: 87 staff members from a wide range of disciplines (including doctors, nurses,health care assistants, management, speech and language therapy, occupational therapy,physiotherapy, radiography, catering staff and students) have completed the training. 36%of participants scored lower than 70% on the pre-test, while 64% scored higher than80%. 100% of the participants scored 95% or above on the post test with 93% scoring100%.Conclusions: The programme enhanced the existing knowledge and clinical care skillsof participants. The educational approach empowers participants to become autonomouslearners and active partners in the care of stroke survivors.
050 RELOCATION OF NURSING HOME RESIDENTS
Michelle O’Brien, Jonathon O’Keeffe, Graham Hughes, Diarmuid O’SheaSt. Vincent’s Hospital, Elm Park, Dublin 4, Ireland
Background: In July 2015 an urban nursing home (NH) provider notified the HealthInformation and Quality Authority (HIQA) of their intention to close. HIQA carried outan inspection in September 2015 finding that there were appropriate plans in place toensure the care and welfare of the residents during the transition. In December 2015 theNH closed and residents were transferred to alternative places of accommodation.Methods: Five months later a follow-up of the residents was carried out by a member ofthe geriatric team in the local tertiary hospital. A telephone call was made to the patient’snew place of residence in order to ascertain wellness, illnesses, number of admissions tohospital since transition or deaths since transition. Online death notices were also utilisedto obtain details surrounding deaths.Results: Of the 29 residents to be relocated; 26 transferred to alternative nursing homes(ranging from 1–4 months prior to NH closure), 2 patients died in the NH (4 and 1month respectively prior to closure) and 1 patient died in hospital (3 months prior toclosure). Four deaths occurred post transition. The deaths following transfer to new nurs-ing home occurred between 2 and 7 months post transition. Only one patient experi-enced an admission to an acute hospital post transition, the admission occurred 2months post transition and the patient died one month later (in the new NH).Conclusion: Care transitions are not without their risks. Appropriate advance care plan-ning in situations such as this can minimise these associated risks.
051 EDMONTON FRAIL SCALE AS A PREDICTOR OF ADVERSEEVENTS IN OLDER PATIENTS UNDERGOING SYSTEMICCANCER THERAPY IN IRELAND
Michelle O’Brien, Victoria Mallett, Mary Coghlan, Daphne Yen, Elisabeth Doran,David Williams, Anne Horgan, Bryan Hennessy, Oscar Breathnach, Liam Grogan,Patrick MorrisBeaumont Hospital, Beaumont, Dublin 9, Ireland
Background: The Edmonton Frail Scale (EFS) is a geriatric assessment tool. It covers:Cognition, Health, Independence, Performance, Social, Medications, Nutrition, Mood,and Continence. We prospectively examined the EFS as a predictor of adverse outcomesin older patients undergoing systemic cancer therapy.Methods: With ethics approval, patients aged ≥ 65 years, who were prescribed a newsystemic treatment by their Consultant Medical Oncologist were approached for partici-pation. All patients gave written informed consent and were assessed using the EFS.
Patient demographics, cancer diagnosis and ECOG performance status (PS) were col-lected. Adverse events were assessed using the NCI CTCAE v4. The association betweenEFS and toxicity during systemic treatment was examined.Results: Over six months, 48 patients (25 men, 23 women) of median age 72 years(range 66-92) were included. Patients had the following primary cancer diagnoses; lowergastrointestinal 25 (31%), breast 8 (17%), lung 7 (15%), upper gastrointestinal 6 (12%),and others 12 (25%). Patients were categorised as; no frailty 25 (52%), apparently vulner-able 12 (25%), mild frailty 8 (10%), moderate frailty 2 (4%) and severe frailty 1 (2%).Only 6 (12%) patients had an ECOG PS of 2 or above. A positive correlation betweenEFS and PS was identified. A positive association between EFS and number of toxicityevents was seen (r = 0.26). During systemic treatment, 8 (16%) patients had treatmentsheld, of whom 1 (12%) of patients had a baseline high frailty score (EFS>11). Overall,no statistically significant association was seen between EFS and dose delay (r = −0.04)or between EFS and hospitalisation (r = 0.19).Conclusion: In this prospective study, frailty, as evidenced by EFS score, was associatedwith toxicity from systemic therapy. However, EFS did not predict for dose delay or hos-pitalisation. Definitive conclusions are limited by relatively small numbers and heteroge-neous patient population.
052 EXERCISE PROFESSIONALS: BARRIERS AND FACILITATORSTO WORKING WITH STROKE SURVIVORS
Marie Condon, Marie GuidonRoyal College of Surgeons in Ireland, Dublin, Ireland
Background: Stroke survivors (SSs) are largely inactive despite the benefits of exercise.Exercise professionals (EPs), with skills in exercise prescription and client motivation,may have a role to play in promoting exercise among SSs. However, the number of EPsworking with SSs is estimated to be low.Methods: The aim of this study was to investigate EPs’ opinions on working with SSsincluding their barriers and facilitators to working with SSs. The study also investigatedEPs’ skills, interest and experience working with SSs and the relationship between EPs’barriers and facilitators with their training on stroke. A descriptive cross-sectional studywas conducted using a researcher designed online survey between October andDecember 2015. Purposive sampling was used to survey EPs on the Register of ExerciseProfessionals in Ireland (n = 277). Descriptive and interferential statistics were calculated.Results: The response rate was 31.4% (78/277). Only 22.1% of EPs had experienceworking with SSs. The primary barriers identified by EPs were a lack of training on psy-chological problems post stroke (83.5%), unsuitable equipment for SSs (68.4%) and thelevel of supervision SSs require (56.2%). Facilitators included the availability of suitableequipment (97.2%), practical training (100%) and courses (93%) on stroke. EPs that hadnot completed training on stroke were significantly more likely to agree with the barriersof lack of training on psychological problems post stroke and lack of disability-relatedpolicies. EPs (76.3%) were interested in one-to-one exercise sessions with SSs but only52.6% were interested in group exercise sessions. EPs indicated having good motivationskills (81.6%) but 42.1% reported only acceptable skills when dealing with SSs with psy-chological problems.Conclusion: EPs are interested in working with SSs despite their lack of experience andpractical barriers. Training opportunities and access to suitable equipment have beenidentified as facilitators for EPs working with SSs.
053 MAKING A MEDICINE FOR THE ELDERLY WARD DEMENTIAFRIENDLY - PHASE 1
Elaine O Connor, Denise Hartigan, Siobhan Kennelly, Emily Keely, Mary Lunn,Kay Murphy, Eimear Short, Susan O ReillyConnolly Hospital, Dublin, Ireland
Background: The Irish National Audit of Dementia Care in Acute Care identified anumber of issues relating to the physical ward environment that impact on the wellbeingof people with dementia. Implementation of dementia friendly design principles includingthe use of colour, effective signage, lighting and noise reduction have been seen to impactpositively on the experiences of people with dementia in the ward setting.Methods: As part of a larger Genio funded project to develop an integrated care path-way for people with dementia in the acute setting a multidisciplinary subgroup was set upto apply dementia friendly design principles to a designated area of an acute medicine forthe elderly ward. The aim was to use the environment design as a therapeutic tool toenable people with dementia to maintain their independence and promote wellbeing.Results: Whilst there was space for patients, there was no dedicated area on the ward forpatients to access; poor signage for toilets and bathrooms as well as no colour schemeavailable to assist the patient with dementia. In keeping with the audit’s recommendationfor the physical environment, this will be incorporated in the room and throughout theward.Conclusion: The work to the room will be completed in August 2016 with training for1:1 carers and ward staff in its use. It is anticipated for phase 2 that evaluation of the useof the room with patients, families, 1:1 carers and ward staff will commence fromSeptember 2016 onwards.
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055 THE FEASIBILITY OF A NATIONAL DEMENTIA REGISTER FORIRELAND
Louise Hopper, Suzanne Hughes, Teresa Burke, Kate IrvingDublin City University, Dublin, Ireland
Background: There is an acknowledged lack of information about dementia in Ireland,including very poor coding of dementia across all care settings. Yet with dementia preva-lence set to increase as our population ages, there is an urgent need to gather valid epi-demiological data that provides accurate and reliable national estimates of current andfuture dementia prevalence, and facilitates the development of robust and effectivedementia health and social policy (Cahill, O’Shea, & Pierce, 2012). This study, commis-sioned as part of the Alzheimer Society of Ireland evidence-based policy series, examinedthe feasibility of developing a national dementia register for Ireland.Methods: A rapid review of national and international patient registry literature wasundertaken to identify registry functions, underlying design and process models, andbest-practice guidelines for their development. A ‘landscape analysis’ identified the legal,ethical, clinical, technology, and financial issues relevant to the creation of an Irish demen-tia register. Following ethical approval, we conducted two focus groups with people withdementia and twenty-one expert stakeholder interviews with clinicians and with represen-tatives from research, health, and social care organisations in Ireland and the UK, existingIrish patient registries, and international dementia registries. Discussions followed anagreed structure, were audio-recorded, transcribed, and analysed using inductive contentanalysis.Results: Common themes emerged from the literature and stakeholder discussions withregard to: registry function; benefits and risks; data collection; data management; govern-ance; legislation; barriers and facilitators; Irish complexities; and best-practice.Conclusions: The results provide an evidence-base on which to progress the issue ofimproved recording structures for dementia in Ireland. Given the strategic approach thegovernment is now taking to address research and information systems as part of the2014 National Dementia Strategy, it is opportune to examine the potential for a frame-work to collect information in a reliable, accurate, valid, complete, and timely way.
056 IMPACT OF RHINOVIRUS SPECIES “A” OUTBREAK ONVULNERABLE GROUP OF ELDERLY RESIDENTS IN LONGTERM CARE FACILITY
Tomasz Tomasiuk, Catherine DunleavyTara Winthrop Private Clinic, Dublin, Ireland
Background: Rhinoviruses (RV) are common RNA viruses causing self-limiting, shortillnesses (“common cold”); however they can be associated with significant morbidity infrail elderly groups. This study was conducted in a 140 - bedded nursing home to analyseincreased mortality observed during the outbreak of RV, which occurred between 17-Aug-2015 and 21-Sept-2015.Methods: This was a retrospective analysis to look at how and whether RV might beassociated with increased morbidity and mortality. Review of resident’s records was con-ducted to examine all relevant criteria.Results: Total number of new Respiratory Tract Infections-29 (n = 140) = 20.7%.Number of swabs positive for Rhinovirus Type A – 3 (n = 13) =23% (met criteria of
an outbreak).Clinical presentation: pyrexia-20.6%, productive cough-75%, dyspnoea-41.3%.New changes on auscultation-93% (wheezes - 44.8%, crepitation-48.2%, rhonchus-
41.3%)Average age of affected residents was 77.2 years (M (12) 76.9, F (17) 77.4)On average affected residents had 8 underlying conditions and 31 % had COPD/
= 29) of all affected. Antibiotics were used in 89% and systemic steroids in 34% of cases.Total mortality between 17-Aug-2015 and 21-Sept-2015 was 8 (n = 140) =5.7 %( 50%
higher than average).Mortality in affected group was 6 (n = 29) = 20.6%4 (n = 6) (66.6%) deaths were as results of Lower Respiratory Tract Infection; however
Rhinovirus wasn’t detected.Overall 6-months mortality within the affected group was 16 (n = 29) =55.1%
Conclusions: The mortality rate for our frail patient group increased significantly duringthis outbreak. The findings support the limited evidence in the literature. It is difficult toprove that RV caused death in all cases, but our experience mirrors that already reported.The viral infection is a significant predisposing factor, which can be associated with moresevere bacterial infections in vulnerable patients.
057 UTILISATION OF LEAN SIX SIGMA PROCESS IMPROVEMENTMETHODOLOGIES IN ACUTE HIP FRACTURE CARE OF THEOLDER PERSON
Background: Hip Fracture care is increasingly being recognised as a hospital care qualitytracer condition to evaluate a hospital’s organisational and interdepartmental clinicaleffectiveness.Methods: A 6-month Acute Hip Fracture Care Project was initiated in May 2015 as partof a University affiliated Hospital Lean Academy ‘green belt’ professional certificate train-ing programme in our hospital. Three key hip fracture standards of care were utilised.These were: 1) proportion of patients operated on within 48 hours of EmergencyDepartment (ED) presentation, 2) proportion of patients administered fascia iliac nerveblock, 3) proportion of patients admitted to the orthopaedic ward within 4 hours of hos-pital presentation. Following the utilisation of structured Lean Six Sigma processimprovement methodologies and extensive stakeholder engagement, key changes imple-mented included introduction of a hip fracture fast track admission protocol, develop-ment of an OrthoGeriatric Electronic Patient Record pre-operative assessment template,and targeted multi-departmental hip fracture care education and Irish Hip FractureDatabase awareness dissemination.Results: Changes were implemented on a phased basis during November 2015. Ourhospital’s IHFD 2014 report data was compared to 3 months of data on older personhip fractures admitted from November 2015 to January 2016. 1) Proportion of patientsoperated on within 48 hours improved from 62% (n = 106/169) to 79% (n = 37/47), 2)fascia iliac block utilisation improved from 8.5% (n = 13/154) to 60% (28/47). 3)Percentage of patients admitted to the orthopaedic ward within 4 hours did not improvewith a slight decrease from 0.6% (1/172) to 0% (0/47) noted; however, mean time tohospital ward was shown to have improved from 15 hours (over the 10-month periodpreceding project completion January to October 2015) to 10.45 hours.Conclusions: Substantial improvements in older person acute hip fracture care can beachieved with the utilisation of Lean Six Sigma process improvement methodologies.
058 DOES ADMISSION TO SPECIALIST GERIATRIC MEDICINEWARDS LEAD TO IMPROVEMENTS IN ASPECTS OF ACUTEMEDICAL CARE FOR PATIENTS WITH DEMENTIA?
Robert Briggs1, Emma O’Shea2, Anna de Siún2, Paul Gallagher3, Suzanne Timmons3,Desmond O’Neill1, Sean Kennelly11Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences,Tallaght Hospital., Dublin, Ireland2Irish National Audit of Dementia Care in Acute Hospitals., Cork, Ireland3Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork., Cork,Ireland
Background: People with dementia are among the most frequent service users in theacute hospital. age-attuned comprehensive assessment of physical, mental health andsocial care needs on a specialist ward represents current best practice in this setting.
Despite this, there is little evidence demonstrating improved care processes specificallyon specialist Geriatric Medicine Wards (GMW). Therefore, the aim of our study was toreview whether admission to a specialist ward leads to improvements in importantaspects of care for people with dementia.Methods: We analysed combined data involving 900 patients from the Irish andNorthern Irish audits of dementia care. Data on baseline demographics, admission out-comes, clinical aspects of care, multidisciplinary assessment and discharge planning pro-cesses were collected.Results: Less than one-fifth of patients received the majority of care on a specialistGMW. Patients admitted to a GMW were less likely to undergo a formal assessment ofmobility compared to non-geriatric wards (119/143 (83%) vs 635/708 (90%), OR = 0.57(0.35 to 0.94)) and were more likely to receive newly prescribed antipsychotic medicationduring the admission (27/54 (50%) vs 95/2809 (36%), OR = 1.95 (1.08 to 3.51)).
Patients admitted to a GMW were more likely to have certain aspects of dischargeplanning initiated, including completion of a single plan for discharge (78/118 (66%) vs275/611 (45%), OR = 2.38 (1.58 to 3.60)).
Surgical wards performed more poorly on certain aspects including having a nameddischarge co-ordinator (32/71, 45%), and documentation of decisions regarding resusci-tation status (18/95, 19%).Conclusion: Relatively low numbers of patients with dementia received care on a special-ist GMW.
There appears to be a more streamlined discharge planning process in place on thesewards but they did not perform as well as one would expect in certain areas, such ascompliance with multidisciplinary assessment and antipsychotic prescribing.
059 TWO YEAR REVIEW OF IRISH HIP FRACTURE DATABASEFROM A TEACHING HOSPITAL
Ronan O’Toole, Padraig Bambrick, Patrick O’Donoghue, Eva Gaynor, Peter Spencer,Dermot Power, Joseph DugganMater Misericordiae University Hospital, Dublin, Ireland
Background: The Irish Hip Fracture Database (IHFD) was established as a web-basednational database in 2012. It followed on the significant improvements appreciated in hipfracture care with the National Hip Fracture Database in England and Wales and thepublication of Fragility Fracture “Blue Book” Standards of Care by the BritishOrthopaedic Association and the British Geriatric Society.
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Methods: We reviewed and compared the IHFD 2014 and 2015 Hip Fracture HIPEprinciple diagnosis patients (age 60+) admitted to our hospital via the EmergencyDepartment (ED).Results: A number of improvements in hip fracture care were identified for patients dis-charged in 2015 compared with 2014. There was an increase in the proportion of patientsoperated on within 48 hours during ‘working hours’ (Mon to Sun 08:00-17:59) of EDpresentation, which improved from 56.8% (n = 96/169) in 2014 to 72.3% (n = 107/148)in 2015. OrthoGeriatric preoperative assessment rates increased from 14.8% (n = 25/169) in 2014 to 27.9% (n = 43/154) in 2015. Development of pressure sores (excludingpatients who died) decreased from 8.3% (13/156) in 2014 to 6.7% (n = 9/135) in 2015.The proportion of patients who had a specialised falls assessment prior to discharge(excluding patients who died) increased from 72.4% (n = 118/163) in 2014 to 83% (n =117/141) in 2015. Bone protection medication on discharge (excluding patients whodied) remained essentially static at 61.3% (n = 100/163) in 2014 compared with 60.7%(85/140) in 2015.Conclusions: Substantial improvements in hip fracture care have been documented inour hospital using the IHFD. Conclusions: Substantial improvements in hip fracture carehave been documented in our hospital using the IHFD. However, there remains scopefor ongoing care improvement.
060 A QUALITY IMPROVEMENT INITIATIVE FOR DEVELOPMENTOF AN INTERDISCIPLINARY AMPUTEE REHABILITATIONPATHWAY IN A POST-ACUTE REHABILITATION UNIT
Emma Nolan, Louise McCarronCappagh National Orthopaedic Hospital, Dublin, Ireland
Background: Quality improvement involves the implementation of initiatives that aim tomonitor, assess and improve the quality of healthcare provided. These initiatives strive tocontinually optimise performance and patient care. Within a post-acute rehabilitation unit,the need was identified to develop an integrated, interdisciplinary amputee rehabilitationpathway to guide clinical practice and enhance quality of service-provision for clients postlower-limb amputation.Methods: The HSE Change Model, an evidence-based tool designed to support health-care professionals in implementing change (Health Service Executive, 2008), was selectedto guide development of the rehabilitation pathway. This model facilitates change by guid-ing the user through four phases: Initiation, Planning, Implementation andMainstreaming. A working group, involving representatives from all disciplines within theunit, was first established. These key stakeholders guided the change process throughactions including research into established rehabilitation pathways and clinical guidelinesrelating to post-acute amputee rehabilitation, appraisal of published evidence, site visits toa specialist amputee rehabilitation unit, and six-weekly interdisciplinary developmentmeetings.Results: The amputee rehabilitation pathway is reaching the final stages of develop-ment. This pathway includes evidence-based practice guidelines and informationresources for all disciplines working with clients post lower-limb amputation withinthe following domains: 1) Referral, 2) Assessment, 3) Goal-setting, 4)Early rehabilita-tion, 5) Treatment/intervention, 6) Management of phantom sensation and pain, 7)Care of the remaining limb, 8) Prevention and management of contractures, 9)Psychological adjustment and coping, 10) Falls Management, 11) Environment andEquipment, 12) Wheelchairs and Seating, 13) Prosthetic Use, and 14) Discharge-planning.Conclusions: Using the HSE Change Model and through effective interdisciplinary teamworking, an integrated amputee rehabilitation pathway has been developed and is soon tobe introduced to clinical practice within the rehabilitation unit. There is a strong commit-ment to continuing with the change process and ensuring best-practice for clients admit-ted for rehabilitation post lower-limb amputation.
061 APPLYING TOYOTA LEAN MANUFACTURING PRINCIPLESTO STROKE CARE IN AN IRISH UNIVERSITY HOSPITAL
Cliona Small1, Trish Galvin1, Martin O’Donnell1, Rónán O’Caoimh1, Thomas Monaghan2,Timothy Counihan2, Michael Hennessy2, John Lynch2, Habib Rahman2, John Bruzzi3,Orla Smithwick4, Thomas Walsh11Medicine for the Elderly and Stroke Medicine, Galway University Hospital, Galway, Ireland2Neurology Department, Galway University Hospital, Galway, Ireland3Radiology Department, Galway University Hospital, Galway, Ireland4Emergency Medicine Department, Galway University Hospital, Galway, Ireland
Background: Lean manufacturing principles, originally pioneered by Taiichi Ohno,father of the Toyota Production System, aim to eliminate inefficiencies within automobileproduction, leaving only the crucial steps that add value to the customer. In 2011, theconcept of LEAN management was first applied to stroke medicine expediting time-dependent stroke care, without compromising safety. Given this, we adapted the conceptfor use within a geographically wide (urban-rural), regional hub-and-spoke stroke modelin Ireland, with the aim of increasing the number of eligible patients who receive tissue-plasminogen-activator (tPA) within the recommended Door-To-Needle(DTN) time of≤1 hour (target 80%).
Methods: Using LEAN principles, we identified unnecessary and inefficient steps inacute stroke care. Changes included: introduction of a comprehensive acute stroke/thrombolysis care pathway, earlier identification of FAST-positive patients, consistent pre-arrival notification, enhanced communication/teamwork and earlier access to CT.Protocol changes were implemented in November 2015. Numbers thrombolysed by theservice from November 2015 to May 2016 were obtained and analysed.Results: At the start of the project 45% of patients received tPA within the target DTNtime. During the implementation phase,17-patients were thrombolysed. The mean DTNreduced to 52.3 minutes from a pre-Lean mean of 70.4 minutes, (p = 0.27). Of these,68.75% had a DTN time of ≤1 hour. Reasons for delays included: blood pressure man-agement, delay in registrars contacting the thrombolysis consultant and delay in adminis-tering tPa once the decision was made to thrombolyse. For two of the patients, there wasno pre-arrival notification. In all, 7 patients were thrombolysed outside of normal work-ing hours (08.00–18.00); one of whom had a DTN ≤1 hour, while one had no datarecorded. The remaining five all had a DTN time >1 hour.Conclusions: Lean management can be applied to stroke medicine in Ireland, with excel-lent results. This study highlights the need to focus resources on improving the effi-ciency/acceleration of local out-of-hours stroke services.
062 PATIENT PREFERENCES FOR MEALTIMES IN AN INPATIENTREHABILITATION SETTING
Lauren Tiedt, Mary Mansfield, Sandra Brady, David Robinson, Gina DonohueSt. James’s Hospital, Dublin, Ireland
Background: Malnutrition is common in older patients admitted to hospital, with aprevalence of 32% (Nutrition Screening Survey in Hospitals in UK 207-11. BAPEN.ISBN 978-1-899467-52-1 www.bapen.org.uk. Accessed 11th December, 2015). Poornutritional status can lengthen hospital stay by as much as 4.5 days (Gout, B.S.; Barker,L.A.; Crowe, T.C. Malnutrition identification, diagnosis and dietetic referrals: Are wedoing a good enough job. Nutr. Diet. 2009,66, 206–211). Adequate nutrition should bea fundamental part of hospital care. It has been argued that modern medicine hasevolved to serve its own institutional needs rather than patients’. Hospital routines canconflict with basic human needs such as adequate nutrition. Nutrition in hospital was aprominent concern of patients in a recent assessment of older people’s experience ofIrish healthcare. In our hospital, the main meal is served at 12 noon, to allow for effi-cient staff rostering. Our aim was to assess if this practice aligned with patientpreferences.Methods: A survey was undertaken of all inpatients on hospital rehabilitation wards(n = 4) over the course of 2 days. Age and gender were noted. Subjects were excluded ifunwell or severely cognitively impaired. Satisfaction with current mealtime, individual’susual mealtime, and preference for mealtime were noted. Institutional ethics approvalwas granted by the Nutrition Committee.Results: Of 80 rehabilitation inpatients, 65 completed the survey (3 not at bedside, 2declined, 8 unsuitable for medical reasons, 2 currently nil per os). Average age was 82.5,with 41.5% male:female. Forty-three patients (66.2%) were satisfied with current meal-time. 52.3% of patients took lunch as their main daily meal. Only 10.7% of patientsexpressed 12 noon as their preferred mealtime.Conclusion: In this population of inpatients a majority were satisfied with current meal-times, however, the majority (89.2%) would usually eat later than the time scheduled byward routine.
063 INTRODUCING A CLINICAL PHARMACIST TO A CARE OFTHE ELDERLY (COE) DAY HOSPITAL
Joanna Carroll1, Carmel Curran2, Ciaran Donegan2, David Williams2, AnneMarie Cushen1, Nuala Doyle11Pharmacy Department, Beaumont Hospital, Dublin, Ireland2Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
Background: Medication review is an essential part of comprehensive geriatric care, andis a primary function of the Clinical Pharmacist (CP). A new CP service has been estab-lished in a COE Day Hospital with the aim of improving outcomes from medication use.The CP service centres on medication review and patient education.Methods: Data from the first three months of the service were collected prospectively tomeasure the quantity and type of CP interventions. The potential clinical outcome ofeach intervention was assessed by the day hospital CP and a Gerontology SpR using avalidated visual analogue scale (0-10, 0 representing no potential effect and 10 represent-ing death). The frequency with which advised changes were acted upon by the treatingdoctor was also recorded.Results: 195 patients (mean 81 years age range 58–98 years) were reviewed during 33clinic days. A current medication list was obtained for all patients and an average of 1.8pharmaceutical care interventions were identified per patient. Of these 340 interventions,the medical team or patient agreed with 54%, 39% were not accepted and 6% had anunknown outcome.The interventions were classified according to type as follows: 18% actual or potential
adverse reaction, 14% each for supratherapeutic dose and untreated indication, 11% sub-therapeutic dose and 10% each for improper administration, drug without indication andeducation provided to the patient.
The clinical significance mean scores were categorised as leading potentially to minorharm (<3)= 10%, moderate harm (3–7) = 89% and severe harm (>7) = 1%. Good agree-ment was observed between the two assessors (Pearson correlation coefficient = 0.97).Conclusions: CP medication usage review in the day hospital has resulted in a positivecontribution to the care of elderly patients. Opportunities to improve visibility of the ser-vice will be explored.
064 AN AUDIT OF CAROTID DOPPLER ULTRASOUNDSPERFORMED IN AN ACUTE GENERAL HOSPITAL
Maria Smyth1, Sinead McHugh2, Emer Ahern2, Kenneth Bolger21St. Luke’s General Hospital, Kilkenny, Ireland2St. James’s Hospital, Dublin, Ireland
Background: Current guidelines suggest that carotid doppler ultrasound (US) assess-ment is indicated in patients presenting with a non-disabling stroke or TIA who arepotential candidates for carotid endarterectomy, and those undergoing coronary arterybypass grafting (ACC&AHA guidelines). There are written guidelines available in thisregard, and prompts when the test is being requested. The aim is to determine the appro-priateness of referrals for carotid doppler US in our institution, and to assess the diseasefindings based on age.Methods: We retrospectively reviewed the radiology records of the most recent 100patients to have US performed. Firstly, the order information of these was reviewed todetermine whether the examination was indicated. Secondly, the overall findings werereviewed to establish whether there was stenosis, and the degree if so.Results: One hundred patients were included in the audit, 39 female, 61 male. Elevenexaminations were ordered by GPs and 4 were ordered from an outpatient clinic. Ninety-one of those ordered were clinically indicated, 9 were not. Of the appropriate requests,12 had findings of haemodynamically significant stenosis. Of the inappropriate requests,2 had significant disease, but of note were asymptomatic. The highest number of USwere performed in the 75–84 age group, and the most significant disease was found inthe 65–74 age group. The ≤65 and ≥85 age groups had the least disease. Overall, signifi-cant disease was found in 14 patients.Conclusions: Generally,carotid doppler US are being ordered appropriately, however,despite guidelines and online prompts when placing the order, almost 10 examinationsare being performed unnecessarily. The most common inappropriate referrals were forinvestigation of a carotid bruit and a positive family history of carotid artery stenosis. Thehighest number of examinations were performed in the 75–84 age group, however theyounger 65–74 age group had the most significant disease.
067 EXPLORING THE PALLIATIVE CARE AND SUPPORT NEEDSOF PEOPLE WITH PARKINSON’S DISEASE AND THEIRCARERS
Siobhan Fox1, Alison Cashel2, Geroge Kernohan3, Marie Lynch4, Ciara McGlade1, Tony,O’Brien5, Sean O’Sullivan6, Mary J Foley7, Suzanne Timmons11Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland2Parkinson’s Association of Ireland, Dublin, Ireland3Institute of Nursing and Health Research, University of Ulster, Belfast, UK4Irish Hospice Foundation, Dublin, Ireland5Marymount University Hospital & Hospice, Cork, Ireland6Cork University Hospital, Cork, Ireland7Assessment and Treatment Centre, Cork, Ireland
Background: Palliative care is recommended for non-malignant illnesses, includingParkinson’s disease (PD). However, referral rates to specialist palliative care (SPC) ser-vices are low, and research with healthcare workers in Ireland and the UK highlightsunmet palliative needs in this population. Some healthcare workers perceive a ‘fear’ intheir patients about palliative care. However less is known about the views of people withPD and their carers about palliative care.Methods: Semi-structured interviews were conducted with people with PD (n = 19) andcarers (n = 11), recruited from movement disorder clinics in Cork. Interviews were tran-scribed, and analysed in NVivo.10 software using Thematic Analysis.Results: People with PD and their carers are largely unfamiliar with the term palliativecare; ‘fear’ was not evident in these interviews. When informed of the role of palliativecare, most felt that they would benefit from this input. Patients and carers experienced ahigh illness burden, and wanted extra support. Those with more advanced disease werepragmatic about their health status and had already given much private thought to thefuture. Participants identified two key times of crisis: at diagnosis, and in advancing ill-ness. Participants wanted more information about palliative care, and were open to anyfurther supports to address their psychosocial needs.Conclusions: The holistic and person-centred approach of palliative care can addressthe complex physical and psychosocial symptoms experienced by people with PD andtheir carers. A generalist palliative care approach should be adopted by all healthcareworkers, with most palliative care needs responded to within existing disease managementprogrammes, and SPC input where needed for more complex or refractory symptomsand needs. Further education about palliative care services among people with PD andtheir carers, and among healthcare workers, is essential so that people with PD can accessthese services as needed.
069 A QUALITATIVE EXPLORATION OF THE HOUSING NEEDSOF MARGINALISED OLDER PEOPLE IN SOCIAL HOUSING:FOCUS-GROUPS WITH ‘MAINSTREAM’ AND ‘SHELTERED’TENANTS
Lorna Kenny2, Mary Rose Day3, Cathal O’Connell2, Joe Finnerty2, Suzanne Timmons1,Siobhan Fox11Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland2School of Applied Social Studies, University College Cork, Cork, Ireland3School of Nursing, University College Cork, Cork, Ireland
Background: It’s unclear what is the ‘best’ model of housing provision for older people:‘ageing-in-place’ in the community or ‘sheltered’ housing schemes, specially designed forolder or disabled people. Older people living in social housing are more vulnerable thanthose in the general population; it is particularly important to identify the housing modelthat best meets their needs while remaining cost effective to provide. We thereforedesigned a focus-group study to explore in depth two research questions: 1. What are themain housing and support needs of older people? 2. Which housing model is best suitedto meeting these needs?Methods: A schedule was developed based on our previous national survey results, toexplore further some themes of the survey. Focus-groups were facilitated by tworesearchers, audio-recorded, and analysed with Content Analysis using NViVo 10.0software.Results: Thirty-one people participated in six focus-groups, (‘sheltered’ n = 3; ‘main-stream’ n = 3). Overall, 16 were female; the average age was 72 years (range 60–96 years).Most older people in both mainstream and sheltered housing were very happy with theirhome. Those in mainstream housing were happy with the quality of their home and age-mix of neighbours. Few wanted to move. Those in sheltered housing had even higherlevels of satisfaction and attributed this to a number of benefits of sheltered accommoda-tion: improvement in health-related and overall quality-of-life; houses are generallyadapted for older and disabled people; increased social contact; support from local Clúidstaff; increased safety and security with the individual home, housing complex, andneighbourhood.Conclusions: Older people may be supported to live either in the community or in shel-tered accommodation, provided that necessary physical adaptations and social supportsare in place. Sheltered housing may be appropriate for people who feel particularly vul-nerable and would like an extra level of support.
070 THE EFFECTS OF TIME-LIMITED HOME-CARE REABLEMENTSERVICES FOR OLDER PEOPLE: A COCHRANE SYSTEMATICREVIEW
Andy Cochrane1, Mairead Furlong1, Sinead McGilloway1, DW Molloy2,Michael Stevenson3, Michael Donnelly41Maynooth University, Maynooth, Ireland2Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork,Ireland3Clinical Research Support Centre, Royal Group of Hospitals Trust, Belfast, UK4Centre for Public Health, Queen’s University Belfast, Belfast, UK
Background: Reablement is one promising approach to home-care services for olderadults at risk of functional decline. Unlike traditional home-care, reablement is frequentlytime-limited and aims to maximise independence by offering a interdisciplinary, person-centred, and goal-directed intervention.Methods: We searched nine databases (April – June 2015) including CENTRAL,MEDLINE and CINAHL for randomised controlled trials (RCTs), cluster randomisedor quasi-randomised trials of time-limited (up to 12 weeks) reablement services for olderadults (aged 65 or older).Results: Two studies, comparing reablement with usual home-care services with 811 par-ticipants met our eligibility criteria. One was conducted in Western Australia with 750participants (mean age 82.29 years), and the second in Norway (n = 61; mean age 79years). Very low quality evidence indicates that reablement may improve functional abil-ities (lower scores reflect greater independence; SMD -0.30; 95% CI -0.53 to -0.06; P =0.01, I² = 14%; 2 studies; 249 participants), but made little or no difference to mortalityat one-year (RR 0.97; 95% CI 0.74 to 1.29; P = 0.84, I² = 0%; 2 studies; 811 partici-pants). Very low quality evidence from a single study (750 participants) indicates that thereablement group were less likely to need a higher level of care over the 24 monthfollow-up (RR 0.87; 95% CI 0.77 to 0.98; P = 0.02), reducing the aggregated health andsocial care costs (reablement: AUD 19,888; usual care: AUD 22,757).Conclusions: There remains uncertainty regarding the effects of reablement as the evi-dence was of very low quality according to our GRADE ratings. There is, therefore, anurgent need for high quality trials across different health and social care systems due tothe increasing profile of reablement services in policy and practice in several countries.
Supported by an HRB Cochrane Training Fellowship to the first author
Background: Lee Silverman Voice Treatment (LSVT) BIG and LOUD® and are effect-ive, evidence based physiotherapy and speech treatments for individuals with Parkinson
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disease (PD) (Fox et al. 2012). Therefore, we established an LSVT BIG and LOUDBootcamp. The primary aim of this group was to maintain the treatment effects of LSVTBIG & LOUD and to ensure compliance with LSVT exercises.Methods: Seven individuals with PD attending the day hospital were selected in St.Columcille’s Hospital to attend the LSVT Bootcamp. This was held once a month, on apilot basis over 6 months. All participants had previously completed an individual blockof LSVT BIG & LOUD treatment. Objective outcome measures were completed preand post intervention. A satisfaction survey was completed at the end of the pilot inter-vention. Data was analysed using Excel.Results: Two participants could not be assessed following the group due to hospitalisa-tion. Having completed the intervention, the mean change in Functional Gait Assessmentwas 1 (SD = 2.45). The mean change in Timed Up and Go was 0.8 (SD = 2.28). Themean improvement in 10 metre walk was 0.6 seconds (SD = 0.89). All participants main-tained or improved their speech volume in conversation (mean = 69 dB) and loudness ofsustained phonation (ah) (mean = 79 dB). 83% maintained or improved their maximumphonation time (mean = 18 seconds). 60% of the participants achieved their functionaltherapy goals as measured by goal attainment scaling.Conclusion: LSVT BIG & LOUD Bootcamp is an effective multidisciplinary groupintervention to maintain treatment effects in people with PD. This group intervention hasnow become part of routine service.Reference:Fox C., Ebersbach G., Ramig L., Sapir S. LSVT LOUD and LSVT BIG: Behavioral
Treatment Programs for Speech and Body Movement in Parkinson disease.Parkinson’s disease 2012.
072 GETTING THE MESSAGE OUT THERE: AN ANALYSIS OFPUBLIC AWARENESS CAMPAIGNS FOR DEMENTIA INIRELAND
Background: This work assesses the impact of dementia awareness programmes oninternet search activity in Ireland. There is increasing emphasis in dementia on reducingincidence rates, even within ageing populations.
Over the past number of years, significant research has been undertaken in the area togain a better understanding of the disease and associated risk factors. Lifestyle behavioursthroughout the lifecourse, such as smoking, sleep and lack of cognitive stimulation,among others, are increasingly highlighted as impacting on risk factors for developingdementia in later life.
Efforts to increase public awareness regarding Alzheimer’s disease and dementia,including prevention strategies, have included articles in national newspapers and docu-mentaries aired by national TV broadcasters in Ireland and the UK.Methods: Google Trends was employed to explore trends in dementia as measured byvolume of Google searches since 2004. A closer examination of search trends in 2015was also conducted to identify peak search times and potential catalysts associated withsuch spikes.Results: Google searches on “dementia” have been slowly increasing since 2004.Examining 2015 in isolation, there is a peak in searches in mid-May corresponding withDementia Awareness Week in the UK and a smaller peak in mid-June at the time of theForget the Stigma campaign run by the Alzheimer’s Society of Ireland.
The largest search is observed in November, coinciding with the release of RobinWilliams’ autopsy results, which indicated the presence of Lewy body dementia.However, searches for “dementia prevention” or “dementia symptoms” are much lesscommon over the time period.Conclusions: Results indicate a positive effect of campaigns on awareness; however theage profile of the audience is unknown. High profile dementia cases seem to generate sig-nificant search activity. More needs to be done to highlight preventative factors fordementia to a general audience, linked specifically to awareness campaigns and high-profile cases.
074 DOES “FORM” PREDICT FUNCTION; USING SCORES TOPREDICT LENGTH OF STAY AND DISCHARGE DESTINATION
Sarah Mc Nally, Roisin Howlin, Annette Keogh, Emer Mc Inerney, Sarah MurphySt. Vincent’s University Hospital, Dublin, Ireland
Background: This audit set out to confirm if early cognitive screening of acute strokepatients in a large Dublin teaching hospital could predict their discharge destination andlength of stay.Methods: We audited the charts of newly diagnosed stroke patients admitted over a six-month period. The proforma gathered information on patient sex, age, date of admis-sion, length of stay, CT/MRI results, admission Barthel, MOCA score on initial assess-ment, discharge Barthel score and discharge destination.Results: 120 patients were included in the audit with a confirmed stroke on CTB/MRI.The average age was 73. There were 52 males and 68 females, the average length of staywas 44 days.
Of the 49 patients that scored within mild-no cognitive impairment, 90%(n = 44) wenthome, 2% to further rehab, 6% to LTC and 2% died. The average length of stay for thiscohort is 17days.
Of those that scored within the mild-moderate cognitive impairment (n = 37) 30%went home, 40% went for further rehab, 27% went to LTC and 3% died. The averagelength of stay for this group was 49 days.Of those that scored within moderate-severe cognitive impairment, 12% went for fur-
ther rehab, 63% to long term care and 25% died. Their average length of stay was 90days, nearly five times longer than the first cohort.Not every patient was able to complete a standardised cognitive assessment.42% of these patients went to long-term care and 35% died. This cohorts average
length of stay was 82 days.Conclusion: We have confirmed that early cognitive screening can help predict dischargedestination and length of stay. Early cognitive screening is completed within 48 hours ofadmission. This means that at an early stage the multidisciplinary has a strong indicatorof discharge destination and length of stay. We plan to use these scores prospectively toinform discharge arrangements and the timelines of interventions for newly diagnosedstroke patients.
075 “IT’S A VICIOUS CIRCLE”: HOW INADEQUACIES IN THEIRISH HEALTHCARE SYSTEM IMPACT ON LONG-TERM CAREADMISSIONS OF PEOPLE WITH DEMENTIA
Nora-Ann Donnelly1, Anne Hickey1, Niamh Humphries2, Alan Moore3, Frank Doyle11Royal College of Surgeons in Ireland, Dublin, Ireland2Royal College of Physicians in Ireland, Dublin, Ireland3Beaumont Hospital Dublin, Dublin, Ireland
Background: The provision of homecare takes place within the context of the widerhealthcare system. However, there is a notable absence of studies concentrating onhealthcare system factors in long-term care admissions. We address this absence by exam-ining how inadequacies in the healthcare system impact on long-term care admissions ofpeople with dementia. This is done in the context of the Irish healthcare system.Methods: Thirty-eight qualitative in-depth interviews with healthcare professionals andfamily carers were conducted. Interviews focused on healthcare professionals and familycarers perceptions of the main factors which influence admission to long-term care.Interviews were analysed thematically.Results: Long-term care admissions of people with dementia are affected by inadequa-cies in the Irish healthcare system in three ways. Firstly, community care services appearto be insufficient and inequitable, which limits their effectiveness. Secondly, such limita-tions in community care increase acute care admissions. Finally, admissions of peoplewith dementia to acute care can accelerate the long-term care journey.Conclusions: Inadequacies in the Irish healthcare system have a substantial impact onthe threshold for long-term care admissions. This study demonstrates that we cannotfully understand the factors that predict long-term care admission of people with demen-tia without taking into account how healthcare system factors impact on the continuationof homecare.
076 DANCING FOR PARKINSON’S: A RANDOMIZED PILOT TRIALOF IRISH SET DANCING COMPARED TO USUAL CARE
Joanne Shanahan1, Meg E. Morris2, Orfhlaith Ní Bhriain1, Daniele Volpe3, Tim Lynch4,Amanda M. Clifford11University of Limerick, Limerick, Ireland2La Trobe University, Melbourne, Australia3Casa di Cura Villa Margherita, Venice, Italy4Mater Misericordiae University Hospital, Dublin, Ireland
Background: For some people with Parkinson’s disease (PD), Irish set dancing is arguedto have beneficial effects on movement, balance and quality of life. The feasibility andbenefits of Irish set dancing classes for people with PD has not been compared withusual care.Methods: This pilot trial used a randomised controlled design, with participants rando-mised to Irish set dance classes or a usual care control group. The dance group attendeda 1.5 hour dancing class each week for 10 weeks and undertook a home dance pro-gramme for 20 minutes three times per week. The usual care control group continuedwith their usual care and daily activities. The primary outcome was feasibility; determinedby recruitment rates, attrition, adherence, safety, willingness of participants to be rando-mised, resource availability and cost. Secondary outcomes were motor function (UPDRS-3), health related quality of life (PDQ-39), functional endurance (six minute walk test)and balance (mini-BESTest).Results: Ninety participants were randomized (n = 45 per group). There were no adverseeffects or resource constraints. Although adherence to the dancing programme was93.5%, there was more than 40% attrition in each group. Post-intervention, the dancegroup had greater improvements in quality of life compared to the control group.UPDRS-3 scores deteriorated in the control group. The exit questionnaire showed parti-cipants enjoyed the classes and would like to continue participation.Conclusion: For people with mild to moderately severe PD, Irish set dancing is feasibleand enjoyable and can improve health related quality of life.
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077 THE INFLUENCE OF POTENTIALLY INAPPROPRIATEMEDICATIONS ON HEALTHCARE NEEDS AND MEDICATIONUSE: A RETROSPECTIVE CROSS-SECTIONAL STUDY
Christina Raae-Hansen1, Stephen Byrne1, Denis O’Mahony2, Shane Cullinan1, LauraJ Sahm3, Patricia M Kearney41School of Pharmacy, University College Cork, Cork, Ireland2Department of Medicine, University College Cork, Cork, Ireland3School of Pharmacy, University College Cork & Mercy University Hospital, Cork, Ireland4Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
Background: The use of potentially inappropriate medications (PIMs) is a commoncause of adverse drug reactions (ADRs) among older patients [1]. This study aims todescribe medication use and healthcare services among older patients in Ireland, with andwithout prescribed PIMs.Methods: A retrospective cross-sectional analysis of a primary care cohort. Subsets ofthe STOPP criteria were applied to the baseline data and those with and without PIMswere identified. Information on prescribed medicines and healthcare services use wereextracted from patient records over 5 years (2011–2015) and were compared between thetwo groups.Results: For the preliminary analysis, 100/2047 patients were randomly selected and ana-lysed. PIMs were identified for 59/100 patients with a mean of 2.2 (SD 1.6) criteria perpatient. There were fewer males in the PIM group than the non-PIM group (40.7% ver-sus 68.3%, p < 0.05) but there was no difference in the age between the two groups(median age of 64 versus 65, p>0.05). PIM patients were prescribed more medication intotal (means ±SDs: 9.3–12.8 ± 4.7–7.4, PIMs versus 3.8–5.8 ± 2.4–4.1 non-PIMS, p <0.05) and also more new medications (1.3–4.4 ± 2.1–5.6 versus 0.6–2.2 ± 1.7-3.3). ThePIM group were more likely to consult their GP (5.3–9.0 ± 3.8-6.9 versus 2.5–5.3 ±0.6–3.9, p < 0.05), but there was no significant difference in the number of referrals, newdiagnoses, investigations or hospital discharges between the two groups (all p>0.05).Conclusions: Patients prescribed PIMs are likely to be prescribed a higher numberof medications in total as well as new medications, and to consult their GP moreoften. These preliminary findings highlight the need to target inappropriate prescribingin older patients to improve their medical treatment and reduce associated healthcareneeds.Reference:1. O’Mahony D et al. STOPP/START criteria for potentially inappropriate prescribing in
older people: version 2. Age and Ageing 2015 Mar; 44(2):213–8.
078 TO DANCE OR NOT TO DANCE? A COMPARISON OFBALANCE, PHYSICAL FITNESS AND QUALITY OF LIFE INOLDER IRISH SET DANCERS AND AGE-MATCHED CONTROLS
Joanne Shanahan, Louise Coman, Frank Ryan, Jean Saunders, Kieran O’Sullivan, OrfhlaithNí Bhriain, Amanda M. CliffordUniversity of Limerick, Limerick, Ireland
Background: The population is ageing and regular exercise is advocated to prevent pro-gressive decline in balance, functional independence and quality of life. Set dancing is apopular form of exercise among older adults internationally. Yet, no study has examinedif long-term participation is associated with physical or psychological benefits. The aim ofthis study is to determine if older adults regularly participating in Irish set dancing havesuperior balance, physical fitness and quality of life compared to age-matched controls.Methods: A community-based, observational cross-sectional design was used for thisstudy. Regular set dancers (n = 39) and age-matched controls (n = 33) were recruited.Participants were assessed using the physical activity scale for the elderly (physical activitylevels), mini-BESTest (balance) and senior fitness test (battery of functional fitness tests).Quality of life was also assessed using the EuroQol EQ visual analogue scale.Results: When controlling for between-group differences in levels of physical activity(ANCOVA analysis), the dancers had significantly better balance, functional capacity andquality of life (all p < 0.05) compared to controls. No differences between the groupswere observed in other measures of functional fitness.Conclusion: The findings of this study suggest regular participation in set dancing isassociated with health benefits for older adults. These results may inform future studiesprospectively examining the role of set dancing for falls prevention, emotional wellbeingand cognitive function in community-dwelling older adults.
079 RECOGNITION OF ELDER ABUSE BY FIRST AND THIRD YEARUNDERGRADUATE NURSING STUDENTS
Claire O’Tuathail, Maura Dowling, Bernard McCarthyNUI Galway, Galway, Ireland
Background: The abuse of older people is recognised internationally as a widespreadproblem. It is important for nurses to report suspected elder abuse and, while on clinicalplacement, students have the opportunity to meet older people in different settings.Therefore a student nurse may have the opportunity to recognise and respond to abuseand provide appropriate support. However studies show that healthcare professionals failto recognise abuse.
Aims of the study were to: determine the proportion of first and third year nursingstudents (general and psychiatric) who correctly identify elder abuse in a vignette; to iden-tify variables associated with the correct identification of abuse and to suggest factorsand strategies to increase correct identification.Methods: All participants were given The Caregiver Scenario Questionnaire which mea-sures recognition of elder abuse. Ethical approval was granted by the University ethicscommittee. The questionnaire comprised a fictional vignette about a son who cares forhis mother who has dementia, followed by a list of 14 management strategies.Respondents rated each strategy on a 6-point Likert Scale. Some strategies are abusiveand some are not.Results: Data analysis was undertaken using IBM SPSS Statistics (Version 20) anddescriptive and inferential statistics were to determine correlations between demographicfactors, education and experience and ability to identify elder abuse. The significance levelwas set up at p < 0.05.Conclusions: This paper will present the findings of the first study undertaken inIreland to examine recognition of elder abuse in nursing students. The findings willinform changes that need to be made to undergraduate curricula at national and inter-national levels. It is expected that curriculum content will be improved to reflect the edu-cational needs of student nurses regarding recognition of elder abuse.
080 RESCUING THE PROCESS-BASED APPROACH TONEUROPSYCHOLOGICAL ASSESSMENT: FOCUS ONSTRATEGIES AND PERFORMANCE MECHANISMS RATHERTHAN TOTAL SCORES WHEN ASSESSING OLDER ADULTS
Unai Diaz-Orueta1, Alberto Blanco-Campal2, Kate Irving1, Teresa Burke11Dublin City University (DCU), School of Nursing & Human Sciences, Dublin, Ireland2Our Lady of Lourdes Hospital, Adult Mental Health Services, Department of LiaisonPsychiatry, Drogheda, Co. Louth, Ireland
Background: A cognitive assessment strategy that is not limited to examining a set ofsummary test scores will almost certainly be helpful in detecting and understanding cogni-tive functions in those suffering from neurodegenerative diseases such as Alzheimers.The goal of this study was, therefore, to identify widely used cognitive screening toolsthat may benefit from the inclusion of a process-based approach to complement trad-itional administration and scoring.Methods: A rapid review of literature using different combinations of the terms “demen-tia”, “Alzheimer”, “cognitive impairment”, “post stroke”, “screen”, “primary care” and“community” was performed in order to update Cullen et al’s (2007) review of screeningtests for cognitive impairment. The search was complemented with additional combina-tions of words [e.g. “cognitive screening”, “systematic review”, “MCI”, “Boston ProcessApproach”, “qualitative error analysis” and “quantified process approach”] and was con-fined to studies of adults. Inclusion criteria for the final selection of tests were: (1) testsmeasure a minimum of 3 of the 5 cognitive domains mentioned in DSM-IV-TR; (2) testsare currently used for dementia assessment; (3) tests fulfil the Quality Assessment Toolfor Diagnostic Accuracy Studies (QUADAS) (Whiting, 2003) and (4) tests do not requirehigh professional qualification levels to administer, except when QUADAS criteria recom-mend their inclusion (and the test has potential to be adapted to a process-basedapproach).Results: Initially, 160 screening and assessment tests were identified of which 114 hadnot previously undergone any form of process-based-approach. After applying the inclu-sion and exclusion criteria, 21 screening tools that may benefit from a process-basedapproach were identified, their characteristics summarised and the potential for clinicallyuseful modifications identified.Conclusions: With relatively little effort, widely used cognitive screening tools may beenhanced using a process-based approach to scoring and interpretation that will facilitatedetection of cognitive decline and differentiation between different neurodegenerativeconditions.
083 THERAPEUTIC BENEFITS OF AN ACTIVITY-BASED UPPER-LIMB GROUP IN A SPECIALIST GERIATRIC REHABILITATIONUNIT
Laura Horan, Emma Nolan, Shelagh O’Connor, Anna SzarataCappagh National Orthopaedic Hospital, Dublin, Ireland
Background: Occupational therapy (OT) is a client-centred healthcare profession whichaims to promote health and well-being through engagement in meaningful occupation(World Federation of Occupational Therapy, 2010). The National Clinical Programme forOlder People indicates that the ultimate goal is to facilitate the person in optimising theirindependence (Health Service Executive, 2012). When upper-limb function has beenaffected by illness, injury or disability, a person’s ability to maintain this independence byperforming their activities of daily living can be restricted. This study was carried out todetermine effectiveness of an activity-based upper-limb group, in combination with 1:1upper-limb programmes, in optimising client hand function and facilitating greater inde-pendence in daily functioning. Through the process, the psychosocial benefits of engage-ment in this group were also identified.Methods: This is a retrospective, observational study of 10 clients admitted to a special-ist, post-acute rehabilitation unit. A combined qualitative and quantitative approach wasadopted. Quantitative data was gathered relating to gross grip strength, pinch gripstrength, dexterity and changes in functional ability for 10 clients included in the upper
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limb group. Qualitative data was obtained through conduction of a focus group / face-to-face interviews which aimed to gain a subjective account on the benefits of attendanceat the group intervention.Results: Improvements were achieved in upper-limb strength, dexterity and functionalability for all 10 clients who engaged in the group and 1:1 upper limb programmes. Thiswas noted to translate to greater independence in ADL performance. Through the focusgroup / interview process, clients described psychosocial benefits including improvementin mood and motivation, peer support, diversion and a sense of self-worth.Conclusions: This study describes the physical and psychosocial benefits of an activity-based upper-limb group, used in combination with 1:1 upper-limb programmes, for 10clients admitted to specialist geriatric rehabilitation unit.
084 INAPPROPRIATE PRESCRIBING OF LIGNOCAINE 5%PATCHES (VERSATIS®) IN HOSPITALISED OLDER ADULTSAND COST IMPLICATIONS
Alison Poff, Deirdre McCartan, SKK Lee, Linda Murnane, Linda Brewer, Ciaran DoneganBeaumont Hospital, Dublin, Ireland
Background: Transdermal Lignocaine 5% patch (Versatis®) is licenced for symptomaticrelief of post-herpetic neuralgia. In clinic practice, Versatis® is prescribed off-licence asan adjunct analgesia in combination with simple analgesics for severe pain. We aimed to(i) determine the volume of appropriate and inappropriate prescribing according to thesummary of product characteristics (SPC) (ii) calculate the cost of lignocaine patch pre-scriptions and (iii) compare the cost with other co-prescribed analgesics (Paracetamol,Tramadol, Ibuprofen, Oxycodone, Targin®).Methods: A retrospective multicentre audit across 5 geriatric medical wards (3 acute and2 rehabilitation) at 3 hospital sites was conducted on a single calendar day using patientmedication administration records. Data on patient demographics, co-morbidities andprescribed analgesia were collated. Price comparisons were made between Lignocainepatches and co-prescribed analgesics. Potential cost savings were extrapolated to predictpotential one-year savings.Results: Data were available for 129 patients (>65years). Females predominated (67%, n= 86), with a mean age of 80.9years (range 65-97years). 26 patients were prescribedLignocaine patches. None of the indications were in accordance with the SPC.Unlicensed indications included analgesia for Osteoarthritis and Fractures (34.6%, n = 9each), non-specific indications (n = 5) and 3 undocumented. The total cost of theLignocaine patches for one day was €109.20 (n = 26), compared with €15.74 for all otheranalgesics combined. Over one year this would extrapolate to a cost of €7971.60 forLignocaine patches and €1149.02 for other analgesics combined.Conclusions: Inappropriate prescribing of Lignocaine patches is common. Substantialsavings could potentially be made by adhering to licence-only prescribing. Greater aware-ness of the SPC licenced use and the cost of the patches could promote appropriate pre-scribing of more effective and economical analgesics and thus decrease pharmacy costs.
085 THE VIEWS OF HEALTHCARE PROFESSIONALS ANDPATIENTS ABOUT THE MODIFICATION OF ORALMEDICINES: A SYSTEMATIC REVIEW OF THE LITERATURE
Aoife Mc Gillicuddy1, Laura J Sahm2, Abina M Crean31Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork,Ireland2Department of Pharmacy, Mercy University Hospital and Pharmaceutical Care ResearchGroup, University College Cork, Cork, Ireland3School of Pharmacy, University College Cork, Cork, Ireland
Background: Modifications of oral medicines (e.g. crushing tablets) are frequently neces-sary for older adults due to increased prevalence of dysphagia and altered dosing require-ments [1]. These modifications are generally unlicenced and may compromise the quality,safety and efficacy of the medicine. The aim of this systematic review was to synthesizequalitative literature investigating the views of patients, healthcare professionals and carersabout the modification of oral medicines.Methods: A comprehensive, systematic search of: PubMed, Medline, EMBASE,CINAHL, PsycINFO, Web of Science, ProQuest Databases, Scopus, TRIP, CENTRAL,CDSR and OpenGrey, was undertaken from inception to September 2015. Studies wereeligible for inclusion if they used qualitative methodology to investigate the views of adultpatients, their carers or healthcare professionals about the modification of oral medicines.Thematic synthesis was used to synthesise the findings.Results: Seven studies were included; three involved healthcare professionals and fourinvestigated patient’s views. The healthcare structure; including multi-disciplinary teamengagement, expertise and communication, guideline availability and cost/reimbursementmodel were important factors influencing medicine modifications. A key issue is the indi-viduality of each patient as regards needs, preferences and abilities when choosing oralmedicines. However, decision making is complicated by inter- and intra- patient variabil-ity, the occasionally conflicting priorities of healthcare professionals and knowledge defi-cits due to a lack of resources. The prevailing reactive, ad-hoc assessment of patient’sneeds should be replaced by a systematic assessment process.Conclusions: Further research is needed given the limited number of studies investigat-ing this practice. It is clear from the results that healthcare professionals need to engagewith patients, when considering the choice of dosage form and consider the potentialimplications of medicine modification. Additionally, patients need to communicate their
needs and requirements to healthcare providers so the most appropriate medicine can beselected.Reference:1. Stegemann et al Ageing Research Reviews. doi:http://dx.doi.org/10.1016/j.arr.2010.
04.005.
087 THE KNOWLEDGE, ATTITUDES AND BELIEFS OF NURSESABOUT THE MODIFICATION OF ORAL MEDICINES: AQUALITATIVE INTERVIEW STUDY
Aoife Mc Gillicuddy1, Abina M Crean2, Laura J Sahm3
1Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork,Ireland2School of Pharmacy, University College Cork, Cork, Ireland3Department of Pharmacy, Mercy University Hospital and Pharmaceutical Care ResearchGroup, University College Cork, Cork, Ireland
Background: Oral medicines are frequently modified to meet the needs of older adults[1]. Within nursing homes, medicine administration and hence medicine modification, isundertaken by nurses. These modifications can have clinical and legal implications. Theaim of this qualitative study is to gain an understanding of the knowledge, attitudes andbeliefs of nurses regarding the modification of oral medicines.Methods: Semi-structured, face-to-face interviews with nurses working in nursing homesin the greater Cork region were undertaken between March and May 2016. Nursinghomes were purposively selected to include public, private and voluntary sites, with andwithout specialist dementia units. One nurse at each site was recruited. A topic guide wasdeveloped based on relevant literature, with input from an experienced geriatric nurse,and underwent iterative revision. The interviews were analysed thematically as per Braunand Clarke. Local ethical approval was obtained and all nurses provided written informedconsent.Results: Seven interviews were conducted (71.4% female, mean age(+/−SD) 46.4years(+/−7.7), average interview length 20 minutes 29 seconds). Analysis of the findings indi-cated that nurses felt that modifications are “a necessary evil”. Nurses expressed thatthey only undertake modifications if authorised by the prescriber but nonetheless findthemselves conflicted as they are at the interface of the patient and his/her medication.Emergent themes included: healthcare culture and context, knowledge base, multidiscip-linary involvement, conflicts within their role and concerns regarding the patient.Conclusions: Modifications are viewed as unavoidable due to limitations regarding avail-ability of alternatives. Whilst nurses expressed concern about medicine modification theyvalued input from other healthcare professionals regarding decisions around modifica-tion. The nurse’s relationship with individual patients means that nurses have a vital rolein identifying issues and assessing patient’s needs. Future guidance on medicine modifica-tion should be cognisant of the themes which have emerged here.Reference:1. McGillicuddy et al. doi:10.1007/s00228-015-1979-8.
088 THE IMPACT OF NUTRITIONAL SUPPLEMENTATION ONCOGNITIVE FUNCTION AMONG INDIVIDUALS WITH MILDCOGNITIVE IMPAIRMENT (MCI)
Rebecca Power1, Riona Mulcahy2, Stephen Beatty1, Robert Coen3, John Nolan11Nutrition Research Centre Ireland, Waterford Institute of Technology, Waterford, Ireland2University Hospital Waterford, Age-Related Care Unit, Waterford, Ireland3Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, Ireland
Background: Improved longevity worldwide has resulted in a significant increase in age-related diseases. There has been an exponential rise in the incidence and prevalence ofAlzheimer’s disease (AD), with over 100 million adults globally projected to developdementia by 2050. Consequently, emphasis is now being placed on preventative strategiesto delay the onset or reduce the risk of developing dementia. Emerging evidence suggeststhat targeted nutrition may play a key role in limiting the burden of cognitive impairment.The cognitive impairment study (CARES) is designed to investigate if nutritional supple-mentation improves cognitive function among individuals with mild cognitive impairment(MCI).Methods: CARES is a double-blind, randomised clinical trial aiming to recruit 60 indivi-duals with MCI and 60 controls. Both groups will be randomised to receive either anactive intervention containing fish oil, vitamin E, and the carotenoids lutein (L), zeax-anthin (Z) or meso-zeaxanthin (MZ), or placebo for 2 years. Both groups will undergo aseries of cognitive assessments designed to assess different cognitive domains e.g. atten-tion, memory.Results: Our research group recently found that AD patients had low levels of macularpigment (MP) (p < 0.001) and poorer vision (p < 0.05) versus controls. Located at thecentral retina, MP is important for vision due to its light-filtering and antioxidant prop-erties. Of note, MP is comprised of L, Z and MZ which are solely of dietary origin. Ina subsequent trial, carotenoid supplementation improved MP and the visual function ofAD patients. As no improvements in cognition were observed, we suggest that nutri-tional intervention at an earlier stage of cognitive decline is required. CARES will exam-ine change in cognitive function in MCI patients and controls for active and placebogroups.Conclusion: CARES will add to the growing body of research examining the role ofnutrition as a preventative strategy against cognitive decline with ageing.
089 EXPLORING THE IMPACT A TRAINING PROGRAMME HAS ONHEALTHCARE STAFF ATTITUDES AND UNDERSTANDINGSOF DEMENTIA: A MIXED METHODS EVALUATION STUDY
Orla Quirke, William Evans, Mary BrosnanInstitute of Technology Tralee, Tralee, Co.Kerry, Ireland
Background: Increased longevity is a worldwide development that demonstrates thebenefits of improved socioeconomic and health care factors. Dementia is a conditionassociated with ageing but not unique to the aged. The term dementia refers to a groupof diseases characterised by progressive and mainly irreversible decline in memory, lan-guage and comprehension. Dementia is a global health challenge. From an Irish contextthe number of people with dementia is expected to double by 2031.The Irish government launched The National Dementia Strategy in 2014 and one of
its aims included the provision of quality care for people with dementia. This challengessociety to be dementia friendly. From a healthcare perspective, the strategy requires staffto be prepared to engage with people who have dementia, which in turn would lead tobetter outcomes for staff and patients.The aim of this study is to explore the impact a training programme has on healthcare
staff attitudes and understandings of dementia.Methods: This is a mixed methods evaluative study which involves both questionnairesand semi structured interviews. Ethical approval has been granted for this study.Results: Preliminary findings so far indicate that there was a significant shift towards amore positive approach to dementia care post the training programme. The majority ofthis shift had been accounted for by the items associated with person-centred approachespre mean 47 and post mean is 52. However so far items associated with hope has had anegative effect pre mean 33 and post mean 31.Conclusions: No previous study has formally evaluated this programme or its impacton participant attitudes to or understanding of dementia. The outcomes of this studyhave the potential to influence educational programme delivery, policy development andultimately the healthcare experience of persons with dementia.
092 GPS’ PERSPECTIVES ON PRESCRIBING FOR OLDER PEOPLEIN PRIMARY CARE: A QUALITATIVE STUDY
David O Riordan1, Stephen Byrne1, Aoife Fleming1, Rose Galvin2, Patricia M Kearney1,Carol Sinnott11University College Cork, Cork, Ireland2University of Limerick, Limerick, Ireland
Background: As the main prescribers of medication in primary care, understanding thedeterminants of GP behaviour in relation to prescribing is a first step in the developmentof interventions to address the issue of medication related problems in older adults.Furthermore, GPs are an obvious source of information to better understand the com-plexities of prescribing for these patients 1.The aim of this study is to explore the key determinants of GP prescribing behaviours
for older adults in primary care with a view to developing a behaviour intervention toimprove prescribing for these patients.Methods: Qualitative semi-structured interviews were conducted with 16 GPs.Convenience sampling was supplemented by snowball sampling where necessary in orderto recruit the participants. Qualitative interviews were fully transcribed and analysed usinga framework approach. Three multidisciplinary researchers independently coded the data.Emerging themes were mapped to the Theoretical Domains Framework (TDF), a set offourteen domains relating to theory of behavioural change.Results: The following domains were identified as being important determinants of GPs’prescribing behaviour: “Memory Attention and Decision Processes”, “Beliefs aboutCapabilities” and “Reinforcement”.Participants described prescribing in primary care as a complex process and have to
consider multiple factors when prescribing for older adults. Participants expressed confi-dence in the role of community pharmacists and acknowledged that they provide valuablesupport to the GP. Prescribing in primary care was highlighted as a concern due to itsassociation with litigation.Conclusions: These findings highlight that prescribing for older adults in primary care isa complex process and source of anxiety for GPs. Targeting the domains above mayaddress these negative associations and improve outcomes for patients.Reference:1. Cook JM, Marshall R, Masci C, Coyne JC. Physicians’ perspectives on prescribing ben-
zodiazepines for older adults: a qualitative study. Journal of general internal medicine2007; 22: 303–7.
094 THERE’S NO PLACE LIKE HOME! EARLY SUPPORTEDDISCHARGE FOR OLDER ORTHOPAEDIC PATIENTS
Peter Spencer, Grace Mitchell, Eva Bollard, Dearbhail Flanagan, Dervilla Danaher,Ronan O’Toole, Joseph DugganMater Misericordiae University Hospital, Dublin, Ireland
Background: A key objective of the National Clinical Programme for Older People is areduction in delayed hospital discharges in the acute hospital setting (HSE,2012). Theaims of this study were to assess the effect of a potential early supported discharge(ESD) service on AVLOS, patient therapy/care requirements on discharge and predictedfinancial consequences post-orthopaedic surgery.Methods: An audit was carried out over a 3 month period on patients post-orthopaedicsurgery requiring rehabilitation in a major trauma hospital. Data was obtained includingage profile, type of surgery and length of stay. During this period patients were assessedby the MDT as to suitability for onward rehabilitation and a potential ESD programmeonce medically fit. Further data was gathered analysing ESD requirements for eachpatient deemed appropriate, as well as bed day savings with ESD.Results: Thirty-five people were deemed appropriate for potential ESD over the 3month period. The mean age was 74.37 years. AVLOS for these patients was 21.22 days.With ESD in place a possible reduction of 5.85 days in AVLOS was calculated(15.37days). The potential bed day savings of this patient cohort was a total of 205 beddays per quarter. At a cost of €800 per bed day this would equate to savings of €164,000over a 3 month period and €656,000 per year.Conclusions: An orthopaedic ESD programme could significantly reduce acute hospitalLOS for older adults post-surgery and reduce pressures on affiliated off-site rehabilitationbeds. It could also have positive effects on quality of life, as seen with similar establishedstroke rehabilitation ESD programmes.
096 A JOURNEY OF CHANGE: DEVELOPING EXCELLENCE INEND-OF-LIFE CARE IN RESIDENTIAL CARE SETTINGS
Anna de SiúnIrish Hospice Foundation, Dublin, Ireland
Background: Each year in Ireland 25% of deaths, approximately 7,500, occur in a resi-dential care setting. The Irish Hospice Foundation (IHF) believes no-one should facedeath or bereavement without the care and support they need. In order to ensure thateach person who dies in residential care receives compassionate, dignified, person-centredend-of-life care, the IHF established A Journey of Change, a programme designed toembed a continuous quality improvement approach to developing excellence in end-of-life care.Methods: In consultation with internal and external stakeholders, a programme frame-work was developed. Participating residential care centres (RCCs) engage with a series ofonsite workshops to give them the skills, knowledge and resources to:
(1) develop a unique vision for end-of-life care in their centre(2) continually review their own end-of-life care practices(3) invite feedback from bereaved friends and relatives as part of their review process(4) make meaningful sustainable change, where change is needed
Additional resources (both on-line and tangible) were developed to meet staff informa-tion needs and facilitate networking opportunities.Results: Over 100 public, private and voluntary RCCs for older people are currentlyengaged with the programme, with approximately 300 staff taking part in multiple work-shops. 95% of staff have rated the workshops as ‘very good’ or ‘excellent’. A number ofbespoke change projects have been implemented in participating centres, while initialevaluation feedback suggests that participating in the programme also impacts positivelyon level of team-working and communication. A formal external evaluation of the pro-gramme is currently taking place.Conclusions: Based on emerging evidence regarding best practice in end-of-life care, AJourney of Change is impacting on personal understanding, organisational culture andcare practices around end-of-life care.
097 IMPACT OF A BESPOKE MEDICATION MANAGEMENTSYSTEM ON MEDICATION SAFETY IN AN IRISH NURSINGHOME
Anne Marie O’Regan1, Neil Mackay2, Michael O’Connor3, Margaret Bermingham1
1Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork,Ireland2St Luke’s Nursing Home, Mahon, Cork, Ireland3Pharmacy First Plus, Douglas, Cork, Ireland
Background: Medication safety is a concern in all healthcare settings including nursinghomes. Changes to medication management (MM) in this setting have been proposed asa means of improving safety. We sought to quantify the effect of a MM initiative on therate of medication safety incidents in an Irish nursing home.Methods: The MM initiative involved the introduction of a newly designed patient medi-cation record and the use of the Biodose® system for all medications dispensed to resi-dents. All medication incidents were recorded in hardcopy at the time of the incident andlater recorded electronically. Records from 1st January 2013 to 31st December 2015 wereanalysed in order to capture the time period before and after introduction of the newMM system in May 2014. Data recorded included type of medication incident; implicatedmedication; time and date of incident; reporting of incident and follow-up actions.
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Results: A total of 424 medication incidents were recorded during the study period. Ofthese 275 (64.9%) occurred before the new MM system and 149 (35.1%) after implemen-tation of the new system. Pre- and post-implementation, the majority of incidents origi-nated in the dispensing of medicines (pre: n = 222, 80.7%; post: n = 113, 75.8%). Themost common types of dispensing incidents were medication doses missing from a blisterpack (pre: n = 97, 43.7%; post: n = 37, 32.7%) and extra doses of medication in a blisterpack (pre: n = 36, 16.2% post: n = 17, 15.0%). Pre- and post-implementation, moreerrors occurred during nighttime than daytime medication rounds (pre: 138 vs. 108 inci-dents; post: 67 vs. 58 incidents). The medications most commonly implicated in medica-tion safety incidents were paracetamol, benzodiazepines, transdermal opioids andantipsychotic agents.Conclusion: Introduction of a bespoke MM system improved medication safetyoutcomes in this nursing home. Innovation in MM in this setting is beneficial to patientcare.
098 EXPLORING COMMUNITY LIVING FROM A LIFECOURSEPERSPECTIVE: TOWARD LIFECOURSE POLICY OPTIONS
Emily LoughlinInstitute for Lifecourse and Society, National University of Ireland, Galway, Galway, Ireland
Background: Ageing and disability are part of the lifecourse trajectory, with disabilityadding another dimension to the ageing process. Older people and persons with disabil-ities share a common vulnerability in repect of community living and in relation to main-taining autonomy and independence. Further, the ability of people belonging to eachgroup to connect and interact is often stifled through inadequate policies that leave themsusceptible to heightened risks of institutionalisation. The ageing-disability nexus providesthe rationale for greater cooperation between actors in each sector in order to achievecommon goals such as inclusive, accessible and age-friendly communities.Methods: Desk-based research, involving documentary analysis of relevant communityliving policy in ageing and disability as well as evidence relating to community living, ‘age-ing in place’ and the lifecourse, is being combined with an empirical study using a qualita-tive design as part of a doctoral project which explores community living from alifecourse perspective. This paper presents the conceptual framework that arises from theresearch conducted to date.Results: Evidence suggests that older people and persons with disabilities express a com-mon desire to live and age in their communities. However, heretofore, policies have beendeveloped from silo-specific perspectives that do not necessarily support the aspirationsof the people for whom they are enacted. A policy gap has been identified. Highlightingthe commonalities in ageing and disability supports the pursuance of more holistic life-course policy options.Conclusions: Understanding the conceptualisation of community living is important forpolicy innovation that seeks to support older people and persons with disabilities to real-ise, enhance and maintain meaningful community living. Exploring community living asrefracted through the lens of the lifecourse perspective adds valuable depth of under-standing with regard to the interpretation of the intent and purpose of policy and how itmay be better translated into practice.
099 MAXIMISING THE POTENTIAL OF COMMUNITY DAYHOSPITALS
Breffni Drumm1, Therese Carey1, Eileen Kilkenny2, Kate Sinnott2, Helen Lee2,Diarmuid O’Shea11St Vincent’s University Hospital, Dublin, Ireland2Clonskeagh Hospital, Dublin, Ireland
Background: Comprehensive geriatric assessment (CGA) needs to be provided in a var-iety of settings. There is an increasing need for CGA for frail older people in our commu-nity who wish to continue living at home. Day Hospitals provide an ideal “hub” aroundwhich to integrate hospital and community services for older people in their local com-munity. Outreach services integrated with local day hospitals are one way of achievingthis.Method: We aimed to describe the demographics of the people attending one DayHospital in our local community and their use of specialist geriatric services.Results: 62 clients attend the day hospital on a weekly basis, 11 males and 51 females.Mean age 85yrs (range 66-99yrs). Rockwood Frailty score was available for 58 patients.Mean Rockwood frailty score was 5.91 (range 4-7).
All patients attending are reviewed daily by the clinical team in the day hospital. 28/62(45%) patients were reviewed by the CNM, CNS and Geriatrician at the review meeting.Of the 62 clients, 30(48%) previously attended the local hospital geriatric outpatients orDay Hospital. 6 of 28 (21.4%) patients discussed required re-referral for further assess-ment in our hospital. The mean Rockwood Frailty score of patients who were reviewedwas 6.46. 23 clients had no documented contact with specialist geriatric services in thehospital. The mean Rockwood frailty score of this cohort was 5.53.Conclusion: While day hospitals vary in the services they provide, they all provide aunique and important service for their local community. Closer collaboration betweenSpecialist Geriatric Services and Primary Care teams can maximize the potential of theseservices, improve quality of life for older people identified as needing them while living athome, and reduce the over reliance on acute hospital services in certain situations.Further work is underway to outline and document these important benefits.
100 SINGLE CENTRE EXPERIENCE OF PEG TUBE INSERTION IN ATERTIARY REFERRAL CENTRE
Background: Percutaneous endoscopic gastrostomy (PEG) tubes are an established pro-cedure for long-term nutrition. International guidelines suggest that PEG tubes shouldbe considered if patients require artificial enteral nutrition exceeding 2-3 week but arerarely indicated in patients with short life expectancy or advanced dementia. Appropriatepatient selection play an important part in good outcomes. We audited patients undergo-ing PEG tube placement to identify risk factors associated with morbidity and mortality.Methods: The study population was selected using HIPE coding for admissions relatedto PEG tubes from 2010-2015.Results: We identified 133 initial insertions of feeding tubes; 37 radiologically insertedand 96 inserted via endoscopy with 34 over 75 years old. 25% (34/133) were over 75years old at the time of PEG tube insertion. Indications for insertion included malignancy(2), stroke (6), neurological conditions (3) and dementia (8). 6 patients (18%) died duringadmission, all within 30 days of PEG tube insertion.Conclusions: Our study aimed to further our understanding and inform our discussionwith patients and families. The 30-day mortality reminds us of the challenges in selectingpatients in this group for PEG tube insertion. As guidelines will never be able to coverevery clinical situation, clear compassionate communication with patients and their fam-ilies will always play a crucial role when challenging decisions like these need to be made.
102 FOSTERING COLLABORATION IN AMPUTEEREHABILITATION; ACUTE HOSPITAL, POST-ACUTESPECIALIST REHABILITATION UNIT AND COMPLEXSPECIALIST REHABILITATION CENTRE
Louise McCarron1, Sheena Egan2, Geoffrey Yu2, Grainne Forde3, Emma Nolan11Cappagh National Orthopaedic Hospital, Dublin, Ireland2The National Rehabilitation Hospital, Dublin, Ireland3The Mater Misericordiae University Hospital, Dublin, Ireland
Background: Many patients require a variety of services to achieve optimal rehabilitationand quality of life post amputation. However, the transition between services is oftencomplex, poorly developed and understood, and information sharing across rehabilitativeservices is often inconsistent resulting in increased burden for patients, families and staff.This study involved a service development initiative to improve the transition process forpatients post amputation across three sites; an acute hospital, post-acute specialistrehabilitation unit and a complex specialist rehabilitation centre.Methods: Individual meetings were held with key members of the interdisciplinary teamat each enrolled site. Current transition challenges, materials which could be shared acrosssites, and a range of strategies aimed at improving communication were identified. Afocus group meeting was then held with key team members across all three sites and thisinformation was pooled and discussed. Current communication pathways between sitesand documentation were viewed. Key areas for improvements were identified and com-mon strategies for improving the process of communication across all sites were agreed.In addition, the specialist facilities available at the Complex Specialist RehabilitationCentre were identified and optimal referral pathways were clarified.Results: Improved awareness of services available and contacts within the MDT havebeen established across the three sites. The introduction of site specific transfer formsand sharing of patient education resources has improved communication, avoided dupli-cation and assisted with common goal-setting among health and social care professionalsfor patients at different phases in the rehabilitation process. This has resulted in a moreseamless transition service for patients and a more efficient use of resources within andbetween sites.Conclusion: A shared and collaborative approach to patient rehabilitation across all threesites has resulted in a more patient centred flexible service and a more optimal use ofscarce resources.Acknowledgement: The Interdisciplinary team.
103 THE OLDER MOTORCYCLIST
Donal Fitzpatrick, Des O’NeillCentre for Ageing, Neuroscience and the Humanities, Tallaght Hospital, Dublin 24, Ireland
Background: Motorcyclists are vulnerable road users and are over represented in roadfatality and injury statistics. We aimed to explore the trend of ageing motorcyclists, includ-ing patterns of use, factors in collisions, injury severity and fatality rates and to evaluatethe disproportionate increase in older motorcyclist collisions and injuries.Methods: Literature review using TRID, Cochrane Injuries, Medline, CINAHL,Cochrane Controlled Trials, PsycInfo. We obtained data from the Healthcare PricingOffice, the Road Safety Authority and the Central Statistics Office relating to Irishmotorcyclists.Results: Internationally and in Ireland, there has been a disproportionate rise in injuriesand fatalities involving older motorcyclists in recent years. Older motorcyclists are morelikely to be admitted to hospital, have more severe injuries, are more likely to requireintensive care, have a longer length of stay and suffer more complications. Head and
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thoracic injuries are more common in older motorcyclists and injuries at all sites aremore severe in older adults. The presence of comorbidities and a reduction in physiologicreserve predisposes older motorcyclists to higher mortality and more severe injuries.Also, older motorcyclists are more likely to ride motorcycles with larger capacity engines.They are more likely to crash on higher speed roadways and in rural areas. An increasingproportion of older motorcyclists are returning riders whose riding skill has likely depre-ciated over time but are riding on powerful machines.Conclusions: Motorcyclists are getting older. The nature of motorcycling is changingand for many, especially older riders, it is primarily a leisure pursuit. In general, oldermotorcyclists are safer riders but in recent years there has been a significant rise in fatal-ities and injuries affecting older motorcyclists. Training and safety initiatives for oldermotorcyclists and returning riders may be effective in reducing injuries and fatalities.
106 ANTICOAGULATION MANAGEMENT IN HIP FRACTUREPATIENTS ON WARFARIN AND DIRECT ORALANTICOAGULANTS
Ahmed Osman1, Joanna McGlynn2, Muhammad Nouman Shakoor1, Josie Clare31Department of Medicine, Cork University Hospital, Cork, Ireland2Department of Geriatrics, Cork University Hospital, Cork, Ireland3Department of Orthopaedics, Cork University Hospital, Cork, Ireland
Background: Blue book standards and Irish Hip Fracture Database (IHFD) guidelinesrecommend that hip fracture surgery should be carried out within 48 hours of triage toreduce morbidity and mortality. In our hospital, older hip fracture patients admitted onanticoagulation are managed on a case by case basis. The accepted INR for surgery is 1.4or less.Methods: Data was collected on therapeutic anticoagulation prescription pre admissionfor hip fracture patients, 65 years and older, over a 3 month period. For those on war-farin, data was collected on their admission INR and timing of INR testing pre surgery.Results: 115 older hip fracture patients were admitted between 1st of February 2016 and30th of April 2016. 27 had a diagnosis of atrial fibrillation. Of these 22 (81%) were takingsome form of anticoagulation, 12 (55%) were taking warfarin and 10 (45%) direct oralanticoagulants (DOACs).For those on warfarin, 6 (50%) had an admission INR within therapeutic range (2-3)
and 6 (50%) were in supra therapeutic range (>3). The median time to the first INRresult from presentation was 2 hours (range 1-3 hours). The median number of repeatINR tests pre surgery was 3 (range 2 to 6). Vitamin K was prescribed in an ad hoc fash-ion and the repeat INR timing was widely varied. Of 12 patients taking warfarin 3 (25%)were in theatre within 48 hours of triage time and 9 (75%) were greater than 48 hours. Ofthe 10 patients on DOACs, 7 (70%) went to theatre within 48 hours and 3 (30%) over48 hours.Conclusion: Patients on DOACs were more likely to go to theatre within 48 hours thanthose on warfarin. This study highlights the need for a robust protocol for anticoagula-tion reversal pre hip trauma surgery to reduce avoidable delays to theatre.
108 CHARACTERISING AN IMPLEMENTATION INTERVENTIONTO SUPPORT THE INTRODUCTION OF COMMUNITY-BASEDFALLS RISK ASSESSMENT CLINICS
Sheena McHugh1, Olivia Wall2, Carol Sinnott1, Molly Byrne3, Suzanne Timmons2, PatriciaM. Kearney11University College Cork, Cork, Ireland2St. Finbarr’s Hospital, Cork, Ireland3National University of Ireland Galway, Galway, Ireland
Background: The effectiveness of falls prevention programmes among communitydwelling older adults has been demonstrated. However, research is needed to determinehow to increase implementation in healthcare settings. An implementation intervention,which refers to any strategies designed to support the implementation of a service, canaddress organisational and provider barriers, and increase the likelihood of successfulimplementation. Our aim is to characterise the content of an implementation interventionto support health professionals to deliver community-based falls risk assessment clinics(FRAC), using behavioural science methodology.Methods: We are using multiple data sources to build a description of the implementa-tion intervention. We are conducting semi-structured interviews with a purposive sampleof stakeholders involved in the design and delivery of the intervention (n = 4). We areusing non-participant observation to observe the delivery of one-to-one and group stafftraining sessions, and to observe information sessions with referring health professionalgroups. We are analysing documents including referral material, promotional/educationalmaterial and training packs. Data will be analysed using the Behaviour Change Wheel, aframework for understanding how an intervention produces its effects.Results: A range of BCTs are being used to coach staff and support implementationincluding education, training, and environmental restructuring. While data from inter-views and documents have identified these core ingredients, observation data haverefined the exact techniques being employed, for example the use of feedback andinstruction on how to perform the behaviour.Conclusions: In health care, most implementation efforts are not formally reported or fullyunderstood. Characterising the implementation of the FRAC in this systematic way facilitatesevaluation, further refinement and effective implementation at other sites. The results willhelp us to understand how different strategies facilitate the introduction of new services incomplex healthcare settings and inform future implementation intervention development.
109 INVESTIGATING GAIT AND COGNITION IN ELDERLY COPDPATIENTS HOSPITALISED WITH AN ACUTE EXACERBATION
Gavin Bennett1, Breda Cushen2, Isabelle Killane1,2, Fiachra Maguire1, RichardW Costello2, Richard B Reilly11Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College,University of Dublin, Dublin, Ireland2Clinical Research Centre, Smurfit Building Beaumont Hospital, Royal College of SurgeonsIreland, Dublin, Ireland
Background: With advancing age, Chronic Obstructive Pulmonary Disease (COPD)can place an individual at greater risk of reduced participation in society and mortality(1). Survival in older adults increases with gait speed but little is known about gait inCOPD (2). The objective of this study was to monitor gait of patients admitted to hos-pital with an acute exacerbation of COPD (AECOPD), their cognitive performance andto examine the relationships with clinical improvement.Methods: Gait speed was acquired in 29 patients admitted to hospital with anAECOPD, with a mean age of 71.6 ±8.1 years. Gait speed was acquired employing the4-metre gait speed test on day 1 of hospitalisation, day of hospital discharge and at30 days follow-up. Montreal Cognitive assessment (MOCA) scores were recorded on dayof admission. Linear regression was performed to assess correlations and between-groupdifferences were assessed using student t-tests.Results: Gait speed improved significantly from day 1 of hospitalisation (0.69 ±0.29 ms-1) to follow-up at day 30 (1.01 ±0.31 ms-1) (p = 0.0031). Slower gait speeds on day 1 ofhospitalisation were significantly correlated with longer durations of hospital stay (p =0.0014). There was no significant correlation between gait speed and MOCA score.Conclusions: These results illustrate that gait speed is significantly slower during anexacerbation at admission to hospital, compared to 30 day follow-up. Furthermore, thenovelty of these results is that gait speed at hospital admission predicts length of hospitalstay. Future work should investigate if objective lung function and gait measures are moresensitive at predicting changes during hospitalisation and at 30 day follow-up.References:1. Gooneratne NS, Patel NP, Corcoran A. Chronic obstructive pulmonary disease diag-
nosis and management in older adults. JAGS 2010; 58(6):1153–62.2. Studenski S, Perera S, Patel K et al. Gait Speed and Survival in Older Adults. JAMA
2011; 305(1):50–8.
111 PROTON PUMP INHIBITORS IN GERIATRIC MEDICINEREHABILITATION AND LONG TERM CARE UNITS
Sylvia Karpinski, Michael Dowling, Des O’NeillThe Adelaide and Meath University Hospital, Dublin, Ireland
Background: Proton pump inhibitors (PPI’s) are the most commonly prescribed medi-cation. Long term use is common and often without indication among older people. Itslong term use is also associated with adverse effects including: B12 deficiency (1) irondeficiency, hypomagnesaemia, increased susceptibility to pneumonia, enteric infections,fractures, and hypergastrinemia and drug interactions.(2) The prevalence of PPI usageamong older people in institutional care is undocumented in Ireland.Methods: We reviewed use of PPI’s in a geriatric medicine rehabilitation unit and longterm care units in a dedicated hospital. Prevalence of PPI’s prescription and clinical indi-cation for its use was examined. Patient drug kardexes were reviewed and medical notesused as a source for clinical indication such as gastro-oesophageal reflux, peptic ulcer dis-ease and gastritis.Results: Of 74 patients reviewed ranging in age from 68 to 90, 33 were men and 41women: 27 patients in a rehabilitation unit and 47 in long stay unit. Of 67% of thepatients were on PPIs, 19 (40%) of the patients had a clinical indication for PPI’s while28 (60%) had none.Conclusions: Our results show that a large proportion of older patients in institutionalcare are on PPI’s, the majority without a clear indication. These older and sometimes frailpatients are at high risk of adverse side effects. Clear guidelines for PPI withdrawal andregular review of medication are indicated to prevent adverse events and inappropriateuse of PPI’s.References:1. Valuck RJ, Ruscin JM. J Clin Epidemol 2004; 57: 422–428.2. Sheen E, Triadafilopulos G. Digestive Diseases and Sciences 2011; 56: 931–950.
112 AN EVALUATION OF THE IMPLEMENTATION OF ANINTEGRATED FALLS AND FRACTURES PREVENTIONPATHWAY: A MIXED METHODS STUDY
Sheena McHugh1, Olivia Wall2, Finola Cronin2, Orla Hosford2, Liz O’Sullivan2,Rosemary Murphy3, Suzanne Timmons2, Patricia M. Kearney1, Eileen Moriarty5,Pat Barry4, Kieran O’Connor21University College Cork, Cork, Ireland2St Finbarr’s Hospital, Cork, Ireland3Midleton Hospital, Cork, Ireland4Cork University Hospital, Cork, Ireland5Health Service Executive, Cork, Ireland
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Background: The national falls prevention strategy recommends a greater focus on fallsprevention and the use of sustainable and equitable evidence-based interventions. Fallsprevention interventions are effective however, there are practical, cultural, and profes-sional challenges to implementing such complex interventions. Our aim is to evaluate anintegrated Falls and Fractures Prevention Pathway, a complex service intervention involv-ing changes to existing specialist falls services, standardisation of falls prevention practicesin community hospitals, and the introduction of new community-based falls risk assess-ment clinics (FRAC).Methods: Our approach uses a mixed methods design. Semi-structured interviews willbe undertaken with purposive samples from four stakeholder groups: 1) staff deliveringthe community hospital programme, 2) healthcare professionals referring to the fallspathway, 3) staff delivering the FRAC, 4) service users who have attended a FRAC. Thenumber of clinics, referral rates, uptake and waiting times will be extracted from the clinicadministrative database and analysed descriptively as indicators of uptake and adoption.Interviews are being analysed thematically to identify the barriers and facilitators to imple-mentation, and to examine stakeholder perceptions of the appropriateness, acceptability,feasibility, fidelity and sustainability of the service.Results: Pre-implementation interviews have been conducted with three staff at oneFRAC. Preliminary results suggest there is a perceived need for this service locally. Staffare comfortable conducting the risk assessment in collaboration with colleagues fromother disciplines however, the physical resources and space required to deliver a multidis-ciplinary service are constrained. Participants stressed the need for ongoing support tosustain the service. Iterative data collection and analysis is ongoingConclusions: This study identifies the barriers, related to resources, and facilitators,relating to skills and stakeholder buy-in, which will be used to inform ongoing implemen-tation efforts. Understanding the challenges to adopting and implementing the pathwaywill increase the likelihood of its success and sustainability.
113 REVIEW OF OUTCOMES OF PATIENTS WHO SUSTAINED AHIP FRACTURE SECONDARY TO AN INPATIENT FALL IN ATEACHING HOSPITAL
Peter Spencer, Ronan O’Toole, Patrick O’Donoghoe, Brian Drumm, Dermot Power,Joseph DugganMater Misericordiae University Hospital, Dublin, Ireland
Background: The Irish Hip Fracture Database (IHFD) in 2015 started to collect dataon patients with a Hospital Inpatient Enquiry (HIPE) secondary diagnosis of hip fracturein our hospital. We wished to review outcomes of patients with a secondary diagnosis ofhip fracture related to an inpatient fall in our hospital.Methods: Data was extracted from the HIPE coding system IHFD web portal for allhip fracture patients over the age of 60 with a secondary diagnosis of hip fracture dis-charged in 2015. Outcomes were compared with our hospital’s IHFD 2015 results.Results: Twenty patients were coded by HIPE as having a secondary diagnosis of hipfracture of which 10 were recorded as been caused by inpatient falls. The average patientage was 81.3years of age, 7 were female and were 3 male. Nine had surgery and 1 diedwithout surgery been performed. Using X-Ray order time as the starting point for calcu-lating the time to theatre: 66.7% (n = 6/9) were operated on within 48 hours with a meantime of 53.4 hours and median time of 35.7 hours.
Four patients were transferred to off-site rehabilitation, 1 was discharged home. Fourpatients died as inpatients and there was a 30-day mortality rate of 20% (n = 2/10). Thiscompares with an inpatient mortality and 30 day mortality of 6.3% (n = 10/158) and4.4% (n = 7/158) respectively for patients admitted via ED with a principal diagnosis ofhip fracture discharged in 2015.Conclusion: Our data highlights the high mortality rate of patients who fracture theirhip secondary to an inpatient fall compared with patients with a principal diagnosis of hipfracture who are largely admitted from the community. We would suggest that at leastequivalent standards should be applied to their care. We welcome the collection of thisdata via the IHFD.
114 EPIDEMIOLOGY AND OUTCOMES IN PATIENTS POST HIPFRACTURES REFERRED TO OFFSITE REHABILITATION
Brian Drumm2, Catriona Tiernan1, Aoife Leahy2, Jane Cox2, Lisa Cogan11Royal Hospital Donnybrook, Dublin, Ireland2University College Dublin, Dublin, Ireland
Background: We aimed to describe the epidemiology and outcomes of patients admittedto a rehabilitation hospital serving a national tertiary referral centre with a catchmentpopulation for orthopedic surgery of 300,000 people. From the national hip fracture data-base our knowledge of patients course and discharge location from acute hospital carehas greatly improved. However more data on progress through the rehabilitation hospitalsetting is needed to help guide optimal management and resource allocation.Methods: Patient’s baseline characteristics and hospital course are recorded prospectivelyon all those admitted with hip fractures. Admissions over a twenty-four-month periodfrom September 2013 to August 2015 were examined.
Results: 124 patients were admitted following hip fractures over a 24-month period. Themedian age was 82 (IQR 77 – 86). 80.6% (100) were female. 53.2% (66) lived alone.69.9% (65*) of patients’ fractures occurred indoors. The median LOS of patients was 37.5(28 – 66). 94.4% (117) were discharged home; only 3.2% (4) were discharged to residentialcare. The median Barthel Index (BI) on admission was 13 (12-14), with a mean of 12.8(+/− 2.8). The median BI on discharge was 17 (16-19), with a mean of 17.2 (+/− 2.1).Conclusion: Our study highlights a very low rate of patients being discharged to nursinghome care after referral to off-site rehabilitation. Patients also demonstrated a significantincrease in BI (p < 0.0001). In the context of the Irish Hip Fracture Database (IHFD),National Report 2014, which showed 37% of patients being transferred to long-stay ornursing home care and 6% being transferred to external rehabilitation facilities it high-lights the benefits of dedicated rehabilitation facilities. Of note compared to the IHFDthere were a higher proportion of female patients 80.2% vs. 73%, and none of thepatients were admitted from nursing homes versus 10% in the IHFD.
115 REGRETS OF OLDER ADULTS ENTERING RESIDENTIAL CARE
Laura Fennelly, Ronan O’Toole, Ciara Dowling, Dermot PowerMater Misericordiae University Hospital, Dublin, Ireland
Background: It is commonly assumed that an older adult and their family meet admis-sion to long-term care with some sadness. However, there is currently a dearth of litera-ture surrounding the emotions experienced by elderly people when they reach this pointin their lives. The purpose of this qualitative study was to gain an insight into the regretsreported by a group of elderly Irish people on the cusp of entering long-term care andsome of the factors influencing this emotion.Methods: Semi-structured, qualitative interviews were undertaken with older adults in aninterim care unit of a large teaching hospital in Dublin. A MMSE, Geriatric DepressionScale (GDS) and Barthel Index score supported each of these interviews. Participantswere included if their MMSE score was >20. Interviews gathered details of participants’early lives, careers and relationships, their present regrets, greatest achievements and hap-piest memories. Detailed reports of participants’ responses were written up after the inter-views and this data was subsequently analysed by the interviewer.Results: Twelve older adults were interviewed. The mean age of participants was 82years. Their mean MMSE was 27/30. Key themes that emerged in terms of the regretsexperienced were relationship and family life regrets (not marrying, not having more chil-dren, losing touch with children) and career-related regret. Career-related regret was morecommon amongst the men interviewed.Conclusions: Some patterns emerged in terms of the regrets experienced among thiscohort. The interviews conducted raised interesting correlations between stability in child-hood, happiness in marriage and later contentment. A relatively small number of the par-ticipants scored highly on the GDS, and some (n = 4) of the participants reported nomajor life regrets. Among some elderly people, there is an acceptance of increasing needsand decreasing independence. This change is not necessarily correlated with sadness forthe older person.
116 NOTTINGHAM HIP FRACTURE SCORE (NHFS) –A USEFULTOOL TO PREDIT OUTCOME AFTER HIP FRACTURESURGERY
Joanna McGlynn1, Muhammed Nouman Shakoor2, Ahmed Osman2, James Harty3,Josie Clare31Department of Geriatrics, Cork University Hospital, Cork, Ireland2Department of Medicine, Cork University Hospital, Cork, Ireland3Department of Orthopaedics, Cork University Hospital, Cork, Ireland
Background: The Nottingham Hip Fracture Score (NHFS) was developed and validatedin 2007 as a predictor of 30 day mortality. Hip fracture in older patients is associated witha one month mortality of 7%. (Moppett, I.K, BJA 2012).The NHFS is a summative score of seven preoperative variables which give an esti-
mated risk of 30 day postoperative mortality. The NHFS has a range of 0-10. Low riskfor mortality post hip fracture is a score of 5 or below and high risk a score of 6 andabove. A score of 0 gives an estimated 30 day mortality of less than 1%, a score of 10 anestimated 30 day mortality of 45%.Our aim was to review the NHFS for older hip fracture patients admitted to our unit
and to review our 30 day mortality.Methods: Information on the seven preoperative variables of age, gender, admissionhaemoglobin, AMTS, number of co-morbidities, nursing home residence and history ofmalignancy were collected on consecutive hip fracture patients, over 65 years of age,admitted between September 2015 to April 2016.Results: 280 older hip fracture patients were admitted during this time, with completedata available for 270 patients. The median age was 83 years (65-101years). The medianNHFS was 5 (range 1-9). 143(53%) patients were considered low risk (score 0-5) and 127(47%) high risk (score above 6). The overall 30 day mortality rate for 270 patients was3.7%. Of the patients who died, 90% had a NHFS of 6 or above (high risk).Conclusion: NHFS is a useful predictive tool which highlights older hip fracture patientswith an increased mortality risk. This prediction of risk improves informed decision-making and communication of this risk with patients and relatives.
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118 INTRODUCTION OF SAFETY CROSSES: A TEAM APPROACHTO IMPROVING HIP FRACTURE STANDARDS FOR OLDERPATIENTS
Muhammed Nouman Shakoor1, Joanna McGlynn2, Ahmed Osman1, Claire Roe4,Celia Cronin4, Julie McCarthy5, Josie Clare31Department of Medicine, Cork University Hospital, Cork, Ireland2Department of Geriatrics, Cork University Hospital, Cork, Ireland3Department of Orthopaedics, Cork University Hospital, Cork, Ireland4Quality and Safety Management, Cork, Ireland5Department of Pathology, Cork University Hospital, Cork, Ireland
Background: A safety cross is a one month calendar view which provides an ‘at aglance’ view of live time data which is presentable in a clear format. It is updated dailywith either a green or red colour to reflect the presence or absence of an incident.Examples of the use of safety crosses include the monitoring of falls.We have recently introduced safety crosses to review the time to surgery for our hip
fracture patients. The safety cross is displayed on the orthopaedic ward. A green colourindicates surgery within 48 hours, a red colour surgery of over 48 hours (for one or morepatients). Irish Hip Fracture Database and Blue Book standards are that the majority ofpatients should be in theatre within 48 hours of triage.Methods: In order to help the team to understand and establish the safety cross, weretrospectively produced safety crosses of the time to surgery for hip fracture patientsbetween 1st September 2015 to 30th April 2016.Results: 308 patients had hip fracture surgery during this time with a range of 0-5 hip frac-ture operations per day. 61% of the patients had surgery within 48 hours (monthly range 45-83%). When plotted onto safety crosses this data resulted in 40% of the days being green(all patients having surgery in less than 48 hours, 37% red days (one or more patients havingsurgery in over 48 hours). 23% of the days there was no hip fracture surgery.Conclusion: The introduction of safety crosses for time to surgery is helping to build acollaborative team approach to ensure that our times to theatre improve. We aim to con-tinue this development by the introduction of safety crosses for all the Blue book stan-dards for hip fracture patients on the acute and rehabilitation units.
120 OUTCOMES POST HIP FRACTURE: 12-MONTH MORTALITYDATA
Megan Alcock1, Evelyn Hannon1, Naomi Smith3, Laura Corkery3, Joanna McGlynn1,Josie Clare21Department of Geriatrics, Cork University Hospital, Cork, Ireland2Department of Orthopaedics, Cork University Hospital, Cork, Ireland3Department of Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland
Background: Hip fracture in older patients is associated with a one month mortality of8% and a one year mortality of over 25%. The Irish Hip Fracture Database (IHFD) cap-tures 30 day mortality, but little is known about 12-month mortality data in an Irish hipfracture population. Our aim was to review outcome data for a group of patients in the12 months post hip fracture.Methods: We studied 149 consecutive patients (over 60 yrs) admitted with a hip fracturebetween April and August 2014. Deaths were recorded from the hospital integratedpatient management system and an online death notices website.Results: 30 day mortality was 6% (n = 9). 3.4% (n = 5) patients died within 30 days andduring the hip fracture admission. 2.7% (n = 4) died within 30 days but after discharge fromthe orthopaedic unit (3 in Nursing homes). 12-month mortality was 22% (n = 33). 7.4% (n= 11) patients died during their hip fracture admission, 7.4% (n = 11) during a re-admissionunder another team, 7.4% (n = 11) were not in hospital at the time of their death.Of the 7.4% (n = 11) patients who died during their hip fracture admission, the aver-
age length of stay was 49 days (range 2–124 days).The mean age of the total group of 149 patients was 81 years (68% female, 32% male). The
mean age of the 33 patients who died within 12 months was 84 years (48% female, 52% male).Conclusion: This study is unlikely to have captured all deaths post hip fracture, yet stillshows high 12-month mortality in keeping with other studies. One third of the deathsoccurred during the initial hip fracture admission, but less than half of these deaths werein the first 30 days of admission. Further work will prospectively study the outcomes ofall our hip fracture patients.
121 AN AUDIT OF SWALLOW SCREENING IN ACUTE STROKEPATIENTS
Background: The UK guidelines recommend all patients presenting with acute strokeshould have a swallow screen completed within 4 hours of admission. The Irish NationalStroke Audit recommended swallow screening within 3 hours.Aims: To assess the rate of swallow screening performed in patients within 4 hours ofpresenting to our Hospital with acute stroke.
Results: We reviewed the charts of 30 patients (n = 30) admitted with acute stroke overa two week period in January 2016, 12 M, 18 F. Mean age 76 years (range 57-94yrs). 10patients (33.3%) presented over the weekend.
2 (6.67%) patients had a swallow screen documented within 4 hours of admission.These were completed by SALT (1) and Medical doctor(1).
19 (63.3%) patients were assessed by a Speech and Language Therapist(SALT) within24 hours. Following SALT assessment 2 patients (6.7%) were placed Nil Per Oral (NPO).Neither of theses patients had alternative feeding within 24 hours, one due to failed NGplacement and in the other the reason was not documented. Modified diet was recom-mended for 10 patients (33.3%).
5 (16.7%) patients suffered an aspiration pneumonia, 2 of whom were on modifieddiet and 2 were NPO. Of the 30 patients, 7 (23%) were discharged to long term care, 7(23%) to rehab and 14 (46%) were discharged home.Conclusion: There is significant scope to improve the rate of swallow screening per-formed in acute stroke patients. We aim to do this by training nurses in our emergencydepartment and on our stroke unit to complete swallow assessments. 63% of patientswere assessed by SALT within 24hrs compared to 37% within 48 hrs in the NationalStroke Audit. However, as in other studies we have shown 1/3rd of stroke presentationsare over the weekend when there is limited access to specialised assessment.
123 A STEP IN THE RIGHT DIRECTION: ACTIVITY LEVELS OFPATIENTS ON AN ACUTE STROKE AND CARE OF THEELDERLY UNIT
Deirdre Molloy, Dawn Kelly, Diarmuid O’SheaSt Vincent’s University Hospital, Dublin, Ireland
Background: A wealth of literature has emerged over the last number of decades high-lighting the negative short and long term effects of bed rest on patients. Despite thishowever, we do not have data on how much patients walk while confined to a hospitalward. We measured activity levels of patients on an acute stroke and care of the elderlyunit using pedometers. Additionally, we explored staff and patients’ opinions on mobilisa-tion during hospitalisation, in particular what they perceived as barriers to mobilisation.Methods: 26 patients volunteered to wear a pedometer for five days. A staff and patientsurvey was developed to examine opinions on mobilisation and to establish what factorsnursing staff and patients felt were barriers to mobilisation.Results: Mean daily step count was 456 steps per day, ranging from 48 to 1975. Patientswho were independently mobile accumulated significantly more steps than those thatrequired assistance, but on average accumulated only 771 steps per day. This is signifi-cantly short of the target of 10,000 steps per day. Staff recognised the benefits of patientmobilisation but felt they did not have time to help patients to mobilise. They also feltpatient motivation was a barrier.Conclusion: Patients took significantly fewer steps than the recommended guideline dai-ly amount. In the literature, lower step count during hospitalisation has been linked to anincreased risk of functional decline, discharge to a long term care facility, prolonged hos-pital stays and increased risk of mortality. We plan to adopt a phase three program, ini-tially focussing on independently mobile patients who can easily increase their step count.
124 INCORPORATING THE OPERA INSTRUMENT TO IDENTIFYAND DIRECT THE CARE NEEDS OF FRAIL OLDER PATIENTSIN THE AMAU SETTING
Aoife Fallon2, Riaz Moola2, Jess Armstrong1, Robert Briggs2, Tara Coughlan2,Desmond O’Neill2, Ronan Collins2, Sean Kennelly11Acute Medical Assessment Unit, Tallaght Hospital, Dublin 24, Ireland2Department of Age-Related Healthcare, Tallaght Hospital, Dublin 24, Ireland
Background: Frail older patients represent an increasing proportion of those accessingacute hospital services. The aim of this study was to evaluate outcomes for patients aged≥70 presenting to the acute medical assessment unit (AMAU) based on functional abilityscores on admission.Methods: A prospective cohort study was carried out. Data was collected on patientspresenting between July 2015 and May 2016. Functional ability (FA) is routinely recordedas part of a novel 5-minute nurse-administered instrument - the Older Persons in ED/AMAU Risk Assessment (OPERA) for those aged ≥70 admitted to the AMAU. TheDelphi-derived OPERA instrument reviews premorbid comorbid illness, functional abil-ity (Mobility, self-care, speech and nutrition), and acute illness indicators. FA needs werecalculated as a score of 0(independent) – 7(dependent). A positive response to each ques-tion directs MDT referral to appropriate specialty for review.Results: 1952 patients attended AMAU during this period. 28.4% (555/1952) were aged≥70. 44.3% (246/555) scored 0 on FA. 18.1% (100/555) scored 1, 10.5% (58/555)scored 2, 10.2% (57/555) scored 3, 9.2% (51/555) scored 4, 5.7% (32/555) scored 5,3.6% (20/555) scored 6 and 3.6% (20/555) scored 7. 956 MDT referrals were prompted.70.3% (390/555) were admitted. The highest admission rate, 95% (19/20), was in theFA6 group, 20% (4/20) of whom were nursing home residents and a further 10% (2/20)were newly discharged to nursing homes. No patients in the FA1 group were dischargedto nursing homes; 84% (84/100) went directly home. Average length of stay increased ineach category from 6.4 (0–52) days in the FA1 group to a maximum of 17.2 (2–125)days in the FA5 group. The highest in-hospital mortality rate was in the FA5 group,15.6% (5/32).
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Conclusions: The OPERA instrument was easily incorporated into admission processand supported early referral to MDT services for timely intervention.
125 IMPLEMENTATION OF NATIONAL STRATEGY AND BESTPRACTICE PHYSIOTHERAPY MANAGEMENT OF FALLS IN ALEVEL 4 TEACHING HOSPITAL
Aoife O’Neill, Grainne Forde, Jennifer Stafford, Aoife O’Connor, Anne Horgan,Dervilla DannaherMater Misericordiae University Hospital, Dublin, Ireland
Background: Achieve best practice physiotherapy management of patients at risk of falls(PROF) in an acute model 4 hospital in-line with ‘The National Strategy’ (1) & best prac-tice guidelines (2) including;
• Enhance pathway of care; identify & optimally manage PROF.• Develop best practice physiotherapy clinical prompt tool in-line with Acute Medicine &Care of the Older Person (COTOP) National Clinical Programmes
• Ensure effectiveness through continuous audit, education, re-audit cycle.
Methods:• Medical chart audit completed, identified required improvements• Developed physiotherapy self-assessment questionnaire• Educational in-services conducted to enhance awareness & compliance with the strat-egy (1) & best practice guidelines (2).
• Enhanced & promoted pathway of care• Developed concise, user-friendly, clinical prompt (3)• Resource pack made available• Re-audit post initiative launch• Sustainability ensured by inclusion of falls initiative in Accelerated Learning Programme& audit, education, re-audit
Results:• Initial medical chart audit & self-assessment questionnaire identified areas for focuseddevelopment.
• Initiative launched with in-services, care pathway, prompt tools & resource availability• Re-audit of charts & questionnaire• Identified improved access & management in accordance with guidelines• Standardised falls leaflet provided to PROF• Standardised subjective outcome measures used• Created & promoted visual clinical prompt tool
Conclusions: Improved outcomes in self-assessment tool & medical chart audit post ini-tiative with on-going audit & education.References:1. HSE, Department of Health and Children (2008) ‘Strategy to Prevent Falls and
Fractures in Ireland’s Ageing Population’. National Council on Ageing & Older peo-ple, Report of the National Steering Group on the Prevention of Falls in Older Peopleand the Prevention and Management of Osteoporosis throughout life.
2. National Institute Clinical Excellence Guidelines - Falls: the Assessment & Preventionof Falls in Older People 2003
126 RECOGNITION OF CHRONIC KIDNEY DISEASE ANDSECONDARY RENAL DISEASES IN A NURSING HOMEPOPULATION
Alison Poff, Aoife Lee, Alan MartinBeaumont Hospital, Dublin, Ireland
Background: Chronic kidney disease (CKD) is recognised as raised serum creatinine orlow estimated glomerular filtration rate. The Kidney Disease Improving Global Outcomes(KDIGO) defines low eGFR as <60 mls/min, classifying CKD into stages: 3a (45–59), 3b(30–44), 4 (15–29) and 5 (<15). The prevalence of CKD in Ireland is approximately11.8%, rising to 55.7% in over 80 s.1 Nursing home residents with CKD are a particularlyvulnerable population, but information on the prevalence of CKD and secondary renaldiseases in this group is limited.2 A point prevalence study was performed to determinethe prevalence of CKD and secondary renal diseases in a nursing home population.Methods: Anonymised data was collected from 96 residents. Co-morbidities, mean ofthree most recent blood pressure readings, and haemoglobin, calcium, phosphate andalbumin results were analysed.Results: Mean age was 83.43 years (range 69-95years). Females predominated (58.3%, n= 56). 36 residents had eGFRs ≤59 (37.5%). Documentation rate of CKD was 19.44%.Anaemia was the most common secondary renal disease (44.44%). Mean haemoglobinwas 10.52 for CKD residents versus 11.40 overall. In the CKD group- mean calciumwas 2.38 and phosphate 1.01 (2.36 and 1.05 respectively overall). 8.3% had hypocalcae-mia. No CKD patients had hyperphosphataemia.Conclusion: A significant proportion of nursing home residents had CKD. The majorityof cases were unrecognised and some had secondary renal diseases. Increased recognitionof CKD may reduce incidence of secondary renal disease and thus reduce comorbid dis-ease burden in this population.
References:1. Stack A.G. et al. Prevalence and variation of Chronic Kidney Disease in the Irish
health system: initial findings from the National Kidney Disease SurveillanceProgramme. BMC Nephrology 2014; 15: 185.
2. McClellan WM, Resnick B, Lei L et al. Prevalence and severity of chronic kidney dis-ease and anemia in the nursing home population. J Am Med Oir Assoc 2010; 11:33–41.
128 MAKING REASONABLE ADJUSTMENT TO ENABLE PEOPLEWITH AN INTELLECTUAL DISABILITY ENGAGE IN HEALTHASSESSMENT IN A LARGE-SCALE RESEARCH STUDY
Eilish Burke1, Philip McCallion2, JBernard Walsh1, Mary McCarron11University of Dublin Trinity College, Dublin, Ireland2University of Albany, New York, USA
Background: Designing a health assessment process to be included in any large-scaleresearch study is a complex and challenging task and can be more challenging when parti-cipants have an intellectual disability (ID). The differences in health experiences, the chal-lenges in communication and tolerance of assessment for people with ID require adifferent approach. This paper describes the techniques employed in designing andengaging people with an ID in a suite of 8 objective health measures in the IntellectualDisability Supplement to TILDA.Methods: Following consultation and review by scientific advisory and self-advocacyworking groups, a multiphase approach was designed for the suite of objective measures.The approach to design and testing was informed by emancipatory principles of socialengagement, reciprocity, gain, and empowerment. All assessments were supported byaccessible easy read explanatory documentation. The process was reviewed by independ-ent advocacy groups and experts from the field of ID.Results: In total, 604 participants with ID engaged in the objective health assessments. Anumber of factors were identified which contributed to this success: prior and accessibleinformation, flexibility in assessment approach or affording time needed by each participant.Challenges included unsuitability of some standardised assessments for example grip strengthwhen Autism or Challenging Behaviour was present. Specific techniques were developed toaddress difficulties such as alternate communication, distraction and hand over hand techni-ques along with simplified methods of demonstrating and engaging people.Conclusion: Health screening is an imperative first step in improving health. However,one size does not fit all, making a reasonable adjustment to the delivery promotes under-standing and improves engagement which will contribute to optimum health and well-being for people with ID.
129 AN AUDIT OF TIME INTERVAL FROM PRESENTATION TOSURGERY IN ELDERLY HIP FRACTURE PATIENTS IN A LARGETEACHING HOSPITAL
Background: The current guidelines in Ireland recommend that patients presenting withacute hip fracture undergo corrective surgery within 48 hours and within normal workinghours where it is medically safe to do so. However, there is increasing evidence that per-forming surgery within 36 or even 24 hours may have better outcomes. The aim of thisaudit was to look at how many patients presenting to a large hospital underwent surgerywithin 24, 36 and 48 hours.Methods: In all patients presenting with an acute hip fracture within a 12 month period,the time of arrival to the Emergency Department and time of surgery were recorded.Results: 302 cases were included. Of these, 8% were outside the current 48 hours target.83.1% of patients had surgery performed within 36 hours.Time from presentation to surgery
Conclusion: The majority of hip fracture patients in this audit underwent surgery within36 hours of presentation to the hospital. Almost two thirds of patients (63.9%) had sur-gery within 24 hours. A small but significant number exceeded the 48 hour target.
130 AUDIT OF APPROPRIATE PRESCRIBING IN ELDERLYNURSING HOME RESIDENTS WITH CHRONIC KIDNEYDISEASE
Aoife Lee, Alison Poff, Alan MartinBeaumont Hospital, Dublin, Ireland
Background: The prevalence of CKD in Ireland is approximately 11.8%, rising to 55.7%in over 80 s (1). Appropriate prescribing according in CKD is imperative to avoid adverse
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side effects. Data on renal dosing compliance is limited in nursing home residents, it is esti-mated to be up to 34% (2). A point prevalence study was performed to evaluate recogni-tion of CKD and compliance of renal dosing in nursing home residents.Methods: Drug kardexes, comorbidities and recent egfr (utilising Crockford–Gault equa-tion) were analysed from medical records of 96 residents. The BNF was used to evaluaterenal dosing.Results: The mean age of the nursing home residents was 83.43years (range 69-95years),58.3% were female. 36 patients (37.5%) had CKD. 17 residents had been prescribed atleast one contra-indicated drug or dose inappropriate for renal function.Of the patients with documented CKD (19.44%), 71.42% were prescribed an inappro-
priate medication. 41.38% had inappropriately prescribed medication in undocumentedCKD. Stage 3a and 3b CKD had the poorest documentation rates (4.76% and 22.22%respectively), 60% in stage 4. Stage 4 had the highest inappropriate prescription rate(80%), followed by stage 3b (66.67%) and 3a (33.33%). The patient with stage 5 CKDwas appropriately managed. The commonest inappropriate drug/dosing was cetirizine(33.33%). Memantine, rispiridone, aspirin, ranitidine were also common (9.09% each).Conclusion: Documentation rates of CKD in residents were poor. However the pre-scribing of inappropriate medication was also high in recognized CKD.References:1. Hassan Y, Al Ramahi R.J, Aziz N.A, Ghazali R. Impact of renal drug dosing service
on dose adjustement in hospitalised patients with chronic kidney disease. The annalsof Pharmacotherapy 2009; 43: 1598.
2. Stack A.G. et al. “Prevalence and variation of Chronic Kidney Disease in the Irishhealth system: initial findings from the National Kidney Disease SurveillanceProgramme.” BMC. Nephrology 2014; 15: 185.
132 CAN THE INCORPORATION OF CO-MORBIDITYINFORMATION IMPROVE RISK ESTIMATION IN OLDERPEOPLE WITH MAJOR TRAUMA?
Marie Therese Cooney, Robert Bourke, John Cronin, David Menzies, Rachael DoyleSt. VIncent’s University Hospital, Dublin, Ireland
Background: Trauma in older people is an increasingly important issue. In addition torecent escalation in absolute numbers of trauma presentations in the elderly, their higherrate of medical co-morbidities leads to increased complexity in management. Systems forestimating risk of short term mortality tend to perform worse in older than younger indi-viduals. Risk estimation in older people could be improved through the incorporation ofco-morbidity information. To assess the improvement in risk estimation with the additionof co-morbidity information. 869 major trauma patients enrolled in TARN at St.Vincent’s University Hospital (SVUH), a tertiary referral urban university hospital,between Sept 2013 and Aug 2015.Methods: PS12 estimates the risk of inpatient or 30-day survival in trauma patients basedon Injury Severity Score (ISS), age, gender and Glasgow Coma Scale (GCS). The newerPS14 additionally includes co-morbidities, as a categorical variable defined by the numberof co-morbidities present. PS12 and PS14 were calculated for each individual.Discrimination of each system was compared using AUROC, separately in each age group.Results: In the 419 individuals aged under 65 years, both systems showed excellent dis-crimination with AUROC of 0.97 (95%CI: 0.94 to 1.00) for PS14 versus 0.96 (95%CI:0.93 to 1.00) for PS12, p for difference = 0.23. In the 450 individuals aged 65 years andover, discrimination was significantly better in PS14 (AUROC 0.79 (95% CI: 0.70 to0.88)) compared to PS12 (AUROC 0.71 (95%CI: 0.61 to 0.82)), p for difference <0.001.These findings were consistent when examining older age groups including those aged 75to 84 years and those aged over 85.Conclusions: For older individuals the addition of comorbidity has resulted in significantimprovements. Further refinements including the addition of specific comorbidities, alco-hol use and initial vital signs may yield further improvements in discrimination.
136 THE IMPLEMENTATION OF AN INPATIENT FALLSPREVENTION PROGRAMME USING FALLS SPECIFIC CAREBUNDLE IN AN IRISH UNIVERSITY HOSPITAL
Daniel Gilmartin, Mary Hayes, Louise O’Hare, Karen Fitzgerald, Mary Buckley,Kieran O’ConnorMercy University Hospital, Cork, Ireland
Background: Falls are a major patient safety issue for hospitals. The RCP Fallsafe (1)programme includes a falls specific care bundle for older in-patients and the empower-ment of ward-based falls champions. This approach can reduce in-patient falls by up to25%(2). We report on the introduction and early implementation of such a falls prevent-ing programme in in our 314 bed Irish university hospital.Methods: A multidisciplinary project team led this quality improvement project todefine, analyse and improve our in-hospital falls prevention programme. The project wasdivided into a baseline, introduction and implementation periods (4 months each). Dataon falls prevention processes were collected at baseline and then on a monthly basisthroughout the project. Falls champions were recruited and trained. An evidence-basedfalls prevention care bundle was introduced for all admitted older adult patients toenhance assessment and prevention of in-hospital falls. Ward support and education wasprovided by the project team.Results: Twenty-five falls champions, including nurses, porters and health-care assistants,were trained. Baseline data showed deficiencies in falls assessment and risk factors man-agement. Recording of falls history improved with just regular auditing from 37% to
65%. During the project, there were progressive improvements in basic falls preventionprocesses including access to call bells (41.5% to 61%) and access to safe footwear (69 to77%). Improving the recording of “fear of falling” required changes to nursing admissiondocuments. Reducing new night sedation prescriptions was more challenging.Conclusion: The implementation of an evidence-based care bundle can improve practicein an Irish setting. Implementing such multifaceted change in hospital is complex andinvolves many disciplines. By continuing to implement and sustain these changes it ishoped to significantly reduce in-hospital falls.References:1. Royal College of Physicians. The Fallsafe care bundle. London: 2011.2. Royal College of Physicians. Implementing Fallsafe. London: 2012.
137 STAFF AND PATIENTS PERCEPTIONS: INTRODUCTION OF ACOMPREHENSIVE GERIATRIC ASSESSMENT (CGA)DOCUMENT
Maeve Judge, Louise Hickey, Diarmuid O’Shea, Sarah Cosgrave, Maitiu O’TuathailSt. Vincent’s University Hospital, Dublin, Ireland
Background: The development of an integrated document for patients attending theday hospital for a Comprehensive Geriatric Assessment (CGA) was recommended fol-lowing a tracer audit. Previously all members of the multi disciplinary team (MDT) hadtheir own individual documentation that was filed either in the day hospital or thepatient’s healthcare record.
An audit was completed to establish whether the introduction of a CGA integrateddocument rather than separate MDT notes would reduce repetition, improve patientexperience, staff satisfaction levels and improve efficiency and quality of assessment.Method: 1 week prior to the pilot of the CGA document, new patients were asked tocomplete a short questionnaire in relation to repetition during assessment, efficiency andquality of assessment and overall experience of the day hospital. Day hospital staff alsocompleted a brief questionnaire in relation to the current documentation in the day hos-pital, time spent on documentation, efficiency and quality of assessment and satisfactionlevels with documentation. Following the 8-week pilot of the CGA document patientsand staff were requested to complete the questionnaires in relation to the new document.Results: Combined time taken to complete documentation has decreased from an overall110 minutes per patient to 60minutes per patient. Staff satisfaction levels have increasedfrom 42.5% to 91.25%. Patient’s perception of assessment repetition reduced from 84% to6%. Average frequency of question repetition was reduced from 4 times to 1 time. 83% ofpatients rated their overall experience in the day hospital pre the CGA document as excellentor beneficial and this increased to 100% following the introduction of the CGA document.Conclusion: The CGA is a vital part of geriatric medicine. Efficient use of time, properdocumentation and communication between MDT members improves overall patientexperience. The CGA document is a priceless tool to achieving above.
138 REDUCING PAPER MOUNTAINS: DEVELOPING ACOMPREHENSIVE GERIATRIC ASSESSMENTDOCUMENT
Sarah Cosgrave, Lisa Murphy, Deirdre Molloy, Joanne Murphy, Aisling Davis,Maitiu O’Tuathail, Maeve Judge, Brid Wallace, Breffni Drumm, Kathleen Kelly,Delfina Altamero, Diarmuid O’SheaSt. Vincent’s University Hospital, Dublin, Ireland
Background: Approximately 600 new patients receive a comprehensive geriatric assess-ment (CGA) annually in a Dublin Day Hospital. Each member of the MDT had theirindividual documentation of the patient’s assessment that was filed either in the HCR orin the day hospital, totaling 36 pages. The National Clinical Programme for Older People(2012) recommends that the CGA should be documented in the patient’s permanenthealth record.Method: A tracer audit was completed in 2015, recommending the development of anintegrated care document for patients attending for CGA. Nurse Practice Development(NPD) collated the individual elements of our documentation, highlighting the manyareas of duplication that occurred throughout the separate documentation.
The multidisciplinary team (MDT) drafted a CGA booklet that would follow thepatient through their assessment in the day hospital. The aim of this document was toreduce duplication, reduce time spent on paperwork per patient, improve efficiencywithin the day hospital and improve overall quality of assessment. We sought approvalfrom the Documentation Working Group to pilot the document. The document waspiloted over an 8-week period. Following the pilot, the MDT recommended minorchanges to the document.Result: he final CGA booklet (16 pages) was approved by all the relevant committeesand was launched in March 2016. The new document has improved communicationbetween the MDT, patients are no longer asked the same question multiple times andtime spent on paperwork has decreased significantly.Conclusion: As CGA is evolving, steps will need to be made with our colleagues in ICTand in both primary and secondary care to ensure the information is available to all inthe development of individualised care plans.Reference:HSE (2012) National Clinical Programme Older People. Specialist Geriatric Services
Model of Care Part 1: acute Service Provision
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139 APPLICATION OF THE GERONTONET ADR RISK SCORE TOASSESS THE RISK OF ADVERSE DRUG REACTIONS INPATIENTS OVER 65 YEARS
Amy Copperthwaite1, Anne-Marie Cushen2, Sheena Geoghegan2, Mairí Donald2,David Williams21Royal College of Surgeons in Ireland, Dublin, Ireland2Beaumont Hospital, Dublin, Ireland
Overview: Adverse drug reactions (ADR) are common, particularly among the elderlypopulation, and are associated with significant morbidity and mortality. TheGerontoNET ADR risk score is a tool designed to help identify those elderly patientsmost at risk of ADRs. The aim of this study was assess to apply this score to group ofelderly patients and identify any correlations between an increased score and risk factorsfor developing ADRs factors.Methods: Data was collected from chart review of 60 patients aged ≥ 65 years who wereadmitted to Beaumont Hospital through the Emergency Department over a two monthperiod. Baseline patient characteristics, medical history and drug history were documen-ted for each patient. An accurate medication list was obtained through medication recon-ciliation performed by a pharmacist.Results: The mean age was 80.22 (+/− 6.36) years with 50% each of male and female.67% of patients had ≥ 4 co-morbidities and 70% were prescribed ≥ 8 medications.There was a positive correlation between ADR risk score and both the number of co-morbidities and the number of medications prescribed.Conclusion: The number of co-morbidities and the number of medications prescribedare significant contributors to an increased risk score. These risk factors should be recog-nized and patients subsequently managed with the potential for an ADR in mind. TheGerontoNet tool is quick and easy to use and could be very useful for doctors nottrained in Geriatric Medicine to get an idea of how at-risk their patients are.
140 TAKOTSUBO CARDIOMYOPATHY IN ANOCTOGENARIAN
Christopher Osuafor, Elizabeth Tanya Roy, Toddy DalyMater Misericordiae University Hospital, Dublin, Ireland
Background: Takotsubo (stress-induced) cardiomyopathy is an acute myocardial infarctionmimic predominantly affecting elderly females, characterised by transient systolic and dia-stolic left ventricular dysfunction often preceded by an emotional or physical trigger. Here,we present the clinical outcome of an acute presentation of chest pain in an elderly female.Case Report: An 81-year-old female who had been under physical and emotional stresson account of chronic lower limb ulcers and a recent decision for long term care presentedwith sudden onset chest pain and dyspnoea. Initial electrocardiogram showed ventriculartachycardia and subsequently ST-segment elevation with elevated cardiac markers.Coronary angiogram revealed non-obstructive coronary arteries and left ventriculographyshowed extensive wall akinesis in keeping with takotsubo cardiomyopathy. An echocardio-gram done 12 days later showed complete resolution of the ventricular wall abnormality.Discussion: Takotsubo cardiomyopathy has been increasingly reported in recent years. Itpredominantly affects elderly women with a female-to-male ratio of 9:1 [1]. Its treatmentis essentially empirical and supportive [2]. It should be considered to be an acute heartfailure syndrome which has serious in-hospital complications of which physical triggershas an increased incidence of acute complications. Geriatricians should be well aware ofthis syndrome in light of its predilections for the elderly, association with stress and itssubstantial morbidity and mortality.References:1. Templin C, Ghadri JR, Diekmann J et al. Clinical Features and Outcomes of
Takotsubo (Stress) Cardiomyopathy. N Engl J Med 2015; 373: 929.2. Lagan J, Connor V, Saravanan P. BMJ Case Rep Published online: Mar 5; 2015.
141 EXERCISE BELIEFS AND CONTRIBUTING FACTORSAMONGST ELDERLY NURSING HOME RESIDENTS: A CROSS-SECTIONAL, CASE CONTROL STUDY
Sinead Byrne, Frances HorganRoyal College of Surgeons in Ireland, Dublin, Ireland
Background: The number of Irish older adults residing in nursing homes is continuallyincreasing. Nursing home residents are typically sedentary, leading to poor health andfunctional outcomes. There is a lack of research concerning the exercise beliefs of thisinactive subgroup of older adults. This study aimed to examine the hypothesis that nurs-ing home residents have poor outcome expectations and self-efficacy for exercise, com-pared to community dwelling older adults. It also aimed to analyse the associationbetween these beliefs and participants’ age, functional scores, number of comorbiditiesand psychological health.Methods: Twenty-two nursing home residents and twenty community dwelling olderadults (≥65 years) completed a written survey. Primary outcome measures were theOutcome Expectations for Exercise Scale (OEE), and the Self-Efficacy for ExerciseScale (SEE). Secondary outcomes were the Barthel Index of Activities of Daily Living(BI), number of comorbidities, and the Geriatric Depression Scale-15 (GDS-15). The
Independent Samples T-test and Wilcoxon-sum Rank Test analysed differences betweengroups. Multivariable regression assessed association between variables.Results: Nursing home residents were older (p = 0.03), had a greater number ofcomorbidities (p = <0.01), lower BI scores (p = <0.01), and higher GDS-15 scores (p =0.03) than community dwelling participants. SEE scores were significantly lower amongstnursing home residents than community dwelling older adults (p = <0.01). No differenceexisted in OEE scores between groups (p = 0.78). GDS-15 score was the only variableindependently associated with outcome expectations (p = 0.041), or self-efficacy for exer-cise (p = 0.028).Conclusion: Self-efficacy for exercise is lower amongst nursing home residents than incommunity dwelling older adults. Depressive symptoms are significantly associated withpoor exercise beliefs. The presence of depressive symptoms may represent a significantbarrier to participation in physical activity for older adults both in nursing homes and inthe community.
143 ENVIRONMENTAL AUDIT OF A TYPICAL ACUTE HOSPITALWARD IN SUPPORTING PATIENTS WITH DEMENTIA
Philomena Fogarty, Maeve Brennan, Breda Jones, Marie Doyle, Mary O’Neill,Deirdre Kelly, Sinead O’Sullivan, George Pope, Riona Mulcahy, John CookeUniversity Hospital Waterford, Waterford, Ireland
Background: The physical and social environment of a typical acute ward can influencethe needs and abilities of people with dementia. A dementia-friendly environment helpspeople with dementia reach their full potential and can help avoid needless disability. Theresult is quality of life for people with dementia, their families and staff.This study was undertaken to investigate whether the typical acute ward environment
in an Irish hospital supports the care needs of people with Dementia.Methods: 3 audits were carried out – Enhancing the Healing Environment (EHE) KingsFund, Built Environment Audit Tool – Dementia (BEAT D), Queensland Health FallsPrevention Best Practice Guideline. The BEAT D was independently evaluated by asses-sors in Australia. The selected ward would be typical of an acute medical ward within thepublic Irish hospitals system.Results: The three environmental audits demonstrated broad non-compliance with inter-national best-practice guidance. The ward achieved <50% compliance with each of thedomain guidelines contained within the EHE tool. These results were further investigatedusing the BEAT-D tool which demonstrated that the ward environment audited per-formed below normative standards in comparison to both purpose-built and non-purpose built facilities in Australia. The ward environment presented an increased risk offalls complying with just 13 of 35 relevant falls prevention measures in the Queenslandguidelines.Conclusions: The results presented here are likely to be valid in any Irish acute hospitalward. It is clear from these audits that current environmental configuration is not opti-mised for the confused adult. The audit outcomes however suggest that there is potentialfor positive change in the physical and social environment of a typical acute ward in sup-porting the person with dementia.
144 LOOK BEFORE YOU SCOPE: OUTCOMES OFCOLONOSCOPIES IN OLDER ADULTS BEING REFERREDWITH IRON DEFICIENCY ANAEMIA
David Quigley1, Niamh Fitzgerald1, Daire Rothwell1, Rawan Abdelhaq1, David Kevans2,Joseph Browne11Department of General Internal Medicine, St. James’s Hospital and James’s Street, Dublin 8,Ireland2Department of Gastroenterology, St. James’s Hospital and James’s Street, Dublin 8, Ireland
Background: Colonoscopy is a simple procedure that can be performed in patients ofall ages. However, diagnosis can be technically challenging since not all patients are ableto ingest the large quantities of laxative preparations required to cleanse the colonadequately. The British Society of Gastroenterology (BSG) guidelines recommend thatgastrointestinal investigations should be considered in males and post-menopausalwomen presenting with iron deficiency anaemia (IDA) and IDA should be confirmed bya” low serum ferritin, red cell microcytosis or hypochromia in the absence of chronic dis-ease or haemoglobinopathies”. Aspirin and NSAIDs use can account for up to 15% ofIDA in older adults.Methods: Retrospective review of case notes in all patients >65 years who underwentcolonoscopy for IDA in 2015. We reviewed blood investigations pre endoscopy, proced-ure completion rates and outcomes.Results: 268 patients (120 females and 148 males) were reviewed. Overall mean age was76.4 (SD6.7) years, with 40.2% of patients being anaemic on referral. 93 patients were onaspirin and tended to have lower admission haemoglobin. 115 (42.9%) had an inpatientcolonoscopy and were significantly older (p < 0.05) compared to those undergoing out-patient colonoscopy. 75 (28.0%) of colonoscopies had suboptimal preparation, requiringfurther investigations. 219 (81.7%) patients were completed. 10 (4.6%) patients had acolon carcinoma identified.Conclusions: Colonoscopy can be poorly tolerated in older adults. Almost one third ofpatients had an suboptimal procedure performed and was more common in older
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patients, multiple co-morbidities and those being referred for an inpatient colonoscopy.There was a low incidence of colon carcinoma identified (4.6%) in those with completedcolonoscopies. Better pre procedure screening strategies may obviate the need for colon-oscopy in a significant proportion of patients.
145 DEMENTIA FRIENDLY HOSPITAL DESIGN: USING THEMATICANALYSIS TO IDENTIFY KEY ISSUES FOR PATIENTS, FAMILYMEMBERS AND STAFF IN TALLAGHT HOSPITAL
Dimitra Xidous1, Tom Grey1, Sean Kennelly2, Desmond O’Neill11TrinityHaus (Research Centre), Trinity College Dublin, Dublin, Dublin 2, Ireland2Centre for Ageing, Neuroscience and the Humanities, Tallaght Hospital, Dublin, Dublin 24,Ireland
Background: Hospitals are complex and confusing environments for people withdementia, adding to their distress and disorientation, undermining family and staff sup-port, and impinging on health outcomes. To address these issues Tallaght Hospital andTrinityHaus are being funded by the Health Research Board to research hospital designregarding people with dementia and their families, and to use the findings for evidencebased dementia friendly design guidelines for Irish hospitals. The study presented hereoutlines the stakeholder engagement process undertaken in Tallaght and presents the keythemes emerging from the research.Methods: Structured interviews were conducted with patients and family members,while questionnaires were circulated to 100 patients who attend the Age Related HealthCare Clinic and the Charlie O’Toole Day Hospital. Patients comprised a mixture of old-er people with dementia or those with memory problems. Semi-structured interviewswere also conducted with staff members across the hospital who interact daily withpatients with dementia. Thematic analysis was used to synopsise the feedback into shortstatements, these were refined into codes, and these codes were used to draw outthemes.Results: 41 completed questionnaires were returned, 11 structured interviews with peo-ple with dementia and their carers and 12 staff interviews were conducted. Key themesemerged from this study including: perception and understanding of the built environ-ment; challenges around site design, internal spatial layout, orientation and wayfinding,patient movement, and participatory design.Conclusions: By adopting a grounded theory approach, the multiple perspectives cap-tured in this study, including most importantly people with dementia, ensures that stake-holder needs are at the centre of design. Staff awareness about the importance of thebuilt environment is encouraging and should be seen as a driver of dementia-friendlydesign. Lastly, the influence of the built environment as it relates to health outcomes ofpersons with dementia cannot be understated.
148 EFFECT OF DENOSUMAB IN IMPROVING ORTHOSTATICHYPOTENSION
Kowshika Thavarajah, Fiona O’Sullivan, Elaine Shanahan, Nur Atik Mohd Asri,Ahmed Gabr, Declan Lyons, Margaret O’ Connor, Catherine PetersUniversity Hospital Limerick, Limerick, Ireland
Background: Denosumab is widely used for the treatment of postmenopausal womenwith osteoporosis at increased risk for fracture. It is a fully human monoclonal antibodyto the receptor activator of nuclear factor-kB ligand (RANKL) that blocks its binding toRANK, inhibiting the development and activity of osteoclast, decreasing bone resorption,and increasing bone density1.RANKL leads to the activation of antiapoptotic kinase and nitric oxide synthase and
to Nitric oxide (NO) production in endothelial cells. RANKL acts as a potent vasodila-tor2. This is a pilot observational study for further longitudinal work on an interestinghypothesis. The aim is to determine if denosumab improves orthostatic hypotension(OH) by inhibition of RANKL leading to vasoconstriction and reduction of NOproduction.Methods: Data of 30 patients with head-up-tilt (HUT) test prior to denosumab treat-ment at 3, 6 and 12 months were analysed. 8 were excluded due to incompleteparticipation.Results: 16 patients had OH prior to treatment and only two were on midodrine. Dropin systolic blood pressure varied between 20 mmHg to 101 mmHg and diastolic dropbetween 10 mmHg to 34 mmHg prior to treatment.Following denosumab treatment, 5 of 16 patients had completely resolved OH.
Magnitude of the blood pressure drop improved in 8 patients. 3 patients had worsenedOH; Among them 2 had Parkinsons disease and one was on antihypertensive treatment.Of 6 patients who did not have OH pre treatment, 5 developed OH, in which 3 were
on antihypertensive medications. 2 of 5 patients who developed OH at 6 months hadresolution of OH after 12 months of treatment.Conclusions: HUT test results after a year of denosumab treatment showed improve-ment in OH. Deterioration of OH in several patients was probably due to underlyingParkinson disease and anti-hypertensive medications. Thus, improvement in OH isexpected in patients on longstanding denosumab treatment.
149 SCREENING TO IDENTIFY PATIENTS SUITABLE FORINTEGRATED SERVICE DELIVERY IN THE EMERGENCYDEPARTMENT
Maria Costello1, Lynn Spooner2, Cliona Small1, Antoinette Flannery1, Liam O’Reilly2,Laura Heffernan2, Edel Mannion3, Orla Sheil3, Sinéad Bruen3, Pauline Burke3,Mary McMahon3, Norah Kyne3, D. William Molloy4, Anna Maughan5, Alma Joyce5,Helena Hanrahan2, Georgina Stallard2, John O’Donnell2, Rónán O’Caoimh11Department of Geriatric Medicine, University Hospital Galway, Newcastle Rd, and HealthResearch Board Clinical Research Facility Galway, National University of Ireland, Galway,Geata an Eolais, University Rd, Galway City, Ireland2Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, GalwayCity, Ireland3Frail Elderly Assessment Team, University Hospital Galway, Newcastle Rd, Galway City,Ireland4Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital,Douglas Rd, Cork City, Ireland5PCCC, Shantalla Health Centre, Costello Rd, Galway City, Ireland
Background: The National Clinical Programme for Older People recommends theimplementation of methods to identify/triage frail/at risk older patients in theEmergency Department (ED). While several screening instruments may be suitable, it isnot known which is most accurate and practical to deploy in clinical practice.Methods: We compared the accuracy of three validated, short, frailty and risk-predictionscreening instruments to predict frailty at triage in a university hospital ED. Consecutiveolder adults aged >70 years self-administered the PRISMA-7 and the ISAR on arrival toED triage. Trained nurses independently scored the Clinical Frailty Scale (CFS) blind tothe diagnosis and the results of the self-administered screening. A consultant physicianusing a battery of frailty instruments including the FRAIL Scale independently deter-mined each patient’s frailty status. Accuracy was determined from the area under thecurve (AUC) of receiver operating characteristic curves.Results: In total, 210 patients were screened, median age (interquartile range +/−) 79(+/−9) years of which 47% were male. Based upon the FRAIL scale classification 28%of patients were classified as robust, 40% pre-frail and 32% as frail. The median ISARscore was 3 (+/−3), CFS 4 (+/−2) and PRISMA-7 3 (+/−2). Inter-rater reliability of theCFS was strong, r=0.78.The most accurate instrument for separating frail from non-frail(including pre-frail) was the PRISMA-7 (AUC of 0.88; 95% CI: 0.83-0.93) followed bythe CFS (AUC 0.83;95% CI: 0.77-0.88) and the ISAR (AUC 0.78; 95% CI: 0.71-0.84).The PRISMA-7 was statistically significantly more accurate than the ISAR (p = 0.008) butnot the CFS (z=1.4,p = 0.15). The PRISMA-7 was also the most accurate at differentiat-ing pre-frail from frail, (AUC of 0.71;95% CI: 0.62-0.79).Conclusions: Screening for frailty in the ED with a selection of short screening instru-ments is reliable and accurate The PRISMA-7 was the most accurate, consistent withfindings in primary care.
150 THE IMPLEMENTATION OF A STUDENT ORIENTATIONPROGRAMME IN AN AGE RELATED HEALTHCARE & STROKESPECIALIST AREA
Nicola Cogan, Suzanne Dunne, Deborah Fitzhenry, Cathy Mc Hale, Audrey Cronin,Claire Mooney, Audrey Berigan, Mary Jane HallyTallaght Hospital, Dublin 24, Ireland
Background: Nursing is a practice-based profession and clinical education. Theory is anessential part of the undergraduate nursing curriculum. The Nursing Management Teamworking in the Age Related Health Care and Stroke Department sought to enhance thestudent’s preparation for clinical placement. This specialist area implemented a pre-clinical placement orientation programme.Methods: The Programmes aims were to:
• Instil student nurses with confidence & knowledge to optimise their learningopportunities
• Enhance students’ knowledge of the complex medical conditions associated with careof the older person & Stroke
• Demonstrate the importance of working collaboratively as part of the MultidisciplinaryTeam
Formalised lectures were delivered by both Clinical Nurse Specialists (CNSp) andManagers. An evaluation form was distributed to student’s pre and post the programmeto capture their expectations. The programme was completed by 52 student nurses.Results: All 52 student nurses stated their expectations were met. 51 felt more confidentcommencing their clinical placement while 1 student did not. Students identified the fol-lowing positive outcomes.
• Awareness of services offered by & roles of the CNSp’s and the environment• Provided a forum to ask questions & clarify any concerns pre-clinical placement• Outlined clearly what was expected of students i.e. Acting as a patient advocate• Focus on learning opportunities• Knowledge was gained on different conditions affecting the older person
Conclusion: The programme increased their confidence prior to their clinical placement.It improved their knowledge base around various medical conditions and complex
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nursing care associated with Stroke & Older patients. Students identified specific learningopportunities and were given a clear understanding of the expectations of them in theclinical environment. Further evaluation of the orientation programme is required postclinical placement to ascertain if the programme facilitated the application of theory topractice.
151 BLOOD PRESSURE CONTROL IN POST STROKE PATIENTS: ACAUSE FOR CONCERN?
Cliona Gallagher, Mark O’Connor, Aiden Jennings, Imelda Noone, Tim CassidySt Vincent’s University Hospital, Dublin, Ireland
Background: Hypertension is a recognised risk factor for stroke, the reduction in bloodpressure (BP) in hypertensive patients is of benefit in primary and secondary preventionof stroke. The BP can rise post - stroke and there is debate as to when to initiate treat-ment. International Guidelines recommend a BP of less than 140/90 in non-diabetic and130/80 in diabetic patients.Methods: Retrospective case note audit of 48 stroke patients discharged. The demog-raphy, history of hypertension pre-stroke, and co-morbid conditions for each patient wasrecorded on a standardised proforma. BP on admission, at 7 days post stroke and at dis-charge was recorded, together with any drug intervention initiated. At their follow upclinic, the BP was again recorded.Results: 48 (25 males) patients, mean age of 77.8 (Range 65 – 99) years. 44 patients wereindependent (Pre-stroke Rankin 0 – 2). 15 patients had a history of angina; 7 were dia-betic and 1 patient had evidence of LVH. Pre-stroke 23 /27 (85%) patients were on treat-ment for hypertension.
Admission mean BP was 152 / 83.6 (7 patients with a Systolic BP [SBP] > 180 mmHg).7 days, mean BP was 140.3 / 76.1 mmHg (1 patient SBP > 180 mmHg).Discharge; mean BP was 136.5 / 74.8 mmHg (1 patient SBP > 180 mmHg).Clinic, mean BP was 147.6/ 78 mmHg (4 patients with a systolic BP > 180 mmHg)14 (29.1%) of patients had additional BP lowering treatment initiated. 25% of patientsrequired at least two drugs to achieve BP control.
Conclusion: Immediately post stroke, the BP will climb before falling. On discharge, themajority of stroke patients had a normal BP. Post-discharge there was a rise in the BP.Therefore this suggests that secondary and primary care services need a coordinatedstrategy for stroke secondary prevention.
153 PROFILING FAMILY CARERS OF PEOPLE WITH DEMENTIA:RESULTS FROM A NATIONAL SURVEY
Background: The majority of care for people with dementia is provided by family carers,many of whom are adult children and spouses. Caring for a family member with demen-tia can be demanding, stressful and challenging and can sometimes have negative effectson the carer. This paper presents findings from a national survey of family carers inreceipt of a carer’s allowance for care they provide to an older relative with dementia.Methods: An anonymous postal survey was conducted with 4,000 recipients of a carer’sallowance for care of an older person and a total of 2,311 completed questionnaires werereturned (Lafferty et al. 2014). Secondary analysis was conducted on a sample subset of485 family carers who provided care to a person with a diagnosis of dementia. The aimof the analysis was to profile dementia caregivers, including information on their healthand wellbeing and caregiving activities, and also to develop profiles of the care-recipientswith dementia.Results: Findings show that carers’ age ranged from 20 to 92 years with a mean age of57.7 (SD=13.3). The majority of family carers of people with dementia were female(72.6%), married (65.3%), had no other dependants (61.5%) and were the adult childrenof the care recipients (52.9%). When compared to family carers of people withoutdementia, carers experienced greater symptoms of depression and carer stress. Over halfof dementia carers (51.3%) were at risk of developing clinical depression, while just underhalf (46.8%) reported experiencing moderate to severe or severe levels of carer burden.Conclusions: This paper provides important information about family carers of peoplewith dementia, which can be used to inform health and social policy in Ireland, andmove towards meeting the needs of this particular subset of family carers.
154 SYSTEMATIC REVIEW OF LITERATURE OF SYSTEMS ANDMODELS TO ADDRESS HOSPITAL READMISSIONAVOIDANCE AND DELAYED DISCHARGE
Alice Coffey1, Patricia Leahy-Warren1, Eileen Savage1, Josephine Hegarty1,Nicola Cornally1, Mary Rose-Day1, Bridget Maher2, John Browne3, Laura Sahm4,Rónán O’Caoimh5, Maura Flynn6, Stephen Hutton1, Elizabeth Healy7, Kieran O’Connor8,Kay McGrath9, Aoife O’Mahony1, Katherine Arenella11School of Nursing and Midwifery, University College Cork, Cork City, Ireland
2School of Medicine, University College Cork, Cork City, Ireland3Department of Epidemiology and Public Health, University College Cork, Cork City, Ireland4School of Pharmacy, University College Cork, Cork City, Ireland5Centre for Gerontology & Rehabilitation, University College Cork, Cork City, Ireland6Library, University College Cork, Cork City, Ireland7Public health Nursing HSE South/South West, Cork City, Ireland8Mercy University Hospital, Grenville Place, Cork City, Ireland9Cork University Hospital, Wilton Road, Cork City, Ireland
Background: Prolonged hospital admission and readmission lead to increased risk ofadverse healthcare outcomes. A diverse spectrum of strategies have been proposed acrossmultiple settings to address these patient important outcomes. We conducted a systematicreview to identify successful systems and models addressing readmission avoidance anddelayed discharge.Methods: We searched MEDLINE, CINAHL, PsychINFO, Psychology andBehavioural Sciences Collection, Social Sciences and SocINDEX with Full Text, limitedto English language papers published between 2005–2015. Two authors independentlyassessed studies for inclusion and extracted data. Selected studies were those that expli-citly addressed interventions in acute general hospitals.Results: In total, 85 eligible papers were identified: meta-review of meta-analyses (n = 1),systematic reviews with meta-analyses (n = 8), systematic reviews (n = 36), and RCTs (n= 40). A wide variety of interventions exist to address delayed discharge and readmis-sions. Interventions were classified as clinical/medical, pre-discharge, transitional care,post-discharge, primary care, assessment/ambulatory unit interventions, hospital athome, home-based interventions, tele-healthcare/electronic interventions, and residentialcare interventions. Educational interventions were the most common clinical/medicalintervention but their effectiveness was limited. Transitional care interventions had a gen-erally positive effect, particularly on delayed discharge but less so for older adults.Likewise, primary care, assessment/ambulatory unit and hospital at home/home-basedstrategies. Existing systematic reviews of pre and post-discharge, tele-healthcare/elec-tronic and residential care interventions suggest that there is limited evidence that thesesignificantly influence outcomes.Conclusion: Mixed results were found regarding the effectiveness of many types ofinterventions, which were heterogeneous between studies. The most effective interven-tions to tackle delayed discharge and readmission avoidance were those involving inte-grated systems across the hospital and community, multidisciplinary service provision,individualisation of services and hospital initiated discharge and follow-up byspecialists.
157 AN EXPLORATION OF NURSES PERCEPTION OFBARRIERS TO MOBILISING PATIENTS ON A GERIATRICMEDICINE/STROKE WARD AND STRATEGIES TOIMPROVE THIS
Background: Early mobilisation is key in preventing deconditioning and maintainingfunction in the hospitalised elderly (Covinsky 2003) and this is most effectively done incombination with physiotherapy and nursing (Cassel 2005).Older people in hospital have a 23.3% risk of being unable to return home due to loss
of function and ability to carry out activities of daily living, even during a short period ofhospitalisation (Covinsky 2003).Our study aimed to explore the perceived barriers to patient mobility experienced by
nursing staff and develop strategies for increasing mobility.Methods: A questionnaire was developed to examine attitudes to mobility. Questionswere completed anonymously by nursing staff. A series of focus groups were completedwith nursing staff to further explore barriers to mobility and strategies to facilitate betterpractice. A training programme was established.Results: A total of 27 questionnaires were distributed with a response rate of 81% (n = 22).68% reported difficulty motivating patients to mobilise. 58% felt not enough training wasprovided by physiotherapy. 65% perceived risk of patient injury and 78% perceived risk ofinjury to staff. The main outcome from focus groups was that staff felt patients’ mobilitywas not accurately handed over and that yearly training would be beneficial.Conclusions: Upon identification of barriers to mobility, steps have been undertaken toaddress this. This could potentially lead to better outcomes from regular mobilisation.The greatest perceived barriers to mobility are risk of injury to patients/staff and
motivating patients to mobilise. Focus groups with physiotherapy, nursing staff and wardmanagement have explored ways of addressing this issue.A programme has been developed by physiotherapy to provide optimal staff training,
with plans to receive feedback from staff on completion of training. Work is in progressto develop a system for clear handover of patients’ mobility at ward level.
159 SHORTENING WAITING TIMES FOR “COMPLEX FALLS ANDBLACKOUT CLINIC” OUTPATIENT APPOINTMENTS: AQUALITY IMPROVEMENT INITIATIVE USING FRONTLINEEXPERTISE
Tim Dukelow1, Finola Cronin2, Joanna Cahalane2, Susan Livingston3, Martina Agar3,Orla Hosford2, Liz O’Sullivan2, Rosemary Murphy2, Olivia Wall2, Eileen Moriarty2,Sheena McHugh4, Pat Barry5, Kieran O’Connor11Mercy University Hospital/Saint Finbarr’s Hospital, Cork City, Ireland
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2Health Service Executive, Cork, Ireland3Saint Finbarr’s Hospital/Health Service Executive, Cork, Ireland4University College Cork, Cork City, Ireland5Cork University Hospital/Saint Finbarr’s Hospital, Cork City, Ireland
Background: Falls and fear of falling seriously reduce the quality of life of older people.Established evidence suggests that multi-factorial assessment and tailored individual inter-ventions are the most effective way to reduce falls among older people in the community.However, there are often many barriers to the implementation of evidence based practicein healthcare. One of the recognised barriers to quality of healthcare is a lack of timelyaccess to assessment and intervention. The aim of our project was to reduce the waitingtime for patients attending our complex falls and blackout clinic from three months totwo weeks.Methods: We used a quality improvement methodology to define, analyse and improveour structure within and supporting the falls clinic. We used six principles for improvingaccess: understanding the balance between supply and demand, re-calibrating the system,applying queuing theory, creating contingency plans, influencing the demand, and man-aging the constraints. We defined the baseline processes and optimised them on the basisof analysis.Results: Over a period of 18 months we successfully reduced the waiting times forappointments from over three months to two weeks. This was achieved by developinga greater understanding between demand and supply and then changing processes andstructures. A single point of referral was established for specialist falls services. Byforming a multidisciplinary triage meeting, defining individual patient requirements andeliminating the consultant as a gate-keeper of other services we were able to createmore assessment places and eliminated the backlog of appointments. With greaterengagement with referrers, the appropriate patients now get to the appropriate part ofthe service quicker.Conclusions: Examining clinic processes and creating new structures can improvepatient access without additional resources. We are now seeing more patients and seeingthem quicker in our specialist falls services.
165 SUCCESSFUL IMPLEMENTATION OF AN INTEGRATEDREGIONAL FALLS AND FRACTURE PREVENTION PROJECT:MANAGING PEOPLE IS ESSENTIAL
Tim Dukelow1, Eileen Moriarty2, Finola Cronin2, Liz O’Sullivan2, Rosemary Murphy2,Olivia Wall2, Gabrielle O’Keeffe2, Sheena McHugh3, Pat Barry4, Kieran O’Connor11Mercy University Hospital/Saint Finbarr’s Hospital, Cork City, Ireland2Health Service Executive, Cork, Ireland3University College Cork, Cork City, Ireland4Cork University Hospital/Saint Finbarr’s Hospital, Cork City, Ireland
Background: The National Strategy for the Prevention of Falls and Fractures in Ireland(2008) set out a vision for a future free of falls and fractures for Ireland’s ageing popula-tion. In keeping with this strategy, our catchment area had a goal of implementing anintegrated falls and fracture prevention project. The project has three main work streams:building community capacity for falls risk assessment; re-engineering specialist falls ser-vices to improve access; and standardising continuing care assessments and preventionstrategies. In this paper, we report on the change management involved in this complexintegrated project.Methods: Since 2012, a clinician group has worked with local management in our regionto improve falls services. In 2015, funding was received to appoint a falls developmentpost, an administrator, and a rehabilitation assistant to support the community care ele-ments of the project. Separate funding was received for development of the continuingcare component of the project. In general, the success of most projects is related to peo-ple factors. Therefore, in this wide-ranging project, a structured change managementapproach was taken including influence mapping, stakeholder management and commu-nication plans.Results: All stakeholders were classified according to their influence and support forthe project. A communication plan for all stakeholders was devised. Key elements ofour change management strategy were having senior management sponsorship;involving key influencers early in the process; providing sufficient training for thecommunity teams; and involving appropriate personnel on the steering group.Internal champions were identified in each of the continuing care sites. There wascontinuous learning within the project, changing approaches to problems in subse-quent community clinics set-up.Conclusions: Health care systems are a complex collection of interacting elements.People are central to healthcare delivery and change. Successful projects must win thehearts as well as the minds for staff.
166 AN OLDER PERSON ASSESSMENT AND LIAISON SERVICE INAN IRISH UNIVERSITY TEACHING HOSPITAL: A MIXEDMETHODS CRITICAL ANALYSIS
Mary Hayes, Karen Fitzgerald, Keith McGrath, Tim Dukelow, Catherine O’Sullivan,Kieran O’ConnorMercy University Hospital, Cork City, Ireland
Background: Older people are more likely to have multiple co-morbidities and complexneeds. They are at increased risk of prolonged hospital stay without the appropriatemulti-disciplinary assessment. Not all older patients are admitted under a geriatric medi-cine service, therefore a comprehensive geriatric assessment (CGA) is often provided aspart of a consultation service.
In 2015, we introduced an older person assessment and liaison (OPAL) service coordi-nated by a clinical nurse specialist (CNS) in gerontology. The aim of this study was toanalyse and describe the operational benefits that followed the introduction of the OPALservice in a university teaching hospital.Methods: Using a quality improvement methodology with process mapping and redesignthe OPAL service was introduced. Wasteful steps in the previous consultation service wereeliminated. Clearer pathways were established for medical opinion from geriatric medicine,long term care applications and assessments for rehabilitation. A mixed method analysiswas used to highlight key indicators including timeliness of multidisciplinary assessments,discharge planning, staff satisfaction and appropriate transfer to rehabilitation.Results: In 2015, 405 patients were reviewed by the OPAL service. A ward-based caseidentification by clinical nurse managers was successful at identifying the correct patientsfor OPAL services. There was less duplication of assessments and more timely referralsto rehabilitation were achieved. The CNS was able to instigate earlier CGA and appropri-ate discharge planning. We found that the OPAL service reduced the time required toachieve physiotherapy and occupational therapy reviews. There was more timely andappropriate access to rehabilitation beds for frail older patients with 18% requiring off-site rehabilitation.Conclusions: Using process mapping and redesign an OPAL service can successfully beintroduced. By eliminating wasteful steps more patients can be seen in a timely manner.The CNS in gerontology is a key member of a successful OPAL service.
167 CONSUMER ASSESSMENT OF UNMET NEEDS IN THEDEVELOPMENT OF TARGETED AND APPROPRIATE NOVELFOOD FOR THE OVER SIXTY FIVES
Helen Cummins1, Clare A Corish2, Helen M Roche2, Sinead N McCarthy11Teagasc Food Research Centre, Ashtown, Dublin 15, Ireland2Nutrigenomics Research, Group, School Of Public Health, Physiotherapy and Sports Science,UCD Conway Institute/ UCD Institute of Food & Health, Belfield, Dublin 4, Ireland
Background: Nutrition is a modifiable factor in the ageing process. Protein intake mayslow the development of sarcopenia (1). Packaging, portion size, and taste are alsoimportant considerations when developing foods for older people (2). This research willidentify new product opportunities for older consumers to meet their nutritional needsand to enhance healthy ageing.Methods: Focus groups with 64 free-living adults aged 65 years+ were conducted. All parti-cipants were partly responsible for food shopping and/or cooking, with half of the partici-pants living alone. Open-ended questions were used to generate discussion around health,nutrition and functional foods. All focus groups were recorded and analysed using NVivo.Results: Themes identified included trust, cooking for one and perceived need for func-tional foods. GPs provided trustworthy advice on health and nutrition (“I take theBenecol drinks for the cholesterol because the doctor told me they are good. I’m notmad about them but I take them because she said to.” -ABC1 Female, 65-74). routineswere adjusted to cope with cooking for one (“If I cook today, I’ll do enough potatoes tolast for a few days. …. When I cook chicken breasts I might do three and put the rest inthe freezer..”-ABC1 Female, 75+). Finally, functional foods were seen as something forthe treatment of a recognised health problem, rather than for the prevention of futurehealth issues.(.I had high cholesterol…my daughter brings them into me and she says,them are for your cholesterols….make sure you take them…”-C2DE Male, 75+).Conclusions: Opportunities exist to produce foods specifically targeted to over 65 s topromote healthy ageing. These findings have the potential to influence public health pol-icy in Ireland.References:1. Paddon-Jones D, Rasmussen B Curr Opin Clin Nutr Metab Care 2009; 12: 86–90.2. Ford N, Trott P, Simms C Journal of Marketing Management 2016; 32: 275–312.
168 EFFECTS OF A NOVEL OCCUPATIONAL THERAPYPROGRAMME FOR OLDER PEOPLE WITH MILD TOMODERATE DEMENTIA: A RANDOMIZED CONTROL TRIAL
Prakash Kumar1, Matthew O’Connel1, S C Tiwari2, Rakesh Kumar Tripathi2, RoseAnn Kenny1, A B Dey31Trinity College Dublin, Dublin, Ireland2King George’s Medical University, Lucknow, India3All India Institute of Medical Sciences, New Delhi, India
Background: No definite management strategy is currently available for dementia andits complications. Our aim is to investigate the effects of occupational therapy in main-taining quality of life of patients with mild to moderate dementia.Methods: An open label randomized control trial was conducted among older patientsattending 2 memory clinics in India. Out of 319 attendees screened between November2010 and September 2013, 100 had dementia (DSM IV criteria) and were randomized toa novel occupational therapy programme (experimental, Prakash et al, 2014) of 2 sessionsper week including relaxation exercise, physical exercise, personal activity, cognitive
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exercise, and recreational activity or standard medical treatment (control). Participantswere reassessed after 5 weeks.Results: The mean age of participants was 69.4 years with 78% male, 18 patients werelost to follow-up. Experimental and control participants were matched for gender, educa-tion, occupation, living status, marital status, and severity of dementia. Using an intentionto treat analysis the intervention group showed improvement in the primary outcome fac-tors Geriatric Depression Scale (14.88±4.41 to 13.38±4.12; 95% CI (0.9, 2.0), BristolActivities of Daily Living scale (23.14±6.19 to 17.56±4.78; 95% CI (3.8, 7.2), ModifiedPhysical Performance Test (17.02±3.17 to 19.6 ±3.70; 95% CI (3.8, 7.2) . Significantimprovements were also noted in MMSE, BEHAVE-AD and the physical, psychologicaland environmental domain of WHOQOL-BREF (p < 0.01).Conclusion: This novel occupational therapy programme improves physical perform-ance, functionality, mood, cognition, behavioural status, and quality of life in mild tomoderate dementia patients at short term. A follow up study on a larger sample isrequired to ascertain the long term effect.References:1. Kumar P, Tiwari SC, Goel A, Sreenivas V, Kumar N, Tripathi RK, Gupta V, Dey
AB. Novel occupational therapy interventions may improve quality of life in olderadults with dementia. Int Arch Med 2014; 7(1):1.
169 OPERATIONALISING ROUTINE DELIRIUM SCREENING WITHTHE 4AT FOR OLDER PATIENTS ATTENDING AN AMAU
Riaz Moola, Aoife Fallon, Robert Briggs, Tara Coughlan, Ronan Collins, Des O’Neill,Jess Armstrong, Sean KennellyTallaght Hospital, Dublin, Ireland
Background: Delirium is frequently associated with adverse outcomes, including pro-longed inpatient stay, increased mortality, functional decline and increased need for resi-dential care. Despite these outcomes recurrent studies have demonstrated challenges todelirium identification, thus limiting essential early intervention. The objective of thisstudy was to incorporate and evaluate delirium screening on admission to an AcuteMedical Assessment Unit (AMAU) and review its documentation and follow up ondischarge.Methods: Consecutive patients aged ≥65 presenting to the AMAU were prospectivelyscreened from 15/2/16 to 08/05/16. Delirium screening was performed using the 4AT.The 4AT was integrated into the Symphony® electronic patient record, as a necessarystep in the admission/discharge of all older patients. Discharge letters were evaluated inthose scoring either 1-3 or ≥4 on the 4AT to assess documentation and follow up ofacute definite/possible delirium.Results: 211 people aged ≥65 attended the AMAU during the allocated time. 19/211(9%) scored ≥4 indicating likely delirium, 34/211 (16.1%) scored 1-3 suggesting possibledelirium or cognitive impairment. Two patients in each category remained in hospital atthe time of data collection and were omitted. 52.9% (≥4) and 18.8% (1-3) had knownpremorbid dementia. New diagnoses of dementia were made in 6.1% (3/49) all scoring1-3. Delirium was documented on discharge in 47.1% (8/17) in ≥4 and 3.1% (1/32) in1-3 and its management specified in 62.5% (5/8) in ≥4 and 100% (1/1) in 1-3. On dis-charge, formal cognitive assessments were documented in 6.3% (2/32) of 1-3, although34.4% (11/32) of this group and 29.4% (5/17) ≥4 were referred for further evaluationof cognition on discharge.Conclusions: Incorporating the 4AT as part of the AMAU admission pathway is feas-ible, and useful to support identification of delirium in older patients, thus allowingfor timely management. Future strategies will focus on improving dischargedocumentation.
170 A REVIEW OF ORTHOGERIATRIC ADMISSIONS TO ANACUTE ORTHOPAEDIC UNIT
Joanna McGlynn1, Ahmed Osman3, Mohammed Nouman Shakoor3, James Harty2,Josie Clare21Department of Geriatrics, Cork University Hospital, Ireland2Department of Orthopaedics, Cork University Hospital, Ireland3Department of Medicine, Cork University Hospital, Ireland
Background: There is limited literature describing non hip fracture orthogeriatricpatients. Our aim was to study older patients admitted under the orthopaedic service toreview the demographics, medical and functional problems of hip fracture and non hipfracture patients.Methods: Data was collected on all patients over 65 years of age admitted to the ortho-paedic department between 1st February and 30th of April 2016.Results: 242 older patients were admitted acutely. 109 (45%) had a hip fracture and 133(55%) a non hip fracture admission. The median age was 84 years (range 65-101) for hipfracture patients and 72.5 (range 65-94) for non hip fracture patients. The mean Barthelindex was 14.6 (range 0-20) for hip fracture patients, 18 for non hip fracture patients.The mean Abbreviated Mental test score (AMTS) was 5 in hip fracture patients, 9 in nonhip fracture patients. 27 (25%) of hip fracture patients and 2 (1.5%) of non hip fracture
patients were admitted from a nursing home. 57 (52%) of the hip fracture and 35 (26%)of the non hip fracture patients transferred to an offsite rehabilitation unit. There was aninpatient mortality rate of 5 (4.6%) for hip fracture patients and 1 (0.8%) for non hipfracture patients.The commonest non hip fracture admissions included: fractured radius and/or
ulnar n = 34 (26%), joint or wound infection n = 12 (9%), dislocated hip and/or hip revi-sion surgery n = 17 (13%), fractured ankle n = 16 (12%), fractured humerus n = 13(10%), femur (non-hip) n = 14 (10.5%), spinal trauma n = 4 (3%), tibia and /or fibulafracture n = 7 (5%), quadriceps rupture n = 5 (3.5%), pelvic fracture n = 2 (1.5%) andother n = 9 (6.5%).Conclusion: This study demonstrates the diversity of orthogeriatric admissions. Over50% of patients are non hip fracture admissions, who in general are less dependent thanhip fracture patients. Nevertheless, many still require geriatric expertise.
171 THE STUDY HIGHLIGHTING THE INCONSISTENCIES INTRAINING AND EDUCATION OF STOOL ASSESSMENT(SHITESA) REVISITED
Rachel Mulpeter1, Sarah Petch1, Alex Miodrag2, Ojaswini Pathak2, Joseph Browne11St. James’s Hospital, James’s Street, Dublin 8, Ireland2Department of Geriatric Medicine, Leicester Royal Infirmary, Leicester, UK
Background: The Bristol Stool Chart (BSC) is increasingly used to document bowelhabit in hospitals. Current best practice guidelines state that three type 6 stool sampleswithin three hours should warrant a stool sample being taken, and the patient should beconsidered for isolation pending microbiology results. The SHITESA study in Leicesterfound that there is a distinct lack of education regarding stool typing and quantifying.This observational study aims to replicate the original SHITESA study.Methods: The SHITESA group produced a Type 5, + (moderate size) stool modelaccording to the BSC description “soft blobs with clear cut edges” which was graded bya panel of experts. A photograph of this ‘stool’ was shown to clinical staff members.Participants were asked to identify the type (Bristol 1-7) and amount (small, moderate orlarge volume) of stool. They were also asked whether or not they would isolate thepatient.Results: 100 responses were included - 32 doctors, 44 nurses, 8 Health Care Assistantsand 16 other Allied Health Professionals. The stool was most commonly identified astype 5 (55%) and moderate size (64%). 25% of responders felt that isolation would beappropriate. Only 36% of responses matched the panel’s grading of the sample, 19% ofthese responses were from nurses. Nursing staff correctly answered all three questions in43.2% of cases and Doctors only correctly answered in 34.4% of cases.Conclusion: Similar to the SHITESA study in Leicester, our study demonstrated a dis-tinct lack of education regarding stool education on the basis of typing and quantifying.One quarter of responders would have inappropriately isolated a patient. Inappropriateisolation would have a significant impact on frail, older patients and would burden thehospital financially and logistically. Our study shows that more standardised teachingaround bowel habit and stool type is needed.
172 A LOVE OF WATER; OR HOW TO DROWNON DRY LAND
James Donnelly, Angelina Farrelly, Caoimhe Delaney, Rosaleen LannonMercer’s Institute for Research on Ageing, St James’s Hospital, Dublin 8, Ireland
Background: Hyponatremia is a common finding in the elderly and associated withhigher morbidity and mortality. It can be an indicator of an unwell adult and is oftenmulti-factorial. A meticulous approach to investigation is needed to fully elucidate anyunderlying cause or causes.Case Study: An 83 year old lady presented to our emergency department after a fall. Shehad a background of hypertension, type 2 diabetes and osteoarthritis. On admission ser-um sodium was 112 mmol/L. She was assessed as hypovolaemic which was attributed todiuretic use and self reported diarrhoea. The diuretic was held and slow IV fluid replace-ment was started. Sodium remained low at 116 mmol/L despite her becoming clinicallyeuvolaemic. Further investigation revealed a serum osmolality of 250 mmol/L, urineosmolality of 138 mmol/L and urine sodium <20 mmol/L. She was noted to be produ-cing large volumes of urine and no diarrhoea was noted. Strict fluid restriction <1 L/daywas instigated. Despite apparent fluid restriction sodium continued to decline to 113mmol/L. A urinary catheter was inserted to monitor urine output. She produced copiousamounts of dilute urine with >2 L/day recorded. Chart review revealed an admission 2years previously with a fall where sodium was 117 mmol/L. This had resolved withadmission to a HDU setting and strict fluid restriction. On questioning the patient admit-ted to drinking excessive amounts of fluid despite fluid restriction even drinking out ofthe taps in the bathroom. A diagnosis of psychogenic polydipsia was made and sodiumnormalised with strict fluid restriction. She continued to demonstrate water seekingbehaviour during the course of her admission. Psychiatry for old age input was soughtand she and her family were educated regarding the risks associated with her behaviourbefore discharge.Conclusion: Hyponatremia is an important prognostic indicator in the elderly, and thiscase demonstrates an unusual but important cause to consider.
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174 THE USE OF PROTON PUMP INHIBITORS AMONGINTELLECTUALLY DISABLED OLDER PEOPLE: ANOBSERVATIONAL STUDY
Hadiah Almutairi, Martin Henman, Maire O’DwyerTrinity College Dublin, Dublin, Ireland
Background: Proton pump inhibitor (PPI) use among older people is common.However information about PPI use in older people with ID is sparse and limited despitea high rate of gastrointestinal conditions such as Gastroesophageal reflux disease(GORD).Objective: To investigate the pattern of PPI use among older people with intellectualdisability.Method: Data on PPI use and gender, place of residence, level of ID and age was ana-lysed from IDS-TILDA, Wave two. The sample consisted of 677 participants aged 40years and above. Descriptive statistics and bivariate analyses were carried out.Results: Just over a quarter, 27.3% (n = 185), of participants reported use of PPI, and54% (n = 100) were female. The largest proportion of PPI users (58%) were agedbetween 50-64 yrs. Most of the PPIs were used in medium doses (70%). However onlyin of cases was 38% an indication reported (Peptic Ulcer or GORD) or an NSAID usedconcomitantly. Use among those in residential care homes (55.5%) was much higher thanfor those living independently or with family (9%). PPI use among those who havesevere/ profound ID level was 12% higher than those with moderate ID level.Information about the length of PPI use was missing for 30% but of those with data,just over half recorded using the PPI for more than a year. Omeprazole was the secondmost frequently used agent after Lansoprazole, although it has several potential druginteractions of relevance to this group.Conclusion: PPI use among older people with intellectual disability is prevalent and fre-quently long term, often without a clear indication. PPI use needs to be assessed fre-quently, especially among those with severe/profound ID and those who live inresidential care homes, in order to avoid inappropriate long term of use that could predis-pose them to additional comorbidities.
175 TRANSLATING NEW TECHNOLOGY INTO CLINICALPRACTICE: SHOULD A DIRECT MEASURE OF CEREBRALPERFUSION BE USED IN SYNCOPE AND FALLS ASSESSMENT?
Laura Fitzgibbon2, Ciaran Finucane1, Ikdip Brar2, George Heckman2, Richard Hughson21Mercer’s Institute for Successful Ageing, Dublin, Ireland2Schlegel Research Institute, Waterloo, Ontario, Canada
Background: Orthostatic hypotension (OH) when combined with symptoms on stand-ing and a positive history of falls or syncope is thought to indicate risk of impaired cere-bral perfusion. However age and cognitive impairment are known to reduce theperception of orthostatic symptoms and recall of syncopal and falls events, potentiallyaffecting the validity of this approach. Here we examine if OH combined with self-reported orthostatic symptoms and a positive syncope or falls history is a marker of cere-bral hypoperfusion.Methods: A self-selected sample of N=80 older adults (age 87 (6.1) years; 73.5% female)were recruited from a nursing home population living in Ontario, Canada. All participantsunderwent an active stand (AS). Orthostatic symptoms were quantified using an 8-pointorthostatic symptoms scale. Beat-to-beat blood pressure (mmHg) was recorded through-out using a calibrated volume clamp method, while near-infra red spectroscopy (NIRS)measured relative changes in regional cerebral tissue oxygen saturation (tSO2 - %), oxy-hemoglobin (OxHb – μmol/l) and deoxyhemoglobin (Hb – μmol/l) concentration.Results: 9.3% reported a positive falls history, with 6.4% having sustained OH at up to3 minutes after standing. 51.3% reported one or more orthostatic symptoms. Afteradjusted multivariate analyses (SPSS, V22) orthostatic symptoms were not associated withrelative changes in tSO2, [OxHb] or [Hb], while the presence of OH at 40 seconds afterstanding was associated with a decrease in tSO2 (B =-4.562; P = 0.011) and decrease inrelative [OxHb] (B = -1.88.; P = 0.017).Conclusion: Combining OH and self reported symptoms and a falls/syncope historydid not strengthen these associations. Postural symptoms are an unreliable marker ofcerebral perfusion in older adults, while orthostatic BP changes are a better, yet still lim-ited surrogate marker of cerebral hypoperfusion. A direct measure of cerebral perfusionshould be considered to assess cerebral hypoperfusion and will likely play an emergingrole in syncope and falls risk.
176 OUTPATIENT SERVICES IN GALWAY - A SURVEY OF OLDERPEOPLE’S EXPERIENCES BY AGE ACTION GALWAY GLORGROUP
Age Action Galway Glór GroupAge Action, Dublin, Ireland
Background: In July 2014, Age Action held a meeting of its members in Galway atwhich the Galway Glór group was formed. The group has been meeting at least once amonth since September 2014. The experience of older people accessing outpatient ser-vices was raised a number of times by the group. In order to present a comprehensiveaccount of this experience, the group decided to conduct a survey of older people inGalway.
Methods: Age Action’s policy team oversaw the development of the survey, with thegroup’s members deciding on the format and questions to be included. Online andprinted copies of the survey were developed. In order to increase the response rate to thesurvey, members of the Glor group visited community groups around the county toencourage older people to complete the survey.Results: Many of the findings revealed older people had a positive experience of out-patient services, however, the continuing practice of hospitals block-booking appoint-ments was problematic. Respondents reported that this practice often meant they wereleft waiting to see their doctor.Discussion: Following the publication of the survey findings, members of the GalwayGlor group met with a key stakeholders to highlight the issue of block booking appoint-ments and its impact on older people attending outpatient services.
The research and follow-on meetings shifts the narrative around older people fromone which views them solely as service users to actively engaged citizens who wish tohave their voices heard by decision makers.Conclusion: The research undertaken by the Galway Glór group was a new departurefor Age Action’s policy and advocacy work and one which merits repeating. As part of itscurrent strategic plan (2016-2018) it is anticipated that this type research will be carriedout by other Age Action Glor groups.
178 ANALYSIS OF DELAYED DISCHARGE DATA AND THEIMPACT OF EXTERNAL ISSUES IN A LARGE URBAN ADULTHOSPITAL
Amanda CaseyMater Misericordiae University Hospital, Dublin, Ireland
Background: The increasing recognition of the impact of delays in discharge from acutehospitals has led to a rise in the examination of processes and systems for supportingolder persons following an admission to an acute hospital. The growth in the populationover 65 and the corresponding requirement for increased supports both in primary andresidential care has created extra financial demands on the health service. Funding alloca-tions within the primary and social care divisions have a direct impact on the servicesavailable to older persons within the acute sector.Methods: An analysis of trends in delayed discharges being reported to the HealthService Executive Business Intelligence Unit from 2013 to 2016 was mapped againstexternal factors to examine any causal links and the impact of these changes on the num-ber of patients awaiting discharge from the acute hospital setting.Results: A direct correlation was found between external factors such as seasonaldemands, funding allocations and withdrawals and availability of nursing home place-ments within the catchment area of a large urban adult hospital.Conclusions: Although internal process factors are essential to the flow of olderpatients within the acute hospital, external factors are equally influential and consistentengagement with primary and social care partners both at local and national level arekey to optimising appropriate care for older patients and facilitating the best use ofacute hospital beds.
180 INNOVATING A NOVEL TEST FOR VASOVAGAL SYNCOPE INOLDER ADULTS USING THE ACTIVE STAND
Michelle Sybring1, Hugh Nolan4, Chie Wei Fan2, Clodagh O’Dwyer3, Rose Anne Kenny4,Ciaran Finucane11Mercer’s Institute for Successful Ageing, Dublin, Ireland2Mater Misericordiae University Hospital, Dublin, Ireland3St. Vincent’s Hospital, Dublin, Ireland4The Irish Longitudinal Study on Ageing, Dublin, Ireland
Background: Vasovagal syncope (VVS) is commonly diagnosed in older adults butknowledge surrounding the hemodynamic response to the active stand (AS) test is lim-ited in these individuals. Here we sought to assess differences in the hemodynamicresponse to AS in older adults with VVS compared to age-matched controls (CON)and determine if any detected differences could be used to predict the presenceof VVS.Methods: Adults aged 50 and over (N = 46 VVS, N = 86 CON) completed an AS.Multiple features describing the AS hemodynamic response were extracted, and com-pared between groups. VVS presence was predicted using linear discriminant analysis(LDA), quadratic discriminant analysis (QDA), support vector machine (SVM) and amajority vote classifier.Results: Subjects with VVS demonstrated higher resting heart rate (69.8 ± 13.1 bpm vs63.3±12.1 bpm; P = 0.007), a smaller initial systolic blood pressure drop (−20.2±20.1%vs -27.3±17.5%; P = 0.005), larger drops in stroke volume (−14.7±24.0% vs−2.7 ± 23.3%; P = 0.010) and cardiac output (−6.4 ± 18.5 vs 5.8 ± 22.3;P < 0.001) anda larger increase in total peripheral resistance (8.1 ± 30.4 vs −6.03 ± 22.8; P = 0.002)compared to CON. Majority vote classification predicted presence of VVS with 82.6%sensitivity, 76.8% specificity, and average accuracy of 78.9%.Conclusion: Older adults with VVS display a unique hemodynamic and autonomicresponse to active standing characterized by relative autonomic hypersensitivity and largerdrops in cardiac output compared to age-matched controls. With suitable data analyticsthe AS test can be used to screen older for VVS with a classification accuracy of 78.9%,potentially reducing test time, cost and patient discomfort.
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181 TIME TO REHAB: A ONE YEAR RETROSPECTIVE AUDIT OF AMEDICINE FOR ELDERLY REHABILITATION SERVICE
Christopher Osuafor1, Adefunke Salawu2, Frances McCarthy11Department of Medicine for the Older Person, St Mary’s Hospital Phoenix Park, Dublin,Ireland2Department of Physiotherapy, St Mary’s Hospital Phoenix Park, Dublin, Ireland
Background: St. Mary’s Hospital has a 22-bed specialised ward offering post-acuterehabilitation care to frail older adults. The skilled multidisciplinary team aim to optimiseindependence and aim for a timely discharge. The aim of this audit was to assess therehabilitation service discharge outcomes over a 13-month period.Method: A retrospective audit of all consecutive admissions from December 2014 toDecember 2015 was carried out.Results: 156 patients were included in the audit. 90/156 (57.7%) were females. Medianage was 84 years (59–102 years). Median Addenbrooke’s Cognitive Examination-III was65/100 (range 29–95). Median length of stay was 35 days (1–250 days). Main outcomemeasure used was Berg Balance Scale of which 111/124(89.5%) showed a detectableimprovement in mobility, 11/124 (8.9%) showed no changes while 2/124 (1.6%) showeda decline. 132/156 (83.4%) were discharged home (120/132 directly to their homes, 6/132 to a sheltered accommodation and 6/132 via transitional care). 14/156 (8.9%) weretransferred back to the acute hospital, 7/156 (4.5%) were discharged to a nursing homewhile 5/156 (3.2%) died.Conclusion: The audit shows the majority of patients achieve a successful dischargehome in a time frame suggested as appropriate by the National Clinical Program forOlder People1.Reference:1. Health Service Executive, Royal College of Physicians of Ireland National Clinical
Programme for older people: special geriatric services model of care. Dublin: HealthService Executive, 2011: 93. http://hdl.handle.net/10147/324959.
183 RETURNED MEDICATION: AN OPPORTUNITY FORENHANCED MEDICINES REVIEW IN AN EXTENDED CARESETTING
Ciara Mc Gann, Claire Kavanagh, Louise O’Leary, Gillian Robinson, Elizabeth Dunne,Jennifer Hoare, Chris Dalton, Mary Carroll, Mary Byrne, Simi Chacko, Denis Donohue,Eimear O’DwyerOur Lady’s Hospice & Care Services, Harold’s Cross, Dublin 6w, Ireland
Background: An individual resident dispensing system is in place for four wards in anextended care unit. Excess/unused medicines are returned to the pharmacy departmentat the end of each month. The purpose of this study was to analyse the medicinesreturned to identify possible issues with their administration and to facilitate medicinesreview.Methods: Records of returned medicines were retained in the pharmacy department.Details of items returned in 2015 were collated and reviewed. Pharmacists reviewed resi-dent’s prescription charts to seek possible explanations for non-administration of medi-cines. In the absence of documented explanations, pharmacists worked with nursing staffto identify possible explanations. Nursing, medical and pharmacy staff collaborated toaddress any medicines management problems identified.Results: In 2015, returned medicines constituted 4.5% (336/7024) of total medicinesdispensed. Pharmacist review of resident’s prescription charts identified an explanationfor 49% (164/336) of returns, accompanied by appropriate documentation of non-administration. In the remaining 51% (172/336) of returns full explanation could not befound and follow-up with nursing staff was necessary. Problems were identified withadministration of medicines, resident adherence and documentation inaccuracies whenmedicines were not taken. An explanation could not be identified in 14.5% (48/336) ofinstances, which indicates the potential for undetected administration errors.
Of the total returns, 37% (124/336) were deemed sufficiently significant to warrantfollow-up with medical staff, as they had the potential to impact on the resident’s careand future prescribing.Conclusion: Analysis of medicines returned offers a unique insight into medicine useand provides an opportunity for collaborative working between medical, nursing andpharmacy staff to improve medicines management. These findings identify issues in rela-tion to medication adherence and documentation of administration in the extended nurs-ing care setting. Further investigation, focusing on the results of medicines review andimpact on patient care is recommended.
184 USE OF THE DRUG BURDEN INDEX IN OLDER ADULTS WITHINTELLECTUAL DISABILITIES
Juliette O’Connell, Máire O’Dwyer, Martin HenmanTrinity College, Dublin, Ireland
Background: The Drugs Burden Index (DBI) evaluates medications with anticholinergicand sedative effects and has been associated with poorer physical and cognitive functionin community-dwelling older people (1). The study aims to examine the cumulative drug
burden for older people with an intellectual disability (ID) and identify the associationbetween DBI scores and clinical/demographic characteristics.Methods: Data from Wave 2 of the Intellectual Disability Supplement to the IrishLongitudinal Study on Ageing (IDS-TILDA) were analysed. An inventory of medicationswas compiled and the DBI score for each individual was calculated and analysed.Results: 677 (95.6%) participants had medication data available for analysis. 131 medica-tions with anticholinergic and/or sedative effects were reported in the dataset. 78.6% ofparticipants were exposed to a DBI medication. Mean DBI score was 1.3 (SD 1.2).There was an age gradient which was not statistically significant associated with a higherDBI score, with 61.3% of those over 65 years having a DBI score of 1 or higher (p =0.206). Almost two-thirds (63.4%) of those in residential care and 73.9% of those withepilepsy had a DBI score of ≥1.Conclusion: The DBI scores for this group were much higher than for studies of thegeneral elderly population. Further work is needed to assess whether these scores areassociated with poor health status. In particular, those ≥65 years, in residential care andwith epilepsy had higher DBI scores and would benefit from review of medications toreduce their drug burden.Reference:1. Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, Harris TB,
Hanlon JT, Rubin SM, Shorr RI, Bauer DC. A drug burden index to define the func-tional burden of medications in older people. Arch Internal Med 2007; 167(8):781–7.
187 TRANSLATING EPIDEMIOLOGICAL RESEARCH INTOCLINICAL PRACTICE: EVALUATION OF NEW TOOLSFOR AUTONOMIC ASSESSMENT IN A CLINICALENVIRONMENT
C Finucane1, C Soraghan1, C Byrne3, F Mc Carthy3, C Aspell3, R Kenny2, G Boyle1,CW Fan31Mercer’s Institute for Successful Ageing, Dublin, Ireland2The Irish Longitudinal Study on Ageing, Dublin, Ireland3The Mater Misericordiae University Hospital, Dublin, Ireland
Background: We recently proposed a clinical definition of impaired orthostatic bloodpressure stabilisation (OH(40)) which is associated with incident falls. In developing this,a software tool for rapid quality assessment and feature extraction of phasic BP recordswas developed. As a step towards translating this work into clinical practice we appliedthese tools to audit the quality of records and the prevalence of OH(40) in a clinicalcohort.Methods: Active stand (AS) records from consecutive patients attending St. Mary’sHospital, Dublin were obtained. Using the newly developed tool we assessed the qualityof each record for: 1) data integrity and suitability for analysis; 2) protocol compliance; 3)presence of significant artifacts. Systolic BP(SBP) and diastolic BP(DBP) and heart rate(HR) responses to standing were extracted. The prevalence of OH(40), defined as a dropin SBP of ≥20 mmHg and/or drop in DBP of ≥10 mmHg at 40 seconds after standingwas then assessed.Results: N= 97 patients records were obtained. The following issues with initial dataintegrity and protocol compliance checks were flagged: Height correction issue = 29.8%(29/97); rest period being too short 19.6% (n = 19/97); stand period being too short3.0% (n = 3/97); baseline period being too short 1% (n = 1/97); Physiocal calibrationissues 7.2% (n = 7/97). Six percent (n = 6/97) of records were deemed unsuitable forfurther analysis. Of the remaining records 14.2%(n = 13/91) contained high levels ofartefact. Over one quarter of patients (25.3%; n = 24/91) satisfied the SBP criteria and24.2% (n = 23/91) of patients satisfied the DBP criteria for OH(40). Over one third ofpatients (36%;n = 33/91) had OH(40).Conclusion: Automated phasic BP analysis tools support rapid quality assessment andanalysis of AS records. Steps to improve protocol compliance and data quality duringclinical AS assessment should be considered. Impaired blood pressure stabilisation is pre-sent in over one third of frailer patients and a significant future challenge for globalhealth.
190 AN EXPLORATORY STUDY OF SLEEP QUALITY IN OLDERADULTS IN IRELAND
Siobhan Scarlett, Matthew O’Connell, Hugh Nolan, Rose Anne KennyThe Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
Background: There is increasing interest in the implications of sleep problems on healthand cognition. Little is known about the sleep quality of older adults in Ireland. Thisstudy examined the prevalence of sleep problems in a nationally representative cohort ofolder adults living in Ireland.Methods: Self-reported sleep duration and disturbances data from wave 2 of The IrishLongitudinal Study on Ageing (TILDA) was used for this study. Short was defined as ≤5hours and long sleep duration as ≥9 hours. A sleep disturbance score was calculatedfrom the sum of responses to questions about daytime dozing, trouble falling asleep andwaking up too early. Scores ranged from 0-7, with scores of ≥4 categorised as disturbedsleep.
Results: Analysis included 7,202 participants (mean age 64.4 years, range 50-97). 13.0%reported short sleep, 9.4% reported long sleep. Mean score for sleep disturbances was2.2. 21.7% of participants had disturbed sleep.Short sleep (females: 14.3% vs males: 11.6%, p < 0.01) and disturbed sleep (23.1% vs
20.3%, p < 0.05) were more common in females than males. Long sleep was slightlymore prevalent in males (29.5% vs 30.7%, p = 0.22).There was a strong age gradient; 6.2% of those aged 50-64 reporting long sleep com-
pared to 17.2% of those aged ≥75. Prevalence of disturbed sleep increased from 19.0%to 27.7%. Short sleep increased slightly from 12.3% to 13.4%.31.6% of respondents who rated their health as poor reported short sleep, 44.7%
reported disturbed sleep and 11.3% reported long sleep. Of those with a limiting disabil-ity, 20.5% reported short sleep, 33.4% reported disturbed sleep while 10.4% reportedlong sleep.Conclusions: Short, long and disturbed sleep are common in the older population,increasingly prevalent at older ages and more common in those with poor self-reported health. Further research is needed to understand the impact of abnormal sleeppatterns.
191 AN INVESTIGATION OF THE RELATIONSHIP BETWEENSLEEP DURATION AND COGNITIVE FUNCTION IN OLDERADULTS
Siobhan Scarlett, Matthew O’Connell, Hugh Nolan, Helen O’Brien, Rose Anne KennyThe Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
Background: Ageing is associated with changes in sleep duration. Previous research hasshown sleep duration may contribute to the complexity of age-related cognitive decline,however, findings have been inconsistent. This study explored the relationship betweensleep duration and cognitive function in older adults in Ireland.Methods: Data were from wave 2 of The Irish Longitudinal Study on Ageing(TILDA). Self-reported sleep duration was defined as short (≤5) hours, normal (6–8)hours or long (≥9) hours. Multiple linear regression was used to assess the relationshipbetween sleep duration and measures of global cognition from the Mini-Mental StateExamination (MMSE), verbal fluency and immediate and delayed recall. Analyses incor-porated known confounders including demographics, medications, depression andBody Mass Index.Results: Analysis included 7,202 participants aged (mean age 64.4 years; range 50–97).13.0% reported short sleep, 9.4% reported long sleep. After adjustment for all confoun-ders, long sleep was associated with lower MMSE scores compared to normal sleep (β =−0.45; 95 % CI −0.60,−0.30, p < 0.001). Long sleep was also associated with poorer ver-bal fluency (β = −1.04; 95 % CI −1.51, −0.56, p < 0.001), immediate recall (β = −0.21;95 % CI −0.33,−0.10, p < 0.001) and delayed recall (β = −0.42; 95 % CI −0.61,−0.23,p < 0.001). Short sleep was only associated with lower MMSE (β = −0.16; 95 % CI−0.30, −0.03, p < 0.001) scores.Conclusions: Long sleep is associated with lower cognitive function across all measures.Short sleep only showed an association with lower MMSE scores. This study highlights arelationship between sleep duration and cognitive function in this population and sup-ports previous research suggesting long sleep has a stronger relationship to cognitivefunction than short sleep. Future work using longitudinal analyses will help to reveal thecausal direction of this relationship.
192 AUDIT OF DIABETES MANAGEMENT IN A COMMUNITYNURSING UNIT
Adriana Hadbavna, Frances McCarthyPhoenix Park Community Nursing Unit, Dept. of Medicine for Older Persons, St Mary’sHospital, Phoenix Park, Dublin 20, Ireland
Background: Diabetes mellitus (DM) is common with an increasing prevalence in ourexpanding older population. An individualised treatment approach is necessary in olderpeople in order to prevent complications and avoid hypoglycaemia. The InternationalDiabetes Federation 2013 guidelines for older people highlight specific targets for thosewho are dependent (frail or have dementia), or at the end of their lives. HbA1c range of53–70 mmol/l is suggested for these groups. Our aim was to determine the prevalenceof DM and the level of glycaemic control in a community nursing unit (CNU), which has182 residents and a Geriatrician-led medical team.Methods: We carried out a cross sectional audit of medical and nursing notes of CNUresidents with a known diagnosis of DM.Results: The prevalence of DM was 17.6% (32/182). 31 patients were included (1 wasexcluded as he was newly admitted). 65% were female. Mean age was 85 +/− 6.8 years,90%(28/31) had a diagnosis of dementia with mean MMSE of 14.5 +/− 9.2. The major-ity of patients had high dependency levels with mean Barthel index of 5.2/20 +/− 5.1.19.5%(6/31) were on insulin, 45%(14/31) on oral hypoglycaemic agents (OHAs) and
35.5%(11/31) on diet alone.74%(23/31) of patients had HbA1c measured within the last 12 months with mean of
52.9 +/−12mmol/mol.39% had HbA1c within 53–70 mmol/mol range, but 56%(13/23) had HbA1c <53
mmol/mol.
Tight glycaemic control (fasting glucose< 6 mmol/l on >/= 1 occasion) in preceding4 weeks was common (100%(6/6) on insulin, 90%(9/10) on diet alone and 43%(6/14)on OHAs).Conclusions: Glycaemic control is too tight for many of our dependent residents.Dietary restrictions may be excessive. We plan to highlight the suggested treatment targetsand need for individualised treatment plans to our NCHDs, nursing and dietetic collea-gues in order to avoid hypoglycaemia and improve quality of life.
193 IMPLEMENTATION AND EVALUATION OF A MEDICATIONRECONCILIATION PROCESS IN A SPECIALIST GERIATRICWARD
Background: Adverse drug events (ADEs) are one of the leading causes of injury tohospital patients. Over half of all hospital medication errors occur at the transitionspoints of care. Medication reconciliation can minimise medication errors through a pro-cess of maintaining the most accurate list of medications that a patient is taking acrosstransition points of care. We describe the implementation and evaluation of a medicationreconciliation process in a Specialist Geriatric Ward (SGW).Methods: A medication reconciliation team, including medical, pharmacy and nursingstaff, was assembled in July 2015. Roles for each member were defined. Patients admittedto the SGW under the care of the geriatric service had their medications reconciled atadmission and discharge. A retrospective baseline audit of 50 randomly selected chartsfrom the first three months was conducted. Thereafter, a prospective monthly evaluationof the process was performed to monitor commitment to the process and to track rea-sons for medication reconciliation failure. Patient and caregiver as well as GP and com-munity pharmacist satisfaction with the process was captured using a mixed methodapproach.Results: Overall, there were on average 0.77 medication errors per patient identifiedthrough the medication reconciliation process. Baseline audit showed that 66% of patientshad their admission and discharge medications reconciled. Arising from these results, theprocess was simplified, efficiency of communication between team members wasimproved and progress was presented regularly to improve ‘buy-in’. Subsequent evalu-ation demonstrated significant improvement with admission and discharge medicationreconciliation completed in 76%, and in 86% of patients respectively. Medication recon-ciliation failure was associated with periods of increased patient and staff turnover.Patients and their community health care providers responded positively to theintervention.Conclusions: A medication reconciliation process on SGW identifies medication errors,reduces risk of ADEs and is associated with high levels of patient satisfaction.
194 HOSPITAL FOOD – AN EVALUATION OF PATIENTSATISFACTION WITH LUNCHTIME MEAL AND AUDIT OFCOMPLIANCE WITH STANDARDS
Deirdre M FitzgeraldSt. Columcille’s Hospital, Dublin, Ireland
Background: Whilst some patients can have positive experience of hospital, more nega-tive appraisals of hospital inpatient experiences predominate (HSE Quality ImprovementDivision & Age Friendly Ireland, 2015). Public perception of Hospital food is generallynegative. Patients are at risk of under-nutrition and weight-loss during their hospital stay(Dept. of Health & Children, 2009) impacting their wellness and recovery.Method: St. Columcille’s Nutrition Steering Committee established in 2010 introduced aQuality Improvement Plan to address the quality and safety of the food served as well asthe mealtime experience of patients. These included: On-site preparation of ModifiedConsistency Diets (MCDs) and Food Moulding for Pureed Diets; Increasing NutritionalValue of meals; Annual MDT training and education sessions in nutrition and dysphagia;Meal Feedback Form; Protected Meal Times and Red Tray Protocol to identify thoserequiring mealtime assistance.
Audit and evaluation of patient satisfaction; compliance of lunchtime meal for Texture& Temperature and Provision of mealtime supports was conducted based on the descrip-tors of the Irish Nutrition & Dietetic Institute / Irish Association of Speech andLanguage Therapists, HIQA Standards and Food & Nutritional Care In Hospital AuditTool 2009. Patients on three wards (N = 73) were observed during lunchtime meal and adichotomous pass/fail grading scale was employed as well as recording patient’s directverbal feedback on satisfaction with the meal.Results: In January 2016, 94% patients were satisfied with the lunchtime meal and 84%were consuming >50% of the meal. Compliance with standards for all diets was 97%compared with 66% in 2010. Compliance with provision of mealtime supports was98.4%.Conclusions: Driving constant improvement in food preparation and mealtime supportsyields high patient satisfaction ratings with lunchtime meal and significantly improvedcompliance with quality standards. Further exploration of factors impacting meal con-sumption including timing of the lunchtime is planned.
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195 THE IMPLEMENTATION OF MEMORY BOXES TO IMPROVESTAFF KNOWLEDGE OF ELDERLY RESIDENTS WITHDEMENTIA IN A LONG-TERM CARE FACILITY
Deborrah BrennanTara Winthrop Private Clinic, Swords, Co Dublin, Ireland
Background: One of the core values of nursing the older person is “knowing the per-son” and using this knowledge to work in collaboration with the resident and their familyto provide high quality nursing care. The aim of the research was to implement memoryboxes on a 32 bedded unit caring for residents with mild to moderate dementia toimprove staff knowledge therefore enhancing person-centred care. Memory boxes are aformat of recording an individual’s life story, known as life story work. They are createdto store photographs and personal memorabilia that have meaning for the individual.Method: Memory boxes were implemented through a co-operative inquiry, an actionresearch methodology. The experience of the staff and clinical nurse managers wasexplored on the effectiveness of the memory boxes in improving staff knowledge. Focusgroups and semi-structured interviews were undertaken. Transcripts were subject to con-ventional content analysis to ascertain the findings.Result: The emerging themes from the transcripts indicated that memory boxes have thepotential to: improve staff knowledge of the resident, enable the staff to see the personbehind the dementia, improve communication and staff interaction, improve resident’sself-esteem and modify behaviours.Conclusion: Memory boxes as a format for life story work have the potential to improveperson-centred care for residents with dementia. The implementation of memory boxescould act as a guide for other long term care facilities to improve practice through thedelivery of care that is resident focused.
196 OUTCOMES FROM AN OFFSITE POST-ACUTE CARE SERVICEGOVERNED BY AN ACUTE TEACHING HOSPITAL
Ciara Dowling, Ronan O’Toole, Laura Fennelly, Amanda Casey, Dermot PowerMater Misericordiae University Hospital, Dublin, Ireland
Background: The acute hospital setting is increasingly appreciated as a suboptimal envir-onment for long-term care (LTC) decision making, assessment and processing. The rea-sons for this include the constant pressures on the bed capacity, time constraints on careassessments and the need for individuals to fully recuperate from an acute illness. In2011, an acute hospital developed an off-site post-acute care service with an embeddedethos of re-ablement, addressing the requirements of patients with complex dischargeneeds often resulting in LTC processing. The primary aims of the post-acute care serviceare to avoid prolonged hospital stays in the acute setting, advocates for LTC decisionmaking and processing to take place out of the acute hospital setting.Method: Outcomes of 56 patients with an original discharge plan of LTC transferredfrom the acute to post-acute care service over a 6 month period were measured andreviewed.Results: A total of 56 patients with an average age of 81.3 years were transferred to thepost-acute care service from the governing acute hospital (n = 56). The average length ofstay in the post-acute care setting was 46 days. 21.42% (n = 12/56) avoided LTC andwere discharged home with community support, 73.21% (n = 41/56) were transferred toLTC and 5.3% (n = 3/56) died.Conclusions: The post-acute care service continues to evolve and adapt to the currentneeds of the service users and the healthcare system pressures. These results indicate thevalue and potential of a high-quality post-acute care service with an embedded ethos ofre-ablement. It questions the reliability of making the LTC decision in the acute hospitalsetting.
197 DO-NOT-ATTEMPT-RESUSCITATION (DNAR): THEIMPORTANCE OF PHYSICIAN AND NURSE UNDERSTANDINGOF DNAR ORDERS IN A UNIVERSITY HOSPITAL AND ITSCOMMUNITY
Helen O’Brien1, Siobhan Scarlett1, Anne Brady2, Kieran Harkin3, Rose Anne Kenny1,Jeanne Moriarty21Mercer’s Institute for Successful Ageing (MISA), Dept. of Medical Gerontology, St. James’sHospital, D 8., Dublin, Ireland2Dept. of Anaesthesia, St. James’s Hospital, D8., Dublin, Ireland3Inchicore Family Doctors, Primary Care Centre, St. Michael’s Estate, Inchicore, D 8., Dublin,Ireland
Background: Following the introduction of DNAR orders in the 1970 s, there was wide-spread misinterpretation of the term amongst healthcare professionals. Objectives: Toexamine current understanding of the term DNAR, decision-making surroundingDNAR, awareness of success rates of cardiopulmonary resuscitation, current DNARguidelines and advance care directives.Methods: A questionnaire was distributed to doctors and nurses in an urban universityteaching hospital and affiliated primary care physicians electronically via email and byhard-copy at medical, surgical, nursing and primary care educational meetings. A total of519 completed the survey. The response rate in the hospital doctors group was 35.5%(187/527), 19.8% (292/1477) in the nurses group but 68.8% (150/218) in the specialistnurses group, and 40% (40/100) in the primary care physician group.
Results: In the setting of a DNAR order, 15.4% believed that the patient could not receiveany or at least one of the less invasive treatment options including antibiotics, physiother-apy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, withsignificant differences between groups of professionals (p < 0.001). 24.3% believed that aDNAR order would exclude a patient from receiving chemotherapy, radiotherapy, undergo-ing dialysis or surgery. Alarmingly, 13.3% reported that a patient with a DNAR order couldnot be referred to hospital from home or a nursing home, with variability evident betweengroups (p < 0.001). 33.1% of healthcare professionals markedly overestimated the successrates of resuscitation in out-of-hospital cardiac arrests and 59.7% overestimated successrates in in-hospital cardiac arrests. Participants were aware of their knowledge gap in rela-tion to DNAR orders with 96.3% in favour of further education.Conclusion: Our findings further highlight the misinterpretation of DNAR ordersand are important in the context of advance care directives. Decisions on DNAR mustbe correctly understood to only apply to CPR and should not affect other aspectsof care.
198 DEVELOPING A RAPID ACCESS UNIT (RAC) TO IMPROVEQUALITY OF CARE FOR ELDERLY PATIENTS ATTENDINGTHE LOCAL EMERGENCY DEPARTMENT
Kenneth Tang, Paul Lavery, Cathryn Maybin, Khalil AmirDowne Hospital, SE Trust, Downpatrick, UK
Background: The number of people aged over 65 forms a sizable part of our local com-munities. The Rapid Access Centre (RAC) is a 6 bedded Consultant lead ward that wasestablished in 2015 as a result of strategic drivers, national and regional direction, profes-sional practices and consideration of local and regional population.Aims and Objective: The aims of the RAC include multidisciplinary team approach,high quality patient centred care, rapid access to services, continuity, maintaining health &patient independence & reducing health costs.Methods: We compared two sets of data which looked at hospital admissions before andafter the RAC was established. Each set of data was collected over a 7 month period andincluded basic demographics, length of stay (LOS) and diagnosis. Data from a total of441 patients was collected of which 346 patients were admitted to hospital via the trad-itional A&E route and 95 patients were admitted to the RAC.Results: The average age of our patients from A&E and the RAC were 73 years old and75 years old respectively. The data from the RAC patients showed that 56 patient (59%)being admitted to the ward and 39 patients (41%) being discharged. The average LOS ofpatients admitted by A&E was 5.6 days and those patients assessed for admission inRAC was 4.1 days. Comparison between LOS for individual diagnosis also showed onaverage patients from RAC had shorter length of stay than patients admitted to the wardsby A&E.Conclusion: he results showed that patients admitted via the RAC had shorter durationof stay than patients who had been referred directly from A&E. On average patientsadmitted through the RAC were discharged 1.5 days earlier than those who were directadmissions from A&E. Furthermore the RAC prevented further admission by dischar-ging 41% patients via this Unit.
199 A PHYSIOTHERAPY QUALITY INITIATIVE FOR THE PRE-OPERATIVE CARE OF AMPUTEE PATIENTS WITHIN ANACUTE LEVEL 4 TEACHING HOSPITAL
Background: Over 4,000 Irish people are currently living with an amputation(Irishhealth.com, 2010). In 2015, a profile of MMUH amputee patients showed 71.43%were over 65. The 2015 audit of the amputee service showed that only 57.14% ofpatients were referred to physiotherapy pre-amputation. Best-practice guidelines state“Early assessment and planning of rehabilitation ….helps to prepare the patient forrehabilitation. A pre-amputation consultation also enables the physiotherapist to giveappropriate advice, information and reassurance..” (BACPAR Guidelines, 2006).Methods: Auditing all patients referred to physiotherapy for amputee rehabilitation in2015.Acquiring data from hospital information systems, determining the number of trans-
femoral amputations (TFA) and trans-tibial amputations (TTA), date of surgery, date ofphysiotherapy referral and date of initial physiotherapy visit.Education sessions held with vascular surgical team and CNM regarding pre-operative
physiotherapy benefits.Posters created & placed on relevant wards, promoting pre-operative referrals.Amputee database set up for physiotherapists to access, containing relevant
information.Re-audit of the amputee service carried out for the first quarter of 2016 (January-
March).Results were compared with 2015 amputee audit.
Results: The first quarter of 2016 found 7 TTA & TFA surgeries were carried out on 6patients.Of these 7 surgeries, 5 were referred to physiotherapy pre-operatively (71.43%), com-
pared to 57.14% in 2015.Of these 5 referrals, 4 were subsequently seen by a physiotherapist before surgery
occurred (80% of patients).
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1 patient not seen pre-operatively despite being referred, as referral was sent at theweekend.Conclusions: The number of patients being referred pre-operatively in the first quarterof 2016 has improved on the 2015 audit, however our Key Performance Indicator(75%) has yet to be reached. Strategies to improve numbers of pre-operative referralsneed to be further explored to maximize pre-operative physiotherapy among amputeepatients.
200 RELATIONSHIP BETWEEN PREVALENCE (AND AWARENESS)OF AGE-RELATED MACULAR DEGENERATION AND PLASMACONCENTRATIONS OF LUTEIN AND ZEAXANTHIN IN ANOLDER POPULATION
Rachel Moran1, John Nolan1, Jim Stack1, Aisling M. O’Halloran2, Joanne Feeney2,Kwadwo O. Akuffo1, Rose Anne Kenny2, Stephen Beatty11Waterford Institute of Technology, Waterford, Ireland2University of Dublin, Trinity College, Dublin, Ireland
Background: Lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ) comprise of macu-lar pigment, which protects against age-related macular degeneration (AMD) and opti-mises visual function. This study investigated the relationship between AMD (andawareness) and plasma concentrations of L and Z, in The Irish Longitudinal Study onAgeing (TILDA).Method: Baseline demographic and health variables including the participant’s useof supplements and awareness of AMD were collected. Plasma was analysed forconcentrations of L and Z by high-performance liquid chromatography. Retinalphotographs were graded using a modified version of the InternationalClassification and Grading System for AMD. For this report (n = 4563), we cate-gorised participants into three groups- Group 1: grading-confirmed AMD in associ-ation with self-reported AMD (n = 70); Group 2: grading-confirmed AMD in thoseself-reporting no AMD (n = 264); and Group 3: grading revealed no presence ofAMD and self-reported no AMD (n = 4229).Results: Plasma L and Z were both significantly higher in Group 1, when comparedwith Group 2 (p = 0.003 and p = 0.017, respectively) and Group 3 (p < 0.0005 and p =0.007, respectively). Interestingly, significantly more participants were supplementing inGroup 1 (56.5%), compared with Group 2 (19.9%) and Group 3 (18.8%) (p < 0.0005).Participants with a known positive family history of AMD also had a higher prevalenceof the condition (p = 0.005), and dietary supplementation was higher in association with aknown family history of AMD (p < 0.0005).Conclusion: These findings indicate that plasma concentrations of L and Z were sig-nificantly higher in association with confirmed presence of AMD, awareness of AMD,and supplement use. Of the 334 participants with AMD, 264 participants (79%) wereunaware they were afflicted with the condition. Given the findings of AREDS 2, andthe known benefits of supplementation for participants with non-advanced AMD,these results provide a rationale for the consideration of AMD screening amongstolder adults.
202 SPECIALIST COMMUNITY NURSING UNIT: EMERGENCYTRANSFER RATES TO ACUTE HOSPITAL
Aoife Leahy1, Brian Drumm2, Frances McCarthy11St. Mary’s Hospital Phoenix Park, Dublin 15, Ireland2UCD Medical School, Dublin 8, Ireland
Background: Our community nursing unit cares for 186 long stay nursing homeresidents. This unit has access to daily geriatrician led medical and multidisciplinaryteam input on a referral basis. Three monthly reviews ensure residents have accessto comprehensive geriatric assessment and provide an opportunity for the team todiscuss advance care plans. Extended care units have been criticised due to hightransfer rates to the acute hospital. We investigated transfer rates in our nursingcare model.Methods: We retrospectively reviewed the medical charts of all residents who had anemergency transfer from our facility from January 2015 to January 2016. We obtainedbaseline demographic information, indication for transfer, length of stay and survivalrates post transfer. Number of medical reviews during study period was calculated. Wedetermined the number of residents who had died, assessed place of death and DNARstatus of patients.Results: In the study period, there were 21 patients who had 24 transfers. Our transferrate was 12.9 transfers per 100 beds per year. Reasons for transfer were classified asmedical (45%), surgical (30%) and ED review (25%). Mean length of stay in acute hos-pital was 5.8 days. 90% of patients survived their hospital admission and were trans-ferred back. (n = 19). 2 patients died during their admission. Number of medicalreviews by our onsite staff ranged from 5 to 46 in the year period. There were 58deaths during the study period with 96% dying in our unit, all with advance care plansin situ.Conclusion: The transfer rate of 12.9 is much lower than previous studies. Due to onsite medical staff, the majority of medical problems are managed on site. The emphasis
of advance care planning during our 3 monthly reviews has meant that the majority(96%) of the residents die in their home environment.
203 EXPLORING PATIENTS UNDERSTANDING OF ADVANCEHEALTHCARE DIRECTIVES: A SNAPSHOT FROM A CARE OFTHE OLDER PERSON ASSESSMENT UNIT
Anne Shekleton, Dzulkarnain Khalil, Bláithín Ní Bhuachalla, Mian Basit, Martin Mulroy,Olwyn LynchOur Lady of Lourdes Hospital, Drogheda & Louth County Hospital, Dundalk, Co.Louth, Ireland
Background: An Advance Healthcare Directive (AHD) is an advance expression madeby a person with capacity, outlining their wishes and preferences relating to medical treat-ment decisions, potentially arising if they were to subsequently lack capacity or couldn’texpress preference. The Assisted Decision-Making (Capacity) Act 2015 provides a legisla-tive basis for Advance Healthcare Directives in Ireland. This study aimed to determine ifpatients attending a Care of the Older Person Clinic were familiar with AHD’s and assessif this was something they wished to discuss.Methods: A questionnaire was designed with the following 3 questions 1) Have youheard of an Advanced Care Directive? 2) Would you like the topic discussed at this visit?3) If yes, would you be interested in doing an Advance Care Directive in the future? Awritten explanation of an AHD was included. A Clinical Nurse Specialist assisted thepatient in completion and provided further clarification. Patients attending clinics in theAssessment Unit over one month were invited to participate. Individual cognitive scoreswere also recorded. Questionnaires were excluded when the patient could not understanddue to cognitive impairment.Results: Thirty-nine patients consented to completing the questionnaire however 4 weresubsequently excluded secondary to severe cognitive impairment. Of 35 patients, 94% (n= 34) did not know what an AHD was. Only 34% (n = 12) wished to discuss it furtherand of those 83% (n = 10) reported they would consider making one in the future. While20% had normal cognition or mild impairment, the majority had moderate impairmenton objective cognitive testing.Conclusions: While the majority of patients had objective cognitive impairment, this isnot unusual in Care of the Older Person Clinics, where advance healthcare directives arelikely to be pertinent. The findings suggest poor baseline understanding of ADH’s and inthis cohort, little interest in making one.References:1. Chan, J. S., Kaiser, J., Brandl, M., Matura, S., Prvulovic, D., Hogan, M. J., Naumer, M.
J. (2015). Expanded temporal binding windows in people with mild cognitive impair-ment. Curr Alzheimer Res, 12(1), 61–68.
2. SettiA., Burke, K. E., Kenny, R. A., Newell, F. N. (2011). Is inefficientmultisensory processing associated with falls in older people? Exp Brain Res, 2209,375–284.
204 QUANTITATIVE TIMED UP AND GO TO MEASURE FALLSRISK AND FRAILTY LEVELS IN ELDERLY PATIENTS POST HIPFRACTURE
Grace Coakley1, Dara Meldrum2
1Cappagh National Orthopaedic Hospital, Dublin, Ireland2Royal College of Surgeons in Ireland, Dublin, Ireland
Background: Falls risk assessment is necessary post-hip fracture and is recommendedby NICE guidelines. The assessment of frailty is important in the rehabilitation of hipfracture patients as it can be predictive of outcome. The Quantitative Timed Up and Go(QTUG) is a novel assessment which involves the use of inertial sensors and providesestimates of falls risk and frailty levels. The aim of this study was to compare the QTUGfalls risk and frailty estimates with clinical outcome measures of Tinetti Gait and BalanceAssessment and Clinical Frailty Scale (CFS).Methods: A prospective cohort study was conducted sampling participants post hip frac-ture admitted to a sub-acute rehabilitation unit (n = 16). Falls risk and frailty level esti-mates generated from QTUG were compared to Tinetti and CFS at two time points,admission and discharge.Results: There were significant improvements in both QTUG falls risk and frailty levelestimates and clinical outcome measures of Tinetti and CFS between admission and dis-charge (p < 0.05). There was a strong negative correlation between the QTUG falls riskestimate and Tinetti scores on admission (r = −0.67, p = 0.004) and discharge (r =−0.76,p = 0.001), although QTUG estimated a greater percentage of participants as at high riskof falls than Tinetti (QTUG rated 50% of participants at high falls risk compared to12.5% as rated by Tinetti). There was no relationship between QTUG frailty level andCFS on admission (r = 0.22, p = 0.41), however there was a strong correlation on dis-charge (r = 0.70, p = 0.003).Conclusion: The QTUG provides multifactorial falls risk assessment which may bemore clinically useful than Tinetti, while the QTUG frailty estimate was unable to distin-guish between patients on admission but may be useful on discharge. Further researchshould investigate use of QTUG for longitudinal follow up to assess predictive ability offalls risk and frailty level estimates.
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205 PHYSICAL ACTIVITY MODULATES GEOGRAPHICALVARIATIONS IN COGNITIVE AGEING: RESULTS FROM THEIRISH LONGITUDINAL STUDY ON AGEING
Marica Cassarino, Annalisa SettiUniversity College Cork, Cork, Ireland
Background: Recent evidence indicates that rural individuals show poorer cognitive per-formance than urban dwellers. Urban environments offer a wider range of cognitivestimulation, and are associated with higher levels of tonic arousal. A cross-sectional asso-ciation between urban living and better performance in global cognition (MontrealCognitive Assessment, MoCA) has been found after controlling for individual level fac-tors (Cassarino, O’Sullivan, Kenny & Setti, 2015). Another study found a non-linear rela-tionship between land-use mix and dementia. The present study aimed to assess whetherthe cognitive disadvantage of living in a rural environment may be compensated by modi-fiable lifestyle factors, i.e. physical activity. We hypothesised that levels of physical activitywould modulate cognitive performance especially for rural dwellers, who most need cog-nitively stimulating activities.Methods: Cross-sectional analyses of MoCA were conducted for healthy Irish peopleaged 50+ participating in Wave 1 of The Irish Longitudinal Study on Ageing, in relationto the interaction between levels of physical activity measured through the InternationalPhysical Activity Questionnaire, and residence either in urban, suburban, or rural areas,while controlling socio-demographic, health, and other lifestyle factors.Results: After controlling for confounders, engaging in vigorous weekly physicalactivity modulated the association between environment of residence and global cog-nition, with physically active rural participants showing no differences from the urbangroup in terms of MoCA scores. No interactions were found for the otherenvironments.Conclusions: The results support the hypothesis that engaging in physical activity cancompensate for urban-rural differences in cognitive performance in ageing. The findingshave implications for the promotion of lifestyle initiatives tailored to the environment ofresidence.References:1. Cassarino, M., O’Sullivan, V., Kenny, R. A., & Setti, A. (2015). Environment and
Cognitive Aging: A Cross-Sectional Study of Place of Residence and CognitivePerformance in the Irish Longitudinal Study on Ageing. Neuropsychology, NoPagination Specified. http://doi.org/10.1037/neu0000253
206 FALLS RATE IN A POST-ACUTE REHABILITATION SETTINGAND THE IMPACT ON PATIENT OUTCOMES
Caitriona Tiernan, Marie Smith, Lisa CoganThe Royal Hospital Donnybrook, Dublin 4, Ireland
Background: Inpatient falls remain the most commonly reported patient safety incident.The UK National Audit of Inpatient Falls 2015¹ report a rate of 6.63 falls per 1000 occu-pied bed days (OBDs) for acute hospitals. Our study looks at the falls rate in a 42 bedoff-site post-acute rehabilitation elderly unit and provides a descriptive account of thecharacteristics and outcomes of those who fell.Methods: The number of falls for the period June 2014 to December 2015 was recordedon our incident report register. Age, length of stay (LOS), admission and dischargeBarthel Index (BI), cognition, indication for rehabilitation, number of medications andoutcomes were recorded.Results: The falls rate was 4.1 falls per 1000 OBDs. There were 63 falls, with 43 individ-ual patients falling. 10 patients fell multiple times (range: 2–7). The median age was 82(range 64–98). 49% (21/43) were admitted following a fracture. 55.8% (19/43) had cog-nitive impairment on formal testing. 5 falls (8%) resulted in a fracture (5/63). The mediannumber of medications per patient was 7 (range 2–11). Those who fell multiple timeshad a longer median LOS (109.5 days vs 48.5 days), a smaller improvement in BI (2.75vs 3.87), were more cognitively impaired (90% vs 45%) and more likely to sustain a frac-ture (30% vs 3%). 9% (4/43) were discharged to nursing home care.Conclusion: Our falls rate of 4.1 per 1000 OBDs compares favourably to UK figures.The negative impact of falls was reflected in our study where patients who had multiplefalls had longer LOS, were more likely to sustain a fracture and be discharged to nursinghome care. We must continue to improve falls prevention through multi-factorial fallsrisk assessments linked with quality improvement projects.Reference:1. Royal College of Physicians. National Audit of Inpatient Falls: audit report 2015.
London: RCP, 2015.
207 HOSPITAL ADMISSION AND MORTALITY FROM ANENHANCED NURSING HOME CARE FACILITY
Aoife Leahy, Caitriona Tiernan, Brian Drumm, Lisa CoganThe Royal Hospital Donnybrook, Donnybrook, Dublin, Ireland
Background: The nursing home population is vulnerable to acute illness due to advancedage, multiple comorbidities and high levels of dependency. Hospital admissions from nurs-ing homes remain common with annual transfer rate of 30%1. Our centreprovides specialist geriatrician led comprehensive geriatric assessment and advancedcare planning. We evaluated our transfer rate to the acute hospital and associated mortality.
Methods: The number of patients transferred to the acute hospital from our complexcare unit for the period September 2013 to September 2015 was captured. (n = 23). Theclinical indication for transfer, their length of stay and mortality was recorded. We exam-ined the clinical notes of residents who died during this period to determine the place ofdeath and presence of an advanced care plan.Results: For the two year period there were a total of 37 transfer episodes. This is atransfer rate of 34.2 per 100 beds per annum. 57% of these were transferred for acutesurgical issues, the remainder for medical reasons. Mean length of stay was 6 days (range1-18).The median was 3 days. 91% of residents survived their hospital transfer and 83%were alive at 3 months. Over the same period, 29 residents died with 93% dying in thenursing home. 96% of residents died with an advanced care plan in place.Conclusions: We have found that the patients who were transferred were appropriately trans-ferred and survived their transfer after undergoing specialist intervention which was unavailablein our setting. The existence of structured and clear advanced care plans has resulted in themajority of our residents (93%) dying in the familiar surroundings of the nursing home.Reference:1. Arendts et al. The interface between residential aged care and the emergency depart-
ment: a systematic review. Age Ageing 2010; 39(3):306–12.
208 INTRA-INDIVIDUAL DIFFERENCES IN SUSCEPTIBILITY TOTHE SOUND-INDUCED FLASH ILLUSION
Jason Chan, Shannon Connolly, Annalisa SettiUniversity College Cork, Cork, Ireland
Background: The Sound-induced Flash Illusion-the illusory perception of two flasheswhen one flash is presented with two beeps; is associated with cognitive and functionalproblems in older adults. The illusion occurs within ~100ms of Stimulus OnsetAsynchrony (SOA) in younger adults and ~300ms in older adults, but intra-individualsusceptibility to this illusion in older adults is unknown. Understanding intra-individualdifferences is necessary to establish the robustness of the illusion for clinical testing. Thepresent study assessed whether experimental context modulates the illusion.Methods: 29 participants (18 female; M = 67.9, SD = 5.7) were given a long and shortversion of the SiFi. The long version included 5 SOAs (70–230ms) and the short versionincluded 3 SOAs. Additional SOAs should reduce the illusion in the long version.Unimodal and multi-sensory control conditions were also presented.Results: There was increased sensitivity (d’) in the long version compared to the short(long, mean = 3.4; short, mean = 1.2; p = 0.04). There were no differences in the controlconditions. These data suggest that older adults make create use all trials to develop strat-egies to perform a task.Conclusions: Previous research has proposed the use of the SiFi as a non-verbal diag-nostic tool to detect MCI (Chan et al., 2015) as well as for fall-prone older adults (Setti,et al., 2011). This highlights the need for the standardisation of the SIFI for use inresearch and as a clinical assessment tool.References:1. Chan, J. S., Kaiser, J., Brandl, M., Matura, S., Prvulovic, D., Hogan, M. J., Naumer, M.
J. (2015). Expanded temporal binding windows in people with mild cognitive impair-ment. Current Alzheimer Research, 12(1), 61–68.
2. Setti, A., Burke, K. E., Kenny, R. A., Newell, F. N. (2011). Is inefficient multisensoryprocessing associated with falls in older people? Experimental Brain Research, 2209,375–284.
209 QUANTITATIVE ANALYSIS OF THE TIMED UP AND GO INELDERLY PATIENTS POST HIP FRACTURE IN A SUB-ACUTEREHABILITATION SETTING
Grace Coakley1, Dara Meldrum2
1Cappagh National Orthopaedic Hospital, Dublin, Ireland2Royal College of Surgeons in Ireland, Dublin, Ireland
Background: The Timed Up and Go is a reliable and valid outcome measure to assesschange in patients post hip fracture. Advances in technology have used inertial sensorsfor the quantitative analysis of the Timed Up and Go (QTUG) and enhanced the scopefor harnessing information from the test. However, no studies have investigated their usein hip fracture patients. The aim of this study was to investigate the use of the QTUG inthe assessment of hip fracture patients in a sub-acute geriatric rehabilitation setting.Methods: Sixteen participants post hip fracture admitted to an inpatient post-acuterehabilitation unit were assessed on admission and at discharge using the QTUG.Individual phases of QTUG (sit-stand, walk, turn and stand-sit time) were comparedbetween admission and discharge, as well as spatiotemporal characteristics of gait.Results: There was a significant improvement in the overall mean QTUG times betweenadmission and discharge ( -9.3 seconds; 95% CI 5.6 to 12.9, p < 0.001). Each individualphase of the QTUG (sit-stand, walking, turning, stand-sit) also showed statistically signifi-cant improvements. There was no change in the proportion of overall time spent per-forming each phase of the QTUG between admission and discharge, demonstrating eachcomponent improved proportionally.When data were compared to normative data for community-dwelling elderly, 31% of
participants remained greater than 2 SDs outside of normative data for overall TUGtime, 25% for walk time and 13% for turn time. All participants had returned to normalranges for sit-stand and stand-sit transitions.Conclusion: QTUG is a useful outcome measure for assessing patients undergoingrehabilitation post hip fracture. While each phase of QTUG improved proportionately,
the QTUG was useful in comparing patient’s outcomes to normative data and identifyingareas which required further rehabilitative input.
211 THE IMPACT OF THE NURSING HOME SUPPORT SCHEME(FAIR DEAL SCHEME) ON LENGTH OF STAY IN A PUBLICLONG TERM CARE FACILITY
Lisa Cogan, Caitriona Tiernan, Brian Drumm, Morgan CroweThe Royal Hospital Donnybrook, Dublin 4, Ireland
Background: The Nursing Home Support Scheme (Fair Deal) was introduced in 2009.The stated objective of the scheme was to ensure more equitable access to nursing homecare based on the principle of ability to pay. We evaluated 10 years of prospectively col-lected data from patients over the age of 65 years admitted for long term care to a 66bed public nursing facility to determine if patient characteristics had changed post theintroduction of the Fair Deal scheme.Methods: Our facility provides specialist geriatrician led comprehensive geriatric care.Components of care include multidisciplinary input, enhanced nursing care and advancedcare planning. All residents who died during the 10 year period 2006 to 2015 wererecorded. Age on admission, gender, length of stay and age on death were recorded.Residents were divided into two groups: Pre Fair Deal i.e. residents admitted prior toNovember 2009 and Fair Deal i.e. residents admitted under the Fair Deal Scheme.Results: There were 112 deaths in the Pre Fair Deal cohort. 40 males (35.7%) and 72females (64.3%). Average age on admission was 81 years. The average length of stay was2,027 days (5.5 years). The average age on death was 86.6 years. There were 30 deaths inthe Fair Deal cohort. 11 males (36.6%) and 19 females (63.3%). Average age on admis-sion was 84 years. The average length of stay was 790 days (2.2 years). The average ageon death was 86 years.Conclusion: Our data shows that since the introduction of the Fair Deal scheme thelength of stay for nursing home patients reduced. This can be explained by the highercomplexity and comorbidities of patients who are referred to public facilities through theFair Deal scheme. It highlights that these patients have complex care needs and requireon-going comprehensive geriatric care.
212 USE OF THE MALNUTRITION UNIVERSAL SCREENING TOOLIN A CARE OF THE OLDER PERSON ASSESSMENT CLINIC
Dara McGeough, Nicola McShane, Chris Carroll, Mian Basit, Martin Mulroy,Olwyn Lynch, Bláithín Ní BhuachallaOur Lady of Lourdes Hospital, Drogheda & Louth County Hospital, Dundalk, Co. Louth, Ireland
Background: Malnutrition is a state of insufficient intake or uptake of nutrients, result-ing in weight loss and measurable adverse effects on body composition, function andclinical outcome. Frail older patients are at risk of malnutrition. In 2013 it was publishedthat <10% of Irish hospitals screen for malnutrition, despite it contributing to increasedmorbidity and health care utilisation. Malnutrition affects 14300 Irish adults, 93% of theseresiding in the community. The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool to identify adults, who are at risk of malnutrition or are malnourishedor obese. It is validated for use in hospitals, the community and other care settings.Methods: A clinical database was established in the Care of the Older PersonAssessment Unit. From the beginning of April 2016 the MUST tool was introduced as amandatory part of the assessment for all patients attending two of the multidisciplinaryConsultant-led Clinics.Cross-sectional analysis was then undertaken of the prevalence of referrals to the pri-
mary care dietitian pre and post the introduction of the MUST tool.Results: Over a 9 month period 6% (n = 11) of 183 new patients were referred to theprimary care dietitian for review. Since the introduction of MUST, over an 8 week period22% (n = 11) of 50 patients were referred.Conclusions: These findings reflect known national numbers from the NutritionScreening week (2011). The survey was conducted in conjunction with BritishAssociation of Enteral and Parenteral Nutrition, using the MUST Tool and found 27%of patients admitted to the acute hospital setting were at risk of malnutrition. Our dataconfirms the need for nutritional review within comprehensive geriatric assessment inambulatory care. These findings have prompted MUST to be introduced for all patientsassessed and the establishment of a Dietitian-led clinic within the Older PersonAssessment Unit.
213 A REVIEW OF PRESCRIBING PRACTICES IN SECONDARYPREVENTION OF OSTEOPOROTIC FRACTURES IN AREHABILITATION FACILITY
Background: Osteoporosis is a systemic skeletal disease, resulting in an increased sus-ceptibility to fracture. Fragility fracture is a leading risk for further fracture and shouldprompt initiation of therapies which have been shown to confer as much as a 50% reduc-tion in risk of fracture within 3 years(1). Previous studies have shown that while rates ofprescription of anti-osteoporotic medication has increased over the last 2 decades itremains sub optimal(2). The rehabilitation period is an opportune time to implementbone health regimes but can be challenging given the frailty and medical co morbidities
of this particular population. We aimed to examine the prescribing practices in patientswith osteoporotic fractures on discharge from a rehabilitation facility.Methods: We reviewed discharge summaries and prescriptions for fifty consecutivepatients discharged from a rehabilitation hospital, whose primary reason for admissionwas fracture.Results: Hip fractures were the most common fracture (72%, n = 36), followed by verte-bral fractures (8%, n = 4). The majority of patients were female (76%, n = 38) and theaverage age was 82.9 years. 74% of patients were discharged on anti-resorptive treatment(n = 37). 20% of patients were discharged on either calcium or vitamin D replacementalone (n = 10), and 1 patient was discharged on no treatment. There was no informationavailable for 2 patients. Denosumab was the most common anti-resorptive agent, used in29 of the 37 patients (78%). Of those who were discharged on bisphosphonates (n = 8)all had a satisfactory eGFR.Conclusions: Rehabilitation facilities may offer potential for future fracture preventionas 74% of patients (a higher percentage than reported in prior studies) were dischargedon anti-resorptive therapy and a further 20% on combined calcium and Vitamin D.Reasons for non-initiation of therapy were not investigated in this study but may relate toco-morbidity and reduced life expectancy of this frail older population.
214 IMPROVING EFFICIENCY OF LONG TERM CARE REFERRALSTO THE MEDICINE FOR THE ELDERLY SERVICE
Ciara Nolan, Naomi Davey, Nicola Faichney, Riona Mulcahy, John Cooke, George PopeUniversity Hospital Waterford, Waterford, Ireland
Background: Differing pathways and processes exist throughout the country for anapplication into long term care. This invariably involves a Common SummaryAssessment Report (CSAR) which identifies the need for long term nursing care.
This audit was prompted by the extended non urgent Geriatrician outpatient appoint-ment times. The aim of the audit was to determine if referrals sent to the Geriatricdepartment contained adequate information to assist geriatricians in determining suitabil-ity for LTC (long term care).Methods: This was a retrospective chart review of long term care applicants. Charts ofpatients who had a CSAR completed following Geriatric clinic review were audited overa three month period. Referral letters from Primary Care were collected and dataextrapolated.Results: Of the 30 charts reviewed, only 13 had specific referrals for LTC assessment.The majority of referrals had patient details and existing medical conditions. 2/30reported whether a home care package existed. 1/30 gave an opinion on whether thispackage was sufficient or required optimization. 3/30 letters included the applicant’swishes and 0/30 had details on whether the patient had the capacity to consent for LTC.Conclusion: Primary care referrals for LTC consideration were shown to be sub-optimalregardless of the small sample size. Patients’ preferences, wishes and capacity must beconveyed in addition to reversible disease. Information on patients ongoing care needs isoften not reported when referred.
The primary care team are ideally placed in the community to assess the increasingcare requirements of their patients compared to those in hospital services and hencemight be in the best position to complete LTC applications for those who have consentedor have the capacity to refuse.
This would allow those patients requiring Geriatric Consultant input to assess capacityor investigate reversible disease to be expedited through the service.
216 INNOVATION OF AN ELECTRONIC EXECUTIVE DASHBOARD FOR A POST-ACUTE CARE SERVICE:CAPTURINGACTIVITY, QUALITY INDICATORS AND EVALUATINGFUTURE SERVICE NEED
Background: A 74-bed post-acute care service (PACS) was developed in 2011 toaddress the high proportion of acute beds that were being utilised by patients with com-plex discharge needs, no longer requiring acute hospital care. The aim of the service is toassist with alleviating the acute hospital, long-term care (LTC) avoidance and enablepatient’s transition from hospital to home.Methods: A small project team was set up including a clinical nurse manager, consult-ant geriatrician, operations managers and information analyst/ statistician. The projectteam set out to identify required key data that could be automatically extracted fromthe hospital’s existing information technology system that would allow capturing ofactivity levels in keeping with quality metrics. The information display would allowplanning and projection of future service provision. The project group also proposedthat the dash board would collate information on the patient cohort with the mostcomplex discharge needs.Results: A functioning PACs dash board has been incorporated onto the executivehigh-level hospital dash board. The key metrics integrated include; average age, the per-centage of patients discharged to LTC, percentage discharged home, admission source,admission and discharge numbers, the length of stay(LOS) in PACS and overall LOSfrom admission to the acute hospital setting to discharge from post-acute setting andnumber of deaths. To date, the implementation of the dash board has allowed manage-ment to monitor quality indicators such as the number of patients discharged to LTC
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and preempt future capacity requirements for the cohort of patients with complex dis-charge needs.Conclusions: This innovative PACS dash board has been utilised as a mechanism tofacilitate automated visual data and information that can be utilised in a multitude of dif-ferent roles; including quality management, projecting capacity and in developing thefuture strategy for service improvement.
217 ASSOCIATION BETWEEN ANAEMIA AND OSTEOPOROSIS INCOMMUNITY DWELLING OLDER ADULTS
Elaine Shanahan, Aine Costelloe, Tina Sheehy, Sheila Carew, Catherine Peters,Margaret O’Connor, Declan LyonsUniversity Hospital Limerick, Limerick, Ireland
Background: Scientific studies have reported that osteoblasts are involved in haemato-poietic stem cell activity with osteoblast ablation leading to loss of bone marrow cellular-ity. Osteoporosis is known to be associated with a reduction in osteoblast number andactivity. Osteoporosis has also been shown to be associated with increased bone marrowfat content. This may relate to changes in mesenchymal stem cells differentiation tofavour adipogenesis over osteoblastogenesis. This change in bone marrow type couldresult in a reduction in haemopoiesis. We therefore hypothosise that older, otherwisehealthy adults with osteoporosis are more likely to have anaemia than those withoutosteoporosis.Methods: DEXA scan and haemoglobin levels were obtained from 347 participants inthe HIACE study which was a cross-sectional study of community dwelling older adults.Mean haemoglobin levels were compared in those with osteoporosis, osteopenia and nor-mal DEXA scans. Univariate analysis was then carried out to adjust for the impact ofB12, folate and ferritin levels on haemoglobin.Results: 356 patients were included. 212 (60.1%) were female. 39.6% (141) had a nor-mal DEXA, 44.7% (159) had osteopenia and 15.7% (56) had osteoporosis. The meanhaemoglobin was 14.31 (SD 1.3) in those with a normal scan, 13.91 (SD 1.43) in thosewith osteopenia and 13.46 (SD 1.13) in those with osteoporosis (p < 0.001). Followingunivariate analysis the adjusted means are 14.23 (SE 0.1) for those with normal scans,13.93 (SE 0.1) for those with osteopenia and 13.58 (SE 0.2) for those with osteoporosis(p = 0.007).Conclusions: Reduced bone mineral density is associated with a reduction in haemoglo-bin levels even when B12, folate and ferritin levels are controlled for. The absolute differ-ences in haemoglobin levels may become more relevant in those with anaemia of othercauses.
218 THE IMPACT OF ELECTRONIC PATIENT MANAGEMENTSYSTEM (EPMS) ON POST-TAKE WARD ROUNDS AND THEPRODUCTION OF DISCHARGE LETTERS
Background: Our department has used digital patient management systems since 1997.In 2014 we instituted a program integrating all current systems, collectively referred to asePMS. The system was developed within the department by clinicians and has become anintegral part of clinical practice, from the admission process to the ongoing managementof patients and the development of a discharge summary. This study reports on theimpact this system has had on overall efficiency of patient management.Methods: The proportion of letters completed from 10th February 2015 to 10th April2016 (post ePMS) was compared to those completed from 1st October 2013 to 31stDecember 2014 (pre ePMS) for a single Geriatric service. A visual analogue scale (0-10with 5 being neutral), was used to rate doctors’ perceived benefit of ePMS in terms ofefficiency of post-take handover and post-take ward round, quality of and ease of gener-ating discharge letters and overall benefit to the ease of patient management from admis-sion to discharge.Results: From 2013-2014 35% of 1106 admission had completed electronic discharges.Since the introduction of ePMS 98.6% of 1321 admissions had a completed discharge let-ter. Using a visual analogue scale to assess the value of ePMS the post-take handover wasfelt to be 12% more beneficial than the standard paper based system. The conduct of thepost-take round and the generation of discharge letters were both 80% more efficientwith ePMS and the overall efficiency of patient management from admission to dischargewas improved by 50% with ePMS.Conclusions: Preliminary data following the introduction of ePMS indicates significantadvantage in terms of production of discharge summaries which are a key step in thetransfer of data from hospital to primary care. It also suggests a digitally driven handoverand post-take ward round is more efficient for doctors.
219 HYPERTENSION CONTROL ASSOCIATED WITH SLEEPAPNOEA SYNDROME IN A DUBLIN STROKE UNIT – APROSPECTIVE ANALYTICAL STUDY
Background: The incidence of stroke is closely related to systolic blood pressure (SBP)levels. Ambulatory blood pressure (ABP) values, lacking a normal nocturnal drop ofblood pressure (of about 10–20%) are at a particularly high risk for stroke. Sleep apneasyndrome (SAS) is underdiagnosed and raises nighttime SBP. We aim to evaluate BPfrom ward measurements and ABPM measurements and relate it to overnight pulseoximetry as an indicator of SAS.Methods: We selected a sample of 14 participants from our acute stroke ward. The vari-ables were average BP value on the ward on the day of assessment, ABP measurementsand presence of SAS criteria by pulse oximetry. The status of “dipper” (n = 8) was givento those with a ≥10% fall, “nondippers” (n = 6) with ≥0% but <10% fall; and “reverse-dippers” (n = 0) with <0% fall in the day time average BP.Results: The prevalence of uncontrolled BP was 21% on ward evaluation and 86% onABPM. This higher rate of pickup of hypertension was statistically significant as perFisher exact test (p = 0.0018). It was found that 71% had daytime hypertension, 71% hadnocturnal hypertension and 42% had a non-dipper profile. The prevalence of SAS was28.5%. We found a statistically significant association between SAS and non-dipper pro-file (p = 0.015) however associations between SAS and day time and nocturnal hyperten-sion were not statistically significant.Conclusions: ABPM showed a 65% increased sensitivity compared to ward BP values atdetecting poor BP control. SAS is strongly associated with the “non dipper” profile. Thiswork reinforces the importance of ABPM in the control of hypertension which is the big-gest risk factor for stoke. Our findings indicate that SAS is a significant cause secondarycause of hypertension in these patients which can be quickly screened for in a non-specialist setting.
221 RELATIONSHIP BETWEEN SKELETAL MUSCLE MASS ANDORTHOSTATIC HYPOTENSION
Elaine Shanahan, Tina Sheehy, Aine Costelloe, Catherine Peters, Declan Lyons,Margaret O’ConnorUniversity Hospital Limerick, Limerick, Ireland
Background: Venous pooling is a normal phenomenon that occurs during standing. It isnormally compensated for rapidly by vasoconstriction and muscle pump activity. Skeletalmuscle therefore plays an important role in promoting venous return and maintainingblood pressure (BP) during standing. We therefore hypothesise that reduced skeletal mus-cle mass would be associated with larger postural BP drops and more orthostatic hypo-tension (OH).Methods: We retrospectively identified all patients that had a Whole Body DEXA andHead Up Tilt (HUT) test carried out in our diagnostic unit in a similar time period.Results of Active Stand(AS) were also recorded where done. Skeletal Muscle Index (SMI)was used to define sarcopenia.Results: 37 patients had a Whole Body DEXA and HUT. 36 also had an AS. 18.9% (7)had sarcopenia. 85.7% (6) of sarcopenic patients had OH on HUT compared to 75%(18) of the controls (X2 = 1.67, p = 0.19). The mean drop in Systolic BP (SBP) was 30mmHg in those with sarcopenia and 22 mmHg in the control group (p = 0.248). Themean drop in Diastolic BP (DBP) was 11.9 mmHg in those with sarcopenia and 8.3mmHg in the controls (p = 0.254).28% (2) of patients with sarcopenia had OH on AS compared to 23.3% (7) of the con-
trols. (X2 = 0.3, p = 0.86). The mean drop in SBP in those with sarcopenia was 3.42mmHg compared to 0.48 mmHg of the controls (p = 0.5). The mean drop in DBP was−1.4 mmHg in those with sarcopenia compared to 0.7 mmHg of the controls (p = 0.4).Conclusions: This study does not show any strong association between skeletal musclemass and OH however this may be largely related to the small sample size. This studydid not look at skeletal muscle function, which is also a key component of sarcopenia,and is likely to play a role in the skeletal muscle pump.
222 CHARACTERISATION OF MEDICATION ERRORS IN A NORTHDUBLIN REHABILITATION HOSPITAL
S Maxwell1, SKK Lee2, L Murnane1, L Brewer21Incorporated Orthopaedic Hospital of Ireland, Dublin, Ireland2Beaumont Hospital, Dublin, Ireland
Background: A medication error is any preventable event that may cause or lead toinappropriate medication use or patient harm while the medication is in the control ofthe healthcare professional, patient or consumer. We aim to characterise the types ofmedication errors detected in the over 65’s transferred to a 160 bed rehabilitation hospitalaccepting admissions from Dublin acute hospitals.Methods: A retrospective case series was conducted from January 1st to December 31st2015 inclusive using patient medication administration records and medication incidentreporting forms. Data on patient demographics and the National Coordinating Councilfor Medication Error Reporting and Prevention (NCC MERP) Index for categorisingmedication errors algorithm were collated.Results: 1663 adults were admitted during the study period. 155 medication errors wereidentified, of which 116 occurred in patients >65 years (average of 9.6/month). Femalespredominated (58.6%, n = 68), with a mean age of 78.9 years (range 65–94 years).Orthopaedic and Geriatric Rehabilitation patient medication errors occurred with similarincidence (53.4% vs 46.6% respectively). NCC MERP categories were (i) A = 0 (ii) B =32.8% (n = 38) (iii) C=56.0% (n = 65) (iv) D = 10.3% (n = 12) and E = 0.9% (n = 1;
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patient required monitoring and management of blood glucose with an insulin slidingscale, having missed a dose of Levemir®).The prescribing stage accounted for 71.6% (n = 83) of medication errors. The types of
prescribing errors were: Incorrect frequency (25.0%, n = 29), drug omission (22.4%, n =26), incorrect dosage (15.5%, n = 18) and duration (13.8%, n = 16). Common drugsinvolved included NOACs (15.5%, n = 18), anti-hypertensives (9.5%, n = 11) and antibio-tics (8.6%, n = 10).Conclusions: In-patient prescribing errors were common. Medication review and recon-ciliation are needed to optimise patient safety and reduce errors.
224 AUDIT OF FRID (FALL RISK INDUCING DRUGS)RATIONALISATION IN AN ACTIVE REHABILITATION UNIT
Sarah Gorey, Nadege Barro, Dermot PowerCappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland
Background: Polypharmacy, especially with FRIDs is a recognised risk factor for falls.FRIDs include antihypertensives, antidepressants, antipsychotics, antihistamines, antie-metics, anticholinergics, opioid analgesia and hypnotics. A medication review is a simple,cost neutral measure to decrease the risk of falls in older adults.Methods: A retrospective review of admission and discharge prescriptions, over threemonths, of patients aged 65 and older, at a rehabilitation unit, linked to a tertiary hospital.Emphasis was placed on the prescribing and deprescribing of FRIDs. The majority ofpatients were undergoing rehabilitation following a fall resulting in fracture.Results: 32 of 34 patients were prescribed polypharmacy (defined as >/= 4 medica-tions) on admission. All 34 discharge prescriptions prescribed polypharmacy. 32 of34 patients had FRIDs included in their prescription on admission, compared with30 of 34 patients on discharge. Overall, 23 FRIDs were deprescribed, but 18 newFRIDs were prescribed. There was an absolute reduction of 17 FRIDs. The cumula-tive number of FRIDs on admission was 104. This was reduced to 87 FRIDs ondischarge prescriptions. The average number of medications per admission prescrip-tion was 10.5, 2.7 of which were FRIDs, compared with 12.6 on average on a dis-charge prescription, 2.5 of which were FRIDs. The FRIDs most likely to bedeprescribed were antidepressants/antipyschotics. The FRID most likely to be pre-scribed was opioid analgesia.Conclusions: Polypharmacy is common amongst elderly fallers. FRIDs are also fre-quently prescribed. In our practice, we deprescribe FRIDs, evidenced by the lower aver-age number of FRIDs on discharge than on admission. However, we also oftenintroduce new FRIDs. We should focus on weaning opioid analgesia before discharge.
226 PRIMARY BETA RELATED ANGIITIS: AN UNUSUAL CAUSE OFRAPIDLY PROGRESSIVE DEMENTIA
Laura Corkery, Denis Curtin, Kieran O’ConnnorMercy University Hospital, Cork, Ireland
Background: apidly progressive dementias (RPDs) develop sub-acutely over weeks tomonths, or rarely acutely over days. Causes include neurodegenerative, toxic/metabolic,infectious, autoimmune, neoplastic and prion diseases. Unlike most dementias, RPD canquickly be fatal. We describe a rare cause of RPD and suggest an algorithm outlining theinvestigative approach to the patient presenting with RPD.Case: An 81-year-old lady presented with a week-long history of confusion and pyrexiaon a background of mild cognitive impairment and falls. On examination, she was disor-ientated and did not recognise family members. She had no meningitic signs. Urine dip-stick indicated leucocytes. Chest radiograph demonstrated upper lobe calcification whileCT brain showed chronic microvascular changes. Initial working diagnosis was deliriumsecondary to urinary tract infection. Despite antibiotics, the patient remained confused,pyrexial, and increasingly dependent. Urine and blood cultures yielded no growth.Cerebrospinal Fluid (CSF) showed protein elevation (>2 g/L) and pleocytosis. Viral CSFPCR was negative. Following consultation with infectious disease and neurology services,empirical TB treatment was commenced -due to pyrexia, CSF findings, and chest radio-graph changes consistent with tuberculous exposure- as well as methylprednisolone, tomanage a possible autoimmune encephalopathy. Despite a modest initial response totreatment, the patient became progressively obtunded. Following discussion with family,comfort was prioritised. The patient died 21 days after admission. Autopsy identifiedcerebral amyloid angiopathy complicated by amyloid-beta related angiitis with multiplemicroscopic cerebral infarcts as cause of death.Conclusions: Primary beta related angiitis is an extremely rare condition. To date, lessthan 100 cases have been described. Clinical features include RPD, headache and focalneurological deficits. Investigations should focus on excluding infective, paraneoplastic/autoimmune differentials. Cerebral biopsy is the gold standard for diagnosis. While noconsensus on treatment exists, immunosuppression leads to significant improvement inmany patients. Relapse has been reported in 25% of initial responders.
227 FUNCTIONAL RECOVERY SCORE PREDICTS FRAILTY INOLDER HIP FRACTURE PATIENTS
Background: Functional Recovery Score (FRS) is a valid and reliable method of asses-sing functional outcomes in hip fracture patients. Hip fractures are more common in frai-ler older people with multiple comorbidities. This study aims to examine the correlationbetween pre fracture functional scores and clinical frailty.Methods: Prospective data collection on 30 consecutive patients (age>65) admitted withhip fracture over a 2 month period. Pre fracture functional and mobility outcomes wereassessed using the FRS and Barthel Index (BI). Frailty was assessed using Clinical FrailtyScale (CFS). The 11 items FRS comprised of 3 components: basic activities of daily living(ADL), instrumental ADL and mobility. A score of 100 indicates complete independence.Results: The mean age of the cohort was 83 years and 77% were women. 5 patients(17%) were Nursing Home residents. 47% (n = 14) were in the highest functional level prefracture (FRS 80–100) and 33% (n = 10) in the lowest (FRS <60). 37% (n = 11) scored20/20 on BI, indicating full independence while 13% (n = 4) had high dependency(BI=6–10). 30% (n = 9) were placed on scales 1 to 3 in the CFS (‘very fit’ to ‘managingwell’), and 23% (n = 7) were categorised as ‘severely frail’. Correlation between FRS, CFSand BI were analysed using Linear Regression model and Correlation Coefficient (r) calcu-lated. We show that FRS was highly correlated with CFS (r = −0.91). Similarly, there isgood correlation shown between CFS and BI with correlation coefficient (r) of −0.78.Conclusion: In patients with hip fracture, FRS yields important predictive informationon clinical frailty. This allows early identification of frailer cohort who will benefit themost from comprehensive geriatric care. FRS may be a better tool than BI to predictfrailty in hip fracture patients.
228 RE-AUDIT ON COMPLIANCE WITH HIP FRACTUREPROTOCOL
Alan Marrinan, Brendan Cummings, Shane Dunlea, Josephine Soh, Susan Van Der Kamp,Conor Hurson, Malachi McKenna, Rachael DoyleSt Vincent’s University Hospital, Dublin, Ireland
Background: Hip fractures are common cause of mortality and morbidity in olderpatients. Acute care and post fracture rehabilitation involve significant healthcareresources. The Hip Fracture Protocol was first introduced in 2014 and an initial auditwas completed during the same period.Methods: Retrospective analysis of 100 consecutive patients (age >65 years) admittedwith hip fractures. Patients were identified using the Irish Hip Fracture Database fromNovember 2015 to May 2016. The Hip Fracture Protocol involves:
(1) Blood tests for bone profile (calcium,phosphate,alkaline phosphatase),25OH-D andPTH
(2) Prescription of calcium & vitamin D supplements, and anti-resorptive agents(3) DXA requests for all patients on discharge
The cohort’s post fracture osteoporotic management was audited against the protocol.Results: The mean age of patients was 81 years and 71% were women. 53% had all therecommended blood tests done. 94% went home on calcium and vitamin D supplementsand 92% on bone protection therapy. Of the 92 patients, 63 were on oral bisphospho-nates and the remaining 29 prescribed Denosumab. 8 patients were discharged withoutbone protection therapy but only 3 patients had reasons documented in clinical notes.DXA requests were completed for all patients.
When compared to previous audit in 2014, compliance with prescription of osteopor-osis treatment is exactly the same (92% vs. 92%). However, there was a definite declinein compliance with measurements of biochemical markers: calcium and phosphate (88%in current audit vs 95% in 2014), vitamin D (57% vs. 92%) and PTH (54% vs. 92%).Conclusion: Excellent compliance was maintained in terms of prescribing osteoporosistreatment. However, improvement is needed in terms of measuring biochemical markersfor osteoporosis. We recommend formal induction and education sessions for all newteam members and that the audit cycle is repeated every 6 months to maintain standardsand improve care of hip fracture patients.
230 FRAIL INTERVENTION THERAPY TEAM: A STEP IN THERIGHT DIRECTION. EARLY ASSESSMENT IN THE EMERGENCYDEPARTMENT
Ciara O’Reilly, Paul Maloney, Eleanor Alexander, Paul Bernard, Yvonne O’Riordan,Donal Gill, Aoife Molloy, Martina Boyle, Sinead Cunneen, Mairi DonaldBeaumont Hospital, Dublin, Ireland
Background: Older people present to the Emergency Department (ED) with medicalconditions often further complicated by functional decline, cognitive deterioration andcomplex social care needs. Services for older patients should provide access to compre-hensive multi-disciplinary team (MDT) assessments and appropriate treatment in themost appropriate setting, without unnecessary delay or admission. Prior to September2015, Beaumont Hospital (BH) provided a responsive MDT service to the ED focusedon discharge facilitation.Methods: The Frail Intervention Therapy Team (FITT), a new MDT was established &based in the ED. The FIT team aimed to identify 100% of frail patients over 75 yearswho presented to the ED during core hours and provide a comprehensive MDT assess-ment. The team compromises of Physiotherapy, Occupational Therapy, Medical Social
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Work, Speech & Language Therapy, Dietetics, & Pharmacy. When the patient was identi-fied as frail, their care needs were established & appropriate MDT referrals were triggeredimmediately. Our methodology was underpinned by the Model for Quality Improvement.Results: Since September 2015, over 2,200 patients have been screened for frailty in theED. Over 75% of patients screened were deemed frail and this resulted in a significantincrease in MDT referrals. When comparing Quarter 1 in 2015 and 2016 there has beenan 11.6% increase in the number patients over 75 presenting to the ED. However, in thisperiod there has been a 59% increase in the number of patients discharged directly homeand a 42% increase in transfers to the wards in less than 9 hours.Conclusions: In line with best available evidence, FITT undertook to provide early inter-vention to frail adults, thereby improving their hospital experience and overall outcomes.Over the past eight months, through a continual cycle of quality improvements, the FITteam has evolved and is now embedded within the ED in Beaumont Hospital.
234 WHAT ABOUT THE MEN? AN AUDIT OF DEXA SCANDEMOGRAPHICS
Emma Tierney, Elaine Shanahan, Declan Lyons, Sheila Carew, Aine Costelloe,Tina SheehyDepartment of Therapeutics and Ageing, University Hospital Limerick, Limerick, Ireland
Background: Osteoporosis is the most common metabolic bone disease and is a leadingcause of morbidity and mortality in older people. However, it often goes unrecognisedand under-treated as it is clinically silent. It’s frequently forgotten about in males who arepresumed less at risk than females. The current prevalence of osteoporosis in Ireland is6.2% in males and 20% in females (Svedbom, 2013). Approximately 25% of fragility frac-tures occur in men (Finkelstein, 2015). Therefore, one might expect the proportion ofDEXA scans to reflect the population incidence of fracture. The aim of this audit was toanalyse DEXA scans performed in the Clinical Age Assessment Unit (CAAU) at ourinstitution, to elicit the proportion of scans being done in male patients and to highlightany potential interval change over time. We also wanted to determine the age range ofpatients being scanned.Methods: CAAU has maintained a database of all DEXA scans performed since 1997.A subset of this data from January 1st to July 31st for the years 2005 and 2015 was ana-lysed using SPSS.Results: There were 1771 DEXA scans performed in the first 6 months of 2005. 90.7%of these were in women with only 9.3% being done in men. In 2015 there was a total of2377 scans performed between January and July, with women representing 89.9% andmen a mere 10.1%.Conclusions: Epidemiological data suggests 20-30% of fragility fractures occur in men,yet only 10% of DEXA scans performed at our institution were on men. Despite theincrease in the total number of scans performed over the last 10 years, there has been nochange in the proportion of male patients. While public awareness campaigns on osteo-porosis have clearly been effective, more needs to be done in promoting awareness ofthis condition in men.
235 EXAMINING THE LINKS BETWEEN DOMAINS OF GAIT ANDTESTS OF GLOBAL COGNITION: A FACTOR ANALYSISAPPROACH
Andrew Creagh, Isabelle Killane, Fiachra Maguire, Orna Donoghue, Rose Anne Kenny,Richard ReillyTrinity College, Dublin, Ireland
Background: Slow gait speed (Oh-Park et al., 2010) has been reported to precede cognitivedysfunction and progression to dementia (Waite et al., 2005). However, gait is multidimen-sional and cannot be fully captured by one characteristic alone. Individual gait variables canbe grouped together to characterise gait performance on specific domains. This study exam-ined the relationship between these gait domains and global cognitive function.Methods: This study used baseline cross-sectional data from 4576 community dwelling,middle-aged and older adults (54% women, age ≥50 years, (mean ± sd) 62.4 ± 8.2) whoparticipated in The Irish Longitudinal Study on Ageing (TILDA), a nationally representa-tive study. Participants performed two, normal paced walks on a GAITRite® mat.
Factor analysis is a data reduction technique employed to reduce key correlated gaitvariables into a lower number of uncorrelated, independent variables (Pace, Rhythm,Variability). Participants are grouped dichotomously based on poor gait factor perform-ance (defined as 1 standard deviation below age, sex, height and BMI adjusted means).
The individual associations between global cognitive assessment test scores (MMSE &MoCA respectively) to those classified with each poor pace, rhythm and variability wereanalysed using Logistic-Binomial regression (adjusted for age, sex, and education).Results: Those classed with poor pace had lower MMSE (Coef. 0.02, p < 0.001) andMoCA scores (Coef. 0.06, p < 0.001) versus those without. Participants with poorrhythm also showed both significantly reduced MoCA (Coef. 0.01, p < 0.05) and MMSEscores (Coef. 0.08, p < 0.001). In contrast, poor variability factor performance did notshow significantly altered test scores.Conclusion: The representation of gait through pace, variability and rhythm domains,generated from factor analysis is more descriptive than using gait speed alone.
Furthermore, by quantifying dysfunctional gait in this manner, associations were foundwith poorer cognition. Future work is needed to investigate the benefits and clinical use-fulness of this approach.
237 ELDER ABUSE CONTEXT AND THEORY IN FINLAND,IRELAND, ITALY AND ROMANIA
Marita O’Brien1, Sam O’Brien-Olinger1, Licia Boccaletti3, Salvatore Milianata3,Ioana Caciula4, Henriikka Laurola5, Sirkka Perttu5, Anna Kadzik-Bartoszewska2,Kate Canning2, Seamus Quinn21Age Action, Dublin, Ireland2The Gaiety School of Acting, Dublin, Ireland3Anziani E Non Solo, Carpi, Italy4Asociatia Habilitas, Bucharest, Romania5Suvanto, Helsinki, Finland
Background: Sociodrama, Tackling Ageism, Preventing Abuse Project (S.T. AGEfunded by ERASMUS+) will develop new learning opportunities in the field of elderabuse prevention. The project draws on the theory of generational intelligence as thefoundation for the development of an innovative approach to tackling this issue inFinland, Ireland, Italy and Romania. This poster presents an overview of phase one ofthe project which constructed the theoretical background underlying the project.Methods: A comprehensive review of the relevant literature and policies from the per-spective of the four countries was undertaken. The review focused on distinguishing thedifferent definitions and typologies of elder abuse have been adopted within the fourcountries and how these inform policy responses. An exploration of a range of theoreticalapproaches along with the risk factors associated with elder abuse were also explored.Results: Emerging theories in explaining elder abuse within individual relationships sug-gest abuse occurs where there is a failure to encounter the humanity of the other. At thecentre of generational intelligence theory is the belief that by recognising differencesbetween generations, there is greater empathy amongst carers. Sociodrama as a mediumfor building empathy is explored. By coming to know the older person as an individualthey therefore, not only provide care to the person, but also care about them.Conclusions: Using generational intelligence to underpin elder abuse prevention has thepotential to revolutionise current approaches to elder abuse prevention. It can provide anew perspective and understanding through which staff and organisations view theirroles, advancing residents’ social identity, enhancing reciprocal relationships and challengeageist assumptions. It is envisaged that the model will lay the groundwork for furtherresearch and educational training models beyond the work of the current project.
238 HIGH BURDEN OF FRAILTY AMONG PATIENTS AGED OVER65 YEARS IN A TERTIARY REFERRAL HOSPITAL
Elizabeth Moloney, Catherine Peters, Mark Conway, Sarah Heywood, Laoise Griffin,Keith McGrath, Patricia Guilfoyle, Elaine Shanahan, Kowishika Thavarajah, MargaretO Connor, Declan LyonsUniversity Hospital Limerick, Limerick, Ireland
Background: Frailty as a concept is associated with key clinical syndromes includingfalls, polypharmacy and worsening mobility. Screening and measurement of frailty isrecommended as part of comprehensive geriatric assessment of older patients. However,there is no clear consensus on its definition and most appropriate screening tool.Prevalence rates for frail older patients presenting in the acute hospital setting range from4–11% depending on the definition and screening tool used.Methods: Assessment of frailty was retrospectively performed on all medical patientsover 65 years admitted to University Hospital Limerick in a 1 week period. The 9 pointEdmonton Frailty Score in app version (Doctot) was utilised as it has been validated foracute medical unit patients. The predicted length of stay of each patient was correlated tofrailty scores using this medical software application tool.Results: Over 7 consecutive days, there were 226 medical admissions in UHL; 118 wereover 65 years. Of the 51 patients screened, 21% patients were assessed as mild frailty,13% moderate frailty, and 27% were deemed severely frail.50.9% were male. Median agewas 75.6 years. Predicted length of stay for patients scoring mild frailty percentages was7.3 days with percentage mortality at follow up of 2.4%, moderate scores had hospitalLOS 9.9 days with mortality 2.9% and severe scores had hospital LOS 15.6 days and12.9% mortality at follow up.Conclusions: A key tenet of the ED Taskforce Report 2015 is the immediate creation ofrapid access elderly assessment and treatment services for elderly patients in all acute hos-pitals. In this regard, rapid mobile assessment tools of frailty can augment national carepolicies to identify vulnerable patients. There is a high burden of frailty in acute medicalwards and utilising predictive length of stay can aid more efficient discharge planning.
239 THE ROLE OF LOOP RECORDERS IN CRYPTOGENIC STROKE
Imelda Noone, Mary Kate Meagher, Diarmuid O’Shea, Rachael, Doyle, Charles McCreery, Tim CassidySt.Vincent’s University Hospital, Dublin, Ireland
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Background: Ischemic Stroke is among the leading causes of severe disability and death,however, the cause remains unexplained in approximately 20–40% of cases resulting inthe classification of Cryptogenic Stroke. Atrial fibrillation (AF) is a well recognised causeof ischaemic stroke, with the risk of further stroke being reduced by two thirds withanticoagulation(1). Implantable loop recorders (ILRs) allow continuous cardiac monitor-ing for up to 3 years in the detection of AF.Methodology: In selected stroke patients (mRankin 0-3) admitted to our UniversityHospital, an ILR device was inserted when no cause for their stroke had been found.This study analyses the differences between those patients who were discovered to haveAF during follow up.Results: 54 ILRs were inserted over an 18 month period. AF (> 30 seconds) wasdetected in 23 (42.5%) patients. Of those with AF, the mean age was 69.5yrs (Range 49–85) and 57% were female. The mean time to detection of AF was 3 months (range 1 dayto 10 months). Comparing risk factors of those with AF to non AF, (hypertension,Ischaemic heart disease, diabetes and previous stroke), the most significant finding wasdiabetes (17%) in the AF group compared to (6.4%) in the non AF cohort.Conclusion: In this select group of Cryptogenic Ctrokes, AF was detected by ILRs in42.5% resulting in a greater use of anticoagulants. Complication rate was low and ILRsmay have a central role in the investigation of embolic stroke of uncertain source.Further studies are required to determine which patients will derive the most clinicalbenefit from ILRs as well as the cost effectiveness of this approach.
241 A RARE CASE OF A THALAMIC INFARCTION PRESENTINGWITH A VERTICAL GAZE PALSY
Michaela Masojada1, John McCabe1, David Williams1, Liam Grogan2, Daragh Moneley3,Alan O’Hare41Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland andBeaumont Hospital, Dublin 9, Ireland2Department of Oncology, Beaumont Hospital, Dublin 9, Ireland3Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Ireland4Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
Background: To discuss a rare case of thalamic stroke presenting with a vertical gazepalsy.Method: We present a case of a 40 year old lady who presented with vertical diplopia,slurred speech and left facial droop. The patient had a background history of NonHodgkins Lymphoma cycle 2 day 6 of RCHOP. Her symptoms gradually improved withonly vertical diplopia remaining after 6 hours. Initial CT Brian showed no acute infarct orhaemorrhage. She presented seven days later with symptoms of arterial compromiseaffecting her right hand.Results: MRI Brain on day 7 showed acute right thalamic infarct, MRA revealed throm-bosis in the right innominate artery hence identifying the likely mechanism of her thal-amic infarct. The patient was anti-coagulated and her symptoms of arterial compromiseresolved. Her symptoms of diplopia improved with the use of prisms. Acute onset of ver-tical diplopia in the setting of infarction is most often associated with midbrain infarcts.We present a case report of a thalamic infarct presenting as vertical diplopia with no mid-brain involvement due to thrombosis of the right innominate artery. Our literature reviewidentified only three previous cases of vertical diplopia as a consequence of thalamicinfarct with no midbrain involvement. The presumptive mechanism in these cases wasinterruption of the supranuclear inputs.Conclusion: Acute onset vertical diplopia can rarely present secondary to thalamicinfarction. We believe this is the fourth reported case of this nature and the first to be theconsequence of thrombosis of the innominate artery.
243 THE FIRST KNOWN CASE OF SPLENIAL HAEMORRHAGEPRESENTING WITH ACUTE AMNESIA
Yoann O’Donoghue1, John McCabe2, Aileen O’Shea3, Alan Moore21School of Medicine, Trinity College Dublin, Dublin, Ireland2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland andBeaumont Hospital, Dublin 11, Ireland3Department of Radiology, Beaumont Hospital, Dublin 11, Ireland
Background: Isolated splenial haemorrhage is rare. There are several reports of retro-splenial or hippocampal lesions presenting with amnesia, however there are no previouscase reports of isolated splenial haemorrhage with this presentation. We report the firstknow case of splenial haemorrhage presenting with amnesia.Methods: We reviewed the clinical and radiological findings of a 66 year-old man whopresented with retrograde and anterograde amnesia of 6 hours duration. A literaturereview was carried out of previous reports of splenial lesions, in particular splenial haem-orrhage, and their presentations.Results: The patient was admitted with a working diagnosis of transient global amnesia(TGA). His past medical history was unremarkable. Neurological examination and ini-tial CT brain were normal. MOCA revealed isolated impairments in visuospatial func-tion. MRI brain revealed a small focus of haemorrhage in the left splenium. Ourliterature review demonstrated one case report of an isolated splenial lesion presenting
with acute amnesia secondary to ingestion of herbicide, but none secondary tohaemorrhage.Conclusion: The diagnosis of acute amnestic syndromes remains challenging. Isolatedsplenial lesions as a cause of acute amnesia are very rare. This case highlights the import-ance of performing appropriate neurological investigations in patients presenting withacute amnesia as TGA remains a diagnosis of exclusion.
244 DOES HE LIKE FAIRY CAKES? EXPLORING COMMUNICATIONIMPAIRMENT, MARGINALISATION AND PERSON-CENTREDCARE
Mary Walsh, Aideen LawlorHealth Service Executive, Dublin, Ireland
Background: Person-centred care is increasingly a primary objective for personswith dementia in residential settings but, in practice, is challenging for residents,staff and family. While conducting a grant supported project in the area of eating,drinking and swallowing in a dementia specific unit, where residents’ food anddrinks preferences and dislikes (FDPD) were reviewed from multiple perspectives,an issue emerged which prompted the reviewer to ask if we are aware of the extentof these challenges.Method: A 70-probe questionnaire based on the menu cycle was administered to staff(SQ) and family (FQ). Following this, selected residents were interviewed re FDPDusing a supported conversation approach that uses a pictorial system called TalkingMats*(TM).Results: While conducting the TM- FDPD interview with a non-verbal resident, thereviewer spotted an item of variance. SQ and FQ reported that he liked fairy cakes buthe indicated that he disliked them in TM-FDPD. The reviewer asked the questionagain in a different section and he reiterated that he disliked fairy cakes. The storyunfolded. While conducting a TM which explored broader eating, drinking and swal-lowing issues, the resident revealed that he had experienced changes in the way thingstaste and smell.Conclusions: The reviewer poses 4 possible explanations for what occurred, whichincludes the possibility that he dislikes fairy cakes, but that he eats them because there islittle choice and he feels powerless to do anything about it. We need to challenge ourassumptions about the extent that we really are listening to residents, including non-verbal behaviour. The issues raised here were only revealed because the reviewer probed;otherwise they would have remained invisible and unheard. Is he (and other non-verbalpeople) unwittingly marginalised because of his communication impairment? If so, whatdo we want to do about it?Reference:*www.talkingmats.com.
245 BLOOD PRESSURE CONTROL IN OLDER PEOPLE AND ITSASSOCIATION WITH CARDIOVASCULAR EVENTS: ASUBGROUP ANALYSIS FROM THE ASCOT STUDY
Background: Ambulatory Blood Pressure Monitoring (ABPM), mostly measured instudies at baseline has been shown to be a more potent predictor of cardiovascular riskthan that measured in the clinic. Less prognostic information is available following initi-ation of therapy, especially in the elderly. The aims of our study were to evaluate the prog-nostic value of ABPM in those ≥65 years on treatment on cardiovascular events andwhether blood pressure can be lowered safely in view of recent studies with lower BPtargets.Methods: We looked at those ≥65 years old from the Anglo-Scandinavian CardiacOutcomes Trial (ASCOT). All patients had at least three other cardiovascular riskfactors, but no previous history of coronary heart disease. They were randomisedusing a prospective, randomised, open, blinded end-point design. RepeatedABPMs were performed over a median follow-up period of 5.3 years. We adjustedfor baseline variables (age, sex, lipid profile, BMI, and diabetes), treatment andclinic systolic BP.Results: During the follow-up period 719 patient s were evaluated, average age was 70.4(+/−3.71) and 26% were female. Their ambulatory systolic blood pressure (SBP) was132.79 mmHg (SD = 11.17), 134.45 mmHg (SD = 11.48) and 126.23 mmHg (SD =14.71) for 24 hour, daytime and nighttime respectively. There were 84 cardiac events. Anincrease of 10 mmHg in daytime, nighttime and 24 hour systolic BP increased the possi-bility of a cardiovascular event giving the respective hazard ratios of 1.29169 (1.04839 to1.59146), 1.18708 (1.02090 to 1.38032) and 24 hour 1.32823 (1.07297 to 1.64422).However those with low nighttime SBP were also at increased risk after adjustment com-pared to those with higher SBP mean values.Conclusions: This study demonstrates that in older hypertensive patients on treatmentadditional prognostic information regarding cardiovascular risk can be gained fromrepeated ABPM measurements. However, tight control of nighttime SBP might result inan increased risk.
247 THE ABBREVIATED MENTAL TEST SCORE: THE 1916QUESTION
Martin M O’Donnell1, Niamh A O’Regan2, David J Robinson21Trinity College Dublin, Dublin, Ireland2Medicine for the Elderly Directorate, St. James’s Hospital, Dublin, Ireland
Background: The Abbreviated Mental Test (AMT) is a 10-item mental test used toscreen for dementia. It assesses long-term memory by asking “What year did World WarI (WWI) begin?”, a question that is culturally specific. The aim of this study was to exam-ine if asking the year of the Easter Rising for long-term memory would be valid in anIrish cohort.Methods: Patients aged ≥65 years were recruited from the day-hospital service of anurban teaching hospital. Following patient assent, demographics were recorded and theAMT was administered with the additional question “What year did the Easter Risingoccur?”. The Mini-Mental State Examination (MMSE) was administered as a referencestandard.Results: Forty-nine patients were recruited, 73.5% female (n = 36), mean age 81.14 years(SD = 6.798). There were significant positive correlations between AMT-standard andAMT-Irish scores (r = 0.706, p < 0.001), AMT-standard and MMSE scores (r = 0.511,p < 0.01) and AMT-Irish and MMSE scores (r = 0.464, p < 0.01). Forty-two patients cor-rectly answered the Easter Rising question (ERQ) while 17 correctly answered the WWIquestion (WWIQ) (p < 0.001). All those who correctly answered the WWIQ, answered theERQ correctly. No patient correctly answered the WWIQ alone. However, in this sample,this difference did not lead to a significantly greater number being classed as normal/abnor-mal. Receiver Operator Curve analysis showed that higher cut-offs for the AMT-Irish wererequired to optimise sensitivity and specificity and that an AMT version that excluded thelong-term memory question had similar psychometrics to the AMT-standard.Conclusions: This study did not identify any statistically significant difference betweenthe AMT and the AMT-Irish in screening for cognitive impairment, however the samplesize was small. Further work is needed to validate AMT-Irish vs. AMT-standard as thereappears to be a significant difference in the level of knowledge between the long-termmemory aspects of each version.
248 HIP FRACTURE CARE FOR ELDERLY PATIENTS IN IRELAND:AN AUDIT OF ACUTE CARE IN A UNIVERSITY TEACHINGHOSPITAL
Deirdre Smith, James Mahon, Kevin McCarroll, JB Walsh, Miriam Casey, Paul Stassen,Fionn Coughlan, Mary Kate McNulty, Georgina Steen, Nessa FallonSt James’s Hospital, James’s St, Dublin 8, Ireland
Background: One-year mortality is up to 33% for elderly hip fracture patients. There isan integrated care pathway (ICP) for these patients in our hospital. We also collect datafor the Irish Hip Fracture Database (IHFD), in particular 6 key performance indicators(KPIs): Admission to orthopaedic ward within 4 h; surgery within 48 h; pressure ulcerassessment; orthogeriatric support; osteoporosis review; falls assessment. Aim: We exam-ined if our hospital meets IHFD standards, and if standards improved from 2014 to2015.Methods: We interrogated our hospital’s IHFD 2014-2015 entries for patients >65 years,comparing them with standards above.Results: Data for 159 patients recorded in 2014. Representative sample from 2015 of 41patients analysed for comparison. In 2014 62% were admitted to orthopaedic ward;100% in 2015, median time to ward 6.78 h, which is outside target time of 4 h. In 201463% had surgery within 48 h; 97% in 2015. In 2014 96% had pressure ulcer assessment,and 97% in 2015, with 6.4% having an ulcer on assessment. In 2014 77% had a bonehealth review recorded; 90% in 2015. Orthogeriatric review recorded for 78% in 2014;100% in 2015. Falls assessment rose from 22% in 2014 to 94% in 2015. Median lengthof stay 18d 2014 and 17d 2015, with more patients being discharged home 2015.Conclusion: There is continuing improvement in hip fracture care in our hospital.Ongoing delays in admission time to wards is reflective of a national beds shortage. Ourresults also give leave to consider best methodology for data collection in an acute setting.
249 NON-SUSTAINED EFFECT OF FAST CAMPAIGN ON ACUTESTROKE PRESENTATION
Nora Cunningham1, Elaine Shanahan1, Catherine Peters1, Margaret O’Connor1,Declan Lyons1, Peter Boers21Department of Therapeutics and Ageing, University Hospital Limerick, Limerick, Ireland2Department of Neurology, University Hospital Limerick, Limerick, Ireland
Background: The Irish Heart Foundation launched its first ever media “FAST” cam-paign in 2010. It proved successful in raising awareness of stroke signs and symptomsand resulted in an increase of more urgent attendees of stroke patients to emergencydepartments through the country. Research carried out by the Royal College of Surgeonsin Ireland (RCSI) also showed that 59% more stroke victims got to hospital in time toreceive potentially life-saving thrombolysis treatment during the first phase of the cam-paign. The aim of this study was to examine our own data to review the impact since thewithdrawal of the media campaign.
Methods: Data was collected prospectively by a single investigator and compiled using theHIPE ESRI national stroke database from May 2012 to December 2015. A retrospectiveanalysis was undertaken on thrombolysed patients admitted during this period.Results: From 2012 to end of 2015 thrombolysis rates at UHL has remained relativelyunchanged averaging at 12%. However upon examining the data it did highlight that theonset to door time has progressively increased from a mean time of 47 minutes in 2012to 94.7 minutes in 2013 and 91 minutes in 2014. The mean time reduced in 2015 to 56minutes.Conclusion: This study does reflect that when a campaign is reduced it can have a nega-tive effect on what it achieved. The decrease in 2015 might be contributed to by localmedia campaign regarding the opening of a new stroke unit in the hospital. The delay instroke patients seeking emergency treatment and response will have a negative effect onpatient outcomes. Due to lack of funding nationally for the sustaining of the media cam-paign, locally we will need to raise our own public awareness with local road shows andvisiting schools and communities.
250 ADDRESSING THE ACUTE NEEDS OF THE OLDEST OLD IN ARURAL HOSPITAL: THE FRAIL ELDERLY ASSESSMENT TEAM(FEAT) PILOT PROJECT
Sarah Ronayne, Amanda Brady, Victoria McGuinness, Mairead O Boyle, Simon RowanMayo University Hospital, Castlebar, Co Mayo, Ireland
Background: Older people have more frequent hospital admissions and occupy morebed days than any other patient group. Patients over 80 years are most at risk of adverseoutcomes e.g. death and institutionalisation (National Clinical Programme for OlderPeople, 2012). In Ireland, the number of people over 80 is expected to reach 440,000 by2041. Older people living in rural communities are more likely to experience difficultyaccessing health services; therefore, it is imperative acute services are streamlined for thismarginalised group.Methods: A multi-disciplinary team was established in the Emergency Department (ED)and Acute Medical Assessment Unit (AMAU) of a Rural Hospital comprising of ClinicalNurse Manager, Medical Social Worker, Occupational Therapist, Physiotherapist andPharmacist. They assessed adults over 80 years in ED and AMAU by screening for FrailtySyndromes, initiating early intervention, discharge planning and early referral to primary careproviders. Frailty syndromes were identified using “PRISMA 7”, “4 Metre Gait Speed Test”,and “Mini-Cog”. Polypharmacy, incontinence and falls history were noted. The efficacy ofthe team was measured by analysing patient outcomes in the domains of “time to frailtyscreening” (ie patients assessed within 4 hours of presentation to ED/AMAU) and dischargeoutcome (ie destination on discharge and re-admission rates).Results: 96% of patients screened had one or more frailty syndromes. Positive dischargeoutcomes were noted (ie 66% patients screened by FEAT discharge to their own home VS61% patients not seen by FEAT. 12% of patients seen by FEAT were discharged to conva-lescence hospitals VS 17% for patients not seen by FEAT). Re-admission rates of patientsseen by FEATwere found to be lower than the hospital average for comparable patients.Conclusions: Co-ordinated, multi-faceted approach to assessment, intervention and dis-charge planning for older people at point of entry to acute hospital leads to improvedpatient outcomes.
253 COMMUNITY SUPPORTS OR NURSING HOME?CHARACTERISTICS AND OUTCOMES OF OLDER PATIENTSATTENDING A DAY HOSPITAL
Sarah Cosgrave, Breffni Drumm, Diarmuid O’SheaSt. Vincent’s University Hospital, Dublin, Ireland
Background: Our day hospital aims to enable patients to remain living safely and inde-pendently at home for as long as possible with the appropriate supports in place. We dis-cuss options available with regard to accessing community supports via the public healthnurse. We also initiate discussions around future care plans if a patient can no longerremain at home.Method: A retrospective review of the 2014 database of patients supported with theirNursing Home Support Scheme (NHSS) application from the day hospital wascompleted.Results: In total 122 patients were supported with a NHSS application from the day hos-pital, 92 female, 30 male, average age 86. 76 patients had a diagnosis of dementia, 9 hadParkinson’s disease and 37 were frail. 68 patients lived at home alone, 44 lived with familyand 10 had moved to LTC prior to day hospital assessment. 107 patients were in receiptof a home care package, 28 attended local day centres and 16 had regular respite.Of the 122 patients, 56 were admitted to long-term care (LTC) facilities. Of those who
moved to LTC, 21 have passed away, 10 in the care of their nursing home and 11 in theacute hospital. 23 patients remained living at home with community and family support.13 of these passed away at home and 10 continue to attend for regular review. These 10patients have seen an increase in home supports including additional home care packagehours, day centre attendance and respite. It is unknown if the remaining 43 patients com-pleted the NHSS application as they have had no further attendances to this hospital.Conclusion: A supportive family/social network and accessing appropriate levels of carein the community enables older people to remain living in their own homes for longer.
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254 RECOGNITION OF DELIRIUM IN AN IRISH EMERGENCYDEPARTMENT
Christine Mc Carthy, Ronan O’Toole, Vinny RamiahMater Misericordiae University Hospital, Dublin, Ireland
Background: Delirium is currently a major cause of morbidity and mortality. Prevalenceof delirium in older patients is approximately 10% in the Emergency Department (ED),it is under-recognised by emergency physicians. The Royal College of EmergencyMedicine (RCEM) and British Geriatric Society (BGS) recommends that delirium screen-ing is a key quality indicator for geriatric emergency care. Our aim is to determine ratesof of delirium recognition in the Emergency Department of an Irish University TeachingHospital and review if formal assessments were being made and documented for same.Method: Records were reviewed on all patients discharged with a diagnosis of deliriumfrom January to March 2016. All those who had been seen by an emergency doctor pre-ceding admission had an ED note review for diagnosis of delirium or a synonym, in add-ition to the documentation of the use of a structured assessment tool such as theConfusion Assessment Method. All patients wherein delirium was not diagnosed in EDhad a medical note review to determine whether it was diagnosed on admission, or subse-quently developed as an inpatient.Results: 54 patients discharged with a diagnosis of delirium were suitable for review. Themedian (range) age was 85 (75–98). 59% were female. 83% had been admitted under aMedical Speciality, the remainder under a Surgical Speciality. In 18 patients, deliriumdeveloped following admission (33% post operatively). Of the 36 patients that were deliri-ous on admission, 25 (69%) had been diagnosed in ED. No patient had a structuredassessment for delirium documented in their ED notes.Conclusion: Recognition of delirium in an Irish ED is sub-optimal. Education on struc-tured assessment tools for all emergency staff could help raise detection of delirium inthis environment, leading to an overall improvement in geriatric emergency care. Furtherstudy following the introduction of this tool is warranted.
255 RETROSPECTIVE ANALYSIS OF ANTICOAGULANTPRESCRIBING FOR ATRIAL FIBRILLATION IN A DUBLINGERIATRIC OUTPATIENTS CLINIC
Patrick O’Donoghue, Ronan O’Toole, Bernadette Monaghan, Toddy Daly,Lorraine Kyne, Joseph DugganMater Misericordiae University Hospital, Dublin, Ireland
Background: Atrial fibrillation is the most common cardiac arrhythmia worldwide andis a major risk factor for ischaemic stroke. Anticoagulant medications are proven toreduce stroke risk. However, given the advent of non-vitamin K antagonist oral anticoa-gulants (NOAC), is Warfarin still the predominant anticoagulant prescribed for patientswith atrial fibrillation? Our study aimed to evaluate anticoagulant prescribing trends andpractices for patients with atrial fibrillation in a geriatric outpatient setting (OPD).Methods: We retrospectively reviewed the clinic notes of all patients who attended thegeriatric OPD between January 2014 and September 2015. Only patients with a docu-mented history of atrial fibrillation in their medical notes were included. It was noted ifpatients were on anticoagulant, antiplatelet treatments or neither. Adverse events such ashaemorrhage were also noted.Results: 257 patients were identified with a history of atrial fibrillation. 48.25% (n =124/257) were on Warfarin, 18.29% (n = 47/257) were on a NOAC, 26.46% (n = 62/257) were on an antiplatelet alone but not anticoagulant therapy and 0.78% (n = 2/257)had no medication list documented. Therefore, 66.54% (171/257) of patients attendingthe clinic with documented atrial fibrillation were on some form of anticoagulation.82.98% (n = 39/47) patients on NOAC therapy had a renal function check in the 6months prior to the clinic review. Of note, 3.5% (n = 9/257)of patients had their anti-coagulant medication changed in the clinic – 66.66% (n = 6/9) of these were changedfrom Warfarin to a NOAC, 22.22% (n = 2/9) from Aspirin to a NOAC and 11.11% (n= 1/9) from no antiplatelet/anticoagulant to Warfarin therapy. 4.68% (n = 8/171) ofpatients on anticoagulation had a major haemorrhage requiring blood transfusion/hospitalisation.Conclusions: Our results reflect recent trends of increased prescribing of NOACs foratrial fibrillation. However, the majority of patients are still maintained on Warfarin ther-apy and it will be interesting to observe how these trends evolve into the future.
256 BENZODIAZEPINE AND Z-DRUG PRESCRIBING FOR OLDERPEOPLE IN A DUBLIN HOSPITAL: A COMPLETEDMULTIDISCIPLINARY AUDIT CYCLE
Sinead Healy-Evans1, Warren Connolly1, Maríosa Kieran2, Elizabeth Tanya Roy1,Frances Mc Carthy21University College Dublin, Belfield, Ireland2Mater Misericordiae University Hospital, Dublin 7, Ireland
Background: Altered pharmacokinetics places older people at risk of adverse effectsof benzodiazepine and Z-drugs including falls, fractures and psychomotor impairment.We aimed to assess the prescribing of these drugs in those > 65 years in a Dublin hos-pital against ICD-10 criteria, NICE guidelines and Royal College of Psychiatrists
recommendations and to assess the impact of a multidisciplinary educationalintervention.Methods: We carried out a cross sectional audit on medical notes, nursing notes andmedication prescriptions of all inpatients > 65 years on our two specialist geriatric medi-cine wards (SGW) and three mixed medical /surgical wards. We subsequently issued newsleep guidelines, delivered two educational sessions to NCHDs and gave pharmacistsdeprescribing rights. The audit cycle was completed by a re-audit nine months from ori-ginal study using identical methods.Results: There was a high prevalence of hypnotic drugs being prescribed 23/101(23%)in the initial audit. This reduced to 20/99 (20%) post intervention. Comparing pre andpost intervention there was a prescribing prevalence rate on the SGW of 14% vs 15% (p= 0.9066) and non SGW of 29% vs 24.5% (p = .616). Post intervention an improvementwas noted in the choice of drugs being prescribed in accordance with the guidelines(100% vs 91% p = 0.0012) and in discontinuation rates with a reduction from 63 % to29% (p = 0.029) in the prevalence of patients staying on the drug for more than 4 weeks.Conclusion: A multidisciplinary polyintervention approach to improving night sedationprescribing practices has resulted in evidence based prescribing and increased deprescrib-ing rates. However it has not improved the overall number of prescriptions. Ongoingeducational strategies with regular audit within the hospital setting are pertinent to furtherimprove prescribing practice.
257 A SNAPSHOT OF BLOOD PRESSURE MEASUREMENTS INHOSPITALISED PATIENTS: ARE WE PAYING ATTENTION?
Hannah Smyth, Daniel Angelov, Paul ShielsMidland Regional Hospital, Tullamore, Co. Offaly, Ireland
Background: Recent evidence shows midlife hypertension is a risk factor for the devel-opment of dementia, vascular disease and heart disease in later life. In contrast, olderadults are at risk of over treatment of blood pressure (BP) leading to orthostatic hypoten-sion. In this study we sought to identify hospitalised patients with: 1) uncontrolled hyper-tension in midlife 2) hypotension in over 70 s with the aim of identifying an opportunityfor screening and reviewing medications.Methods: Prospective study conducted on a one day period on all inpatients inTullamore Regional Hospital. Beside observations and medical charts were used to obtainage, sex, weight, BP (mean of last 3 readings), previous history of hypertension and drugtreatment. Hypertension was defined as a BP above 140/90 mmHg and hypotension asystolic BP below 120 mmHg. The age groups were subdivided into midlife (age 30–69)and older (age 70 and above).Results: A total of 80 patients were reviewed with an average BP of 128/72 mmHg(+/−17/10). Of these 80 patients reviewed 40% (n = 32) were known to have hyperten-sion. 21% (n = 17) inpatients had a BP above 140/90. 30% (n = 5) were in the 30–69 agegroup and only one patient was on an antihypertensive. 70% (n = 12) were over 70. 15%(n = 7) of patients over 70 had a systolic BP<120 mmHg and were on anantihypertensive.Conclusions: Over a third of patients included demonstrated sub optimal control oftheir blood pressure as measured by beside observations. Although there were a numberof middle age adults with uncontrolled blood pressure, this was not acted on. Similarlyolder adults with low blood pressure did not have action taken to review their medica-tions. Bedside BP measurements represent a unique opportunity for intervention.Further work is required to see if redesigning BP charts with prompts to consider chan-ging medications would benefit patients in the long term.
258 BLOOD PRESSURE VARIABILITY IS INCREASED IN OLDERIRISH ADULTS
Background: Hypertension is one of the most common chronic medical conditions and isa major risk factor for cardiac and vascular diseases. Ambulatory blood pressure (ABP)provides an average systolic blood pressure value (SBP) which gives superior risk stratifica-tion compared to that measure at the clinic setting. Blood pressure variability (BPV) mayalso be an important therapeutic target and is easily gained from ABP. Aim: The aim ofthis study is to look at the relative BPV in the community among younger and older adults.Method: BP was measured using an ABPM (SpaceLabs device) at baseline before theinitiation of therapy. Ethics approval for the study was attained.Results: There were 17160 of patients included in this study. 10886 (56.5% female, averageage 51) were under 65 years of age and 6286 (49.5% female, average age 73) greater than65 years. Average SBP were 138.3 mmHg, 118.72 mmHg and 132.02 mmHg for daytime,nighttime and 24 hour blood pressure respectively in the younger population while 139.83mmHg, 126mmHg and 135.75 mmHg in those older than 65 years old. The co-efficeientof variation (CoV) which adjusts for mean SBP was greater in older subjects, 9.6303 vs10.923, p = 0.001 for daytime and 9.6809 vs 9.8495, p = 0.001 for nighttime.Conclusion: This study showed that the elderly population has a greater BPV comparedto a younger population. Certain antihypertensives also reduce BPV and may offer advan-tages when used in an older population.
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259 ASSOCIATION BETWEEN FRAILITY, LENGTH OF STAY ANDDISCHARGE DESTINATION IN THE ACUTE MEDICAL UNIT
Shane Toolan, Marie Therese Cooney, Orla CollinsSt Vincent’s University Hospital, Dublin 4, Ireland
Background: Improving the acute care of the frail older person is a key recommenda-tion of the Acute Medical Programme and the National Programme for Older People.With a view to developing optimal care pathways in our Acute Medical Unit (AMU), wemeasured the frailty profile of older patients and assessed the association between frailty,length of stay (LOS) and discharge destination.Methods: We recorded the Clinical Frailty Scale (CFS) of unselected medical patients aged≥ 65 years admitted to the AMU over a 10 week period. The CFS was scored within 24hours of admission from the history, examination and collateral history where necessary.We divided the level of frailty into 3 groups: 1-3 not frail, 4-6 mild/moderately frail and ≥7 severely frail. The outcome variables were LOS and discharge destination of each group.Results: We recorded the CFS of 113 patients {68 (60%) female}. The overall mean agewas 79.8 years and LOS was 6.43 days. 28 (25%) were not frail, 69 (61%) were mild ormoderately frail and 16 (14%) patients were severely frail. The mean LOS in CFS 4-6 was6.44 days. 20 (28.9%) required off site rehabilitation or convalescence prior to returninghome. The group with the longest LOS was that which required off-site rehabilitation(mean LOS 7.75 vs mean LOS in home/convalescence 5.70 with p-value 0.2206). Thelack of statistic significance is likely due to a small sample size.Conclusion: Over 75% of older patients in the AMU are at least mildly frail with 60%patients having a mild-moderate level of frailty. Our study has shown that a key compo-nent of a frailty care pathway is improved early access to rehabilitation. This study pro-vides valuable information on the resources required to successfully implement a frailtycare pathway in the AMU.
260 PREVENTING FALLS IN THE REHABILITATION SETTING
Marie Smith, Tessymol George, Eliska Chytilova, Javier Papa, Marie Mc Mahon,Caitronia Tiernan, Lisa CoganThe Royal Hospital Donnybrook, Dublin, Ireland
Background: Inpatient falls are considered very serious often resulting in distress, injuryand sometimes death. Systematic reviews suggest that multi-factorial assessment andintervention can reduce falls by 20–30%. A quality improvement initiative was implemen-ted on some hospital rehabilitation units. The initiative involved the implementation ofkey components of multi-factorial assessment and multi-factorial interventions. The aimof the initiative was to reduce falls by 20% over 12 months and a further 20% within a10-month period.Methods: Quality initiative was implemented in 4 rehabilitation units. The projectincluded the application of falls care bundle to all patients. The Falls lead nurses used aPDSA cycle to implement and to sustain the falls care bundle. The care bundle includedmulti-factorial interventions that have been proven by research to be effective in reducingfalls. Data on falls were collected from incident reports. Data on falls care bundle compli-ance were also collected each month by falls lead nurse.Results: In June 2014 the falls rate was 7.1 falls per 1000 bed days. In April 2015 thefalls rate decreased to 4.2 falls per 1000 bed days and by April 2016 the falls ratedecreased to 2.5 falls per 1000 bed days. Concurrently, the compliance with the fall carebundle in June 2014 was 11%, in April 2015, it was 56% and in April 2016, 73%.Overall, the initiative lead to increased awareness of falls among staff and patients and inimproved falls risk assessment and falls care planning. Additionally, a falls huddle wasintroduced as a part of the post-fall assessment.Conclusion: Introducing evidence-based care bundles of multi-factorial assessment andintervention using a quality improvement approach resulted in improved delivery ofmulti-factorial assessment and intervention and a significant reduction in the fall rates.
261 REDUCING PRESSURE ULCER DEVELOPMENT ANDINCREASING PATIENT ENGAGEMENT IN AN ELDERLYREHABILITATION POPULATION
Marie Smith, Marie Mc Mahon, Tessymol George, Mirasol Betamor, Jo Cannon,Barbara SherinThe Royal Hospital Donnybrook, Dublin, Ireland
Background: The development of a pressure ulcer is a serious complication not only interms of patient safety but also in terms of patients’ overall experience. Pressure ulcerincidence in Ireland ranges from 8% to 14% depending on the patient group. A collab-orative quality improvement initiative was introduced to one of the hospital’s rehabilita-tion units (n = 27 beds). The goal was set to reduce the incidence of avoidable pressureulcers to 0% within 6 months.Methods: The quality improvement initiative collaborative is centred on the introductionof the SSKIN (surface, skin inspection, keep moving, incontinence, nutrition) care bun-dle, which is an evidence-based tool to prevent pressure ulcers. PDSA cycles were usedby the nurse lead to implement the SSKIN care bundle with patients who were at risk ofdeveloping a pressure ulcer and were also used to increase patient engagement in prevent-ing pressure ulcers. Data on the incidence of pressure ulcers was collected each monthfrom incident reports and from the safety cross calendar. Questionnaires were used
monthly to collect data on patients’ engagement. SSKIN care bundle compliance datawas collected monthly from the nursing notes.Results: The results from this collaborative showed a 75% reduction in pressure ulcersdevelopment. The compliance with the SSKIN care bundle increased to 80% in 6months. Furthermore, screening of patients for the risk of pressure ulcer developmentincreased in 6 months from 40% to 100%. Additionally, patient awareness of pressureulcer prevention increased from 26% to 73%.Conclusion: Overall, the quality improvement collaborative contributed to increasedawareness of pressure ulcer prevention amongst staff and patients. The reduction in theincidence of pressure ulcers together with increased screening for the risk of pressureulcers contributed significantly to an improved quality of life in elderly patients in therehabilitation unit.
262 DELIRIUM IN ACUTE STROKE: INCIDENCE, RISK FACTORSAND OUTCOME
Hoon Lang Teh, Mary Buckley, Tara Coughlan, Ronan Collins, Desmond O’Neill,Sean KennellyAge Related Healthcare, Tallaght Hospital, Dublin, Ireland
Background: Delirium is a common complication for acute stroke patients especially inolder people. Various studies have shown that post stroke delirium results in poorer out-comes: longer hospitalisation, higher mortality rate, higher dependency and institutional-isation, and lower cognitive function post stroke. The objective of this study was toinvestigate the prevalence, risk factors, phenomenology, and implications of delirium inpatients with acute stroke.Methods: This is a prospective observational study including all acute stroke patientsadmitted to an Acute Stroke Unit (ASU). The 4AT and Delirium Rating Scale-98 (DRS-98) are used to identify and phenotype delirium, based on DSM-V criteria. First screeningcompleted within 72 hours of admission to ASU, and two subsequent assessments withinfirst week of admission for patients with a negative initial screen.Results: To date 16 out of 80 (20%) patients admitted with stroke developed delirium.One third of them had hypoactive delirium, the rest were mixed hypoactive and hyper-active delirium. Comparing the groups those with delirium had higher NIHSS (8.92 vs4.57), and lower Barthel Index on admission (42.86 vs 72.43). Haemorrhagic stroke hadhigher association with delirium compared to ischaemic stroke (62.5% vs 17.2%). Noneof lacunar circulation syndrome (LACS) patients developed delirium, whereas 50% ofpatients with total anterior circulation syndrome (TACS) developed delirium. Age andpre-existing dementia didn’t show statistic significant difference in both groups. Data col-lection is currently still in progress, it is planned to complete by end of June 2016.Estimated sample size about 100 patients, postulated delirium incidence is around 20%.Conclusions: Delirium is not uncommon among patients with stroke, and furtherresearch is needed on contributory factors, optimal detection and management. Thestrong engagement by Irish geriatricians with acute stroke care provides a helpful basisfor furthering this research agenda.
263 INCIDENCE OF AND FACTORS ASSOCIATED WITH REPEATFALLS POST-STROKE: RESULTS FROM AN IRISHPROSPECTIVE COHORT STUDY
Mary Walsh1, Rose Galvin2, David Williams3, Joseph Harbison4, Morgan Crowe5,Ronan Collins6, Dominick McCabe6, Sean Murphy7, Frances Horgan11Royal College of Surgeons in Ireland, Dublin, Ireland2University of Limerick, Limerick, Ireland3Beaumont Hospital, Dublin, Ireland4St James’s Hospital, Dublin, Ireland5St Vincent’s University Hospital, Dublin, Ireland6Tallaght Hospital, Dublin, Ireland7Mater Misericordiae University Hospital, Dublin, Ireland
Background: Falls are common adverse events during stroke recovery [1]. The aim ofthis study was to establish the incidence of falls among persons with stroke discharged tothe community in Ireland, and to compare potential risk factors among those who doand do not experience multiple falls within the first year.Methods: Stroke patients with a planned discharge home from five hospitals wererecruited consecutively. The following variables were recorded pre-discharge: age, strokeseverity, co-morbidities, fall history, prescribed medications, hemi-neglect, cognition, inde-pendence (Barthel Index), Berg Balance Scale, the Timed Up and Go test (TUG), motorfunction, gait speed, fear of falling and mood. Falls were recorded with monthly diariesand interviews at 6 and 12 months. The association of pre-discharge factors with futurerepeat falls was examined using univariable logistic regression. Risk ratios (RR) are pre-sented with 95% confidence intervals.Results: 128 participants (mean age = 68.6, SD = 13.3) were recruited. 111 were followedfor 12 months. Most participants had mild or moderate strokes. The first-year falls-inci-dence was 44.5% (95% CI 35.1–53.6) with 25.5% falling repeatedly (95% CI 18.1–34.6).Fallers experienced between one and 18 falls each (median 2). Five fallers reported sus-taining fractures. Only 10% of repeat fallers and none of those who fractured were onbone health medication at discharge. Few factors were associated with future repeat fallsincluding lower scores (<100/100) on the Barthel Index (RR 4.38, 1.64-11.72), high fear
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of falling (RR 4.42, 1.60-12.26), being prescribed psychotropic medication (RR 2.10,1.13–3.9), and slower times on the TUG (RR 1.03, 1.01–1.05).Conclusions: The falls incidence reported is higher than previous Irish figures, likely dueto prospective falls ascertainment [2]. Falls and fractures were common despite mildstroke severity. Bone health should be considered in this population.References:1. Simpson et al. PLoS One 2011; 6(4):e19431.2. Callaly et al. Age Ageing 2015; 44(5):882–6.
264 SOCIAL CAPITAL AND ITS CONTRIBUTION TO THEWELLBEING OF THE OLDER PERSON IN THE MIDLANDSREGION, IRELAND
Anne Cooney, Lorraine Gaffney, Mary McDonnell/Naughton, Pearse MurphyAthlone Institute of Technology, Athlone, Ireland
Background: Societies are ageing at an unprecedented rate (OECD, 2015). There is arapid demographic transformation with the older person happening nationally and inter-nationally. By 2041, there will be 1.4 million people in Ireland aged 65 and over, threetimes more than the present older population (CSO, 2007, 2012). Social capital has beenshown to positively influence the well-being of the older person.Methods: This study investigates the relationship between the variables of age, gender,education, quality of life, self-reported physical and mental health, and their associationwith social capital in a group of people aged over 65 years in the Midlands Region ofIreland. The study used a quantitative method of survey design. Data was collected froma representative sample (n = 195), using a self-administered survey via a GeneralPractitioner in a primary health care environment. The survey measured the frequency ofthe older person’s participation in civic engagement, volunteering, reciprocity, trust, socialnetworks, religion, levels of loneliness, along with connectedness with family and friends.Results: Preliminary findings highlight the important role of various areas to the well-being of the older person in relation to social capital. Good self-rated health, engagementwith volunteering are positive predictors of social capital produced and consumed.Conclusion: The findings of this study will provide relevant data on the importance andsignificant of the contribution of social capital to the well-being of the older person in anIrish context.
266 AN OBSERVATIONAL STUDY OF AN ANTICOAGULATIONCLINIC IN AN IRISH UNIVERSITY TEACHING HOSPITAL
Background: Warfarin remains the most commonly prescribed oral anticoagulant forvalvular heart disease, and the treatment and prevention of arterial and venous thrombo-embolism. It requires regular monitoring hence the need for warfarin clinics. Novel oralanticoagulants, which do not require routine monitoring of coagulation, have beenapproved for use in non-valvular atrial fibrillation and venous thromboembolism. Wesought to describe a modern cohort of patients receiving dose adjusted warfarin at ananticoagulation clinic in a university teaching hospital.Methods: This was an observational study of patients attending a university teachinghospital over a 6 month period. Ethical approval and written informed consent wereobtained. Consecutive patients were recruited at the anticoagulation clinic and at a geriat-ric/stroke clinic. Data was collected on demographics and social status. The Groningenfrailty indicator and the CSHA Clinical Frailty Scale were used to assess frailty.Results: There were 526 patients with mean age of 67.6 +/− 14.7 years and 58% beingmales. The mean number of INR check per year was 11.8 +/− 5 and sub-therapeuticINR values 5.2 +/− 3.9. There was no correlation between age and poor INR control.Most (50.4%) patients drove to the clinic, 31.4% travelled by taxi, 9% travelled by pub-
lic transport and 3.8% came by either bicycle or foot. A small proportion (4.9%) hadremote INR monitoring by the community intervention team and had dose adjustmentsmade by phone.As an indicator of frailty, 11.8% of attendees used a stick to mobilise and 2.9% a
wheelchair. The majority (84%) were independently mobile. Using the CSHA FrailtyScale, 62% were classified as very fit or well without active disease, with 15% vulnerableor overtly frail.Conclusions: Warfarin dosing is challenging due to its narrow therapeutic index. Thereare implications on travel to warfarin clinics with about 50% of patients not driving and15% being frail.
269 AN EVALUATION OF INHALER TECHNIQUE IN AN ELDERLYHOSPITALISED POPULATION
Mary Randles, Colm Byrne, Evelyn Hannon, Michael O’ConnorCork University Hospital, Cork, Ireland
Background: Inhaled therapies are the cornerstone of treatment in COPD and asthma,common chronic respiratory conditions with a prevalence of 7–12% in the elderly popu-lation. Poor inhaler technique is associated with poor symptom control and increased
hospital admissions. The effectiveness of a specific inhaler device is dependent on thepatient’s ability to use their inhaler and correct inhalation technique. This study assessesthe ability of a hospitalised population of older patients to effectively use their prescribedinhalers.Methods: Patients over 65 who were prescribed at least one regular inhaler prior toadmission to hospital were included. Moderate to severe cognitive impairment and activedelirium were exclusion criteria. Recruited patients demonstrated their inhaler technique,which was evaluated with a standardised checklist. Inhaler technique was classified aspoor, acceptable or good based on the number of critical and non critical errors madeduring their evaluation.Results: 24 patients were initially included for evaluation, the mean age was 77.4(SD ± 7.1). 5 patients were subsequently deemed ineligible (2 not taking inhalers in thelast 3 months, 1 inhaler administered by a carer, 1 patient had a wrist fracture in plastercast, 1 patient had left his spacer at home). Of those evaluated, 47.3% had poor inhal-ation technique. 36.8% had poor physical ability to use their prescribed device. Modifieddosage inhalers (MDI) had the highest rate of both poor inhalation technique and diffi-culty in use (0.71 and 0.57 respectively).Conclusions: A significant proportion of older hospitalised patients with COPD andasthma have difficulty co-ordinating physical activation of their inhalers and inhalationtechniques. This can be due to poor initial device education, reduced dexterity andreduced physical strength. By assessing our inpatients we have the potential to improvesymptom control and compliance through better education and tailoring inhalationdevices to suit our patient’s needs and abilities.
270 DEVELOPMENT OF THE DRUG BURDEN INDEX TOOL FORUSE IN AN IRISH POPULATION WITH INTELLECTUALDISABILITIES
Maire O’Dwyer1, Juliette O’Connell1, Philip McCallion2, Mary McCarron3,Martin Henman11School of Pharmacy and Pharmaceutical Sciences, Dublin, Ireland2Centre for Excellence in Aging and Community Wellness, University at Albany, New York,USA3Dean of the Faculty of Health Sciences, Dublin, Ireland
Background: The Drug Burden Index is an evidence-based tool that includes principlesof dose response and cumulative exposure to describe total exposure of an individual toanticholinergic and/or sedative effects (Hilmer et al, 2007). The DBI has been independ-ently associated with poorer physical and cognitive performance in older adults. There isno standard reference source providing a definitive list of medications which possessthese properties. Our aim was to create this master list of medications used in Irelandwith clinically significant anticholinergic and/or sedative activity, to decide upon theMinimum Daily Dose (MDD), a key component of the DBI calculation, for each.Method: Medications with potential anticholinergic and/or sedative burden were identi-fied by literature review and examination of the Summary of Product Characteristics forall medications in Ireland. This list was then defined by consensus. MDD was selectedaccording to the medication’s Irish SmPC. In addition, the defined daily dose (DDD)from the World Health Organisation (WHO), and the MDD in the British NationalFormulary (BNF) were examined. MDDs were decided as lowest effective therapeuticdose specified in the SmPC for the medication.Results: Overall 383 medicines with potential anticholinergic and/or sedative propertieswere identified. If a drug was both anticholinergic and sedative it was considered to beprimarily anticholinergic, as per previous studies. After final consensus agreement 257medicines (117 anticholinergic, 140 sedative) were included. Of these 128 (50%) wereagents which act primarily on the nervous system. The t�hree main therapeutic groupswere antipsychotics (24�), antidepressants (21) and antiepileptics (20).Conclusion: The use of this list of medicines, along with their MDDs, for DBI calcula-tion could be a useful tool to identify cumulative burden of anticholinergic and/or seda-tive medicines, and to identify patients who would benefit from a medication review toreduce this burden and improve appropriate prescribing.
271 DRIVING PREVALENCE AMONGST PEOPLE ATTENDING AMULTIDISCIPLINARY MEMORY ASSESSMENT SERVICE
C McHale, R Briggs, D Fitzhenry, D O’Neill, T Coughlan, R Collins, J Doherty,A Connolly, N Austin, J Freeman, F Tobin, E Duignan, C Mooney, S LawsonTallaght Hospital, Dublin, Ireland
Background: In much literature dealing with people with age related disease and disabil-ity, safety can sometimes predominate over the preservation of autonomy and function(1). The degree to which safety issues figure at the time of assessment of people attendinga memory assessment clinic in the Irish context is unknown. We assessed the perceptionsof family/carers of safety issues in a cohort attending a newly developed memory assess-ment clinic.Method: Prospective study of cohort attending a multidisciplinary memory assessmentclinic in a university teaching hospital. Data was collected with a focus on informant his-tory, diagnosis and functional decline measurements such as the Exit 25.Results: There were 31 men and 39 women, mean age 76.2 years (range 6191). The diag-nostic formulation was 57.1% (n = 40) non-dementia; 42.9% (n = 30) dementia.Informant history suggests safety concerns in 5.2% of the non-dementia group and 80%concern in those with dementia. Exit-25 scores ranged 0–23 (non-dementia) 2–29
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(dementia). Concerns included cooking 1.6 % (n = 4), medication compliance 2.8 % (n =7), financial issues 0.4% (n = 1), driving 2.4% (n = 6) and falls 0.8% (n = 2). Concerns inthe group with dementia included cooking 3.6% (n = 12) medication compliance 4.5% (n= 15), financial issues 4.5% (n = 15), driving 4.2% (n = 14), falls 1.8% (n = 6) and gettinglost 1.8% (n = 6).Conclusion: The degree to which family/carers consider safety to be an issue for peoplewith memory complaints is higher than a Canadian survey arising from a longitudinalstudy. Despite these concerns there remain a large number of patients navigating risk andfunctioning well with the aid of early diagnosis and support.
273 A STRATEGY TO REDUCE ANTIPSYCHOTIC MEDICATIONPRESCRIBING FOR PEOPLE WITH DEMENTIA IN THENURSING HOME SETTING
Denis Curtin, Jaroslav Olearnik, Alberto San Francisco Ramos, Fiona O’Donovan,Esther Gallagher, Parfrey Rothwell, Ann Meade O’Callaghan, Michael O’Connor,Norma Harnedy, Denis O’MahonySt. Finbarr’s Hospital, Cork, Ireland
Background: Antipsychotic medication to manage behavioural and psychological symp-toms of dementia has been associated with an increased risk of mortality. It is recom-mended that these medications be prescribed only if a patient is severely stressed and adanger to him/her-self or others. Non-pharmacological interventions are recommendedfirst line. If absolutely required, antipsychotic medications should be prescribed at thelowest effective dose for a finite period of time and regularly reviewed (NICE best prac-tice guidelines). Despite this, antipsychotic medications tend to be widely prescribed inlong-term care settings. This study measured the prevalence of antipsychotic prescribingin a nursing home population and also the impact of a bespoke policy document toreduce antipsychotic prescribing.Methods: Chart reviews were carried out on all residents of the long-stay wards. Next, apolicy document was produced by the medical staff, working closely with the clinicalnurse managers (CNMs) on of the long stay wards. This document was adapted from‘Treatment and care of people with behavioral and psychological symptoms of dementia(BPSD)’ document produced by the Alzheimer’s Society. The author worked closely withthe CNMs and efforts were made to reduce antipsychotic medications on a monthlybasis. Re-audit took place after 6 months.Results: At the outset, 36% (17/47) of patients were prescribed antipsychotic medica-tions for BPSD. At the completion of the audit, 29% (13/45) were taking antipsychoticmedications. Total amount of quetiapine reduced by 25%; total amount of olanzapinereduced by 11%; total amount of haloperidol reduced by 21%; total amount of chlorpro-mazine reduced by 78%.Conclusion: It is possible to reduce the prescribing of antipsychotic medications signifi-cantly in the long term care setting. Enlisting the support of senior clinicians and nursingstaff and working together to produce a policy document for our institution was a keyfactor in the success of the project.
274 HIGHER SERUM URATE LEVELS ARE ASSOCIATED WITHGREATER BONE MINERAL DENSITY
Kevin McCarroll1, David Moloney2, Angelina Farrelly2, Deirdre Smith2, Laura Mulkerrins2,Maire Rafferty2, Caoimhe McManus2, Miriam Casey1, Rose Lannon1, James Mahon11Mercer’s Institute for Research on Ageing, Dublin, Ireland2MedEL Directorate, St James’s Hospital, Dublin, Dublin, Ireland
Background: Higher serum urate levels have been associated with greater bone mineraldensity (BMD) at the spine and hip, and lower prevalence of fractures in several largestudies. Though the association was first reported in 2011, the underlying mechanismremains unclear and results have been conflicting. Urate is an endogenous anti-oxidantand may influence bone health via putative effects on osteoblast differentiation and mus-cle strength. We aimed to explore the relationship between serum urate and bone mineraldensity in Irish adults.Method: Subjects were Irish adults with osteopaenia or osteoporosis (as defined bystandard WHO criteria) attending a bone health clinic. Data for analysis was obtainedfrom a clinic database. The relationship between serum urate and BMD (at total hip,neck of femur and lumbar spine) was explored in multiple linear regression model adjust-ing for confounds.Results: Data were available for 628 subjects. 84.7% were female and mean age was 67.2(14.0) yrs, BMI 25.2 (5.0) and urate 283 (85.8) umol/l. 72.5% had osteoporosis and27.5% osteopaenia by DXA criteria. Higher urate levels were associated with greaterBMD at spine (P = 0.027) but not at hip (P = 0.80) after adjustment for age, gender,body mass index and serum 25(OH)D.Conclusions: Our findings replicate other studies in identifying an association of higherurate levels with greater BMD despite our result being limited to the spine. We were notable to account for medications such as thiazide diuretics which increase serum urate,reduce urinary calcium excretion and have been positively associated with BMD andreduced fracture risk. In addition, treatment with teriparatide has been associated withhigher serum urate. More research is needed to better understand the mechanistic reasonsthat underlie this relationship.
275 ALCOHOL DEPENDANCY IN THE ELDERLY – ARE WECAPTURING IT?
Clodagh Murphy, Mary Buckley, Rachel Kearns, Aoife O’Sullivan, Yusuf Malik,Paul Gallagher, Orla CrosbieCork University Hospital, Cork, Ireland
Background: Up to 33% of elderly patients develop late onset substance abuse pro-blems. Physiological changes associated with ageing lead to a change in body compositionresulting in a higher blood alcohol level than younger counterparts. Alcohol abuse in eld-erly can have atypical presentations such as falls with fracture, confusion or depressionwhich may not lead to direct questioning re alcohol intake. The complex multi-morbidelderly patient may also have poor social circumstances and a co existent psychiatric dis-order further “muddying” the history. Alcohol withdrawal is potentially life threatening,with an increased duration and severity with age.Methods: A chart review of 57 consecutive over- 65 medical and surgical admissions onfour wards was undertaken over a two-week period. Details of alcohol consumption pat-terns documented on admission were recorded. The patients were then screened forhigh-risk alcohol consumption using the validated WHO AUDIT- C screening tool. TheWHO AUDIT – C tool is a 3 question survey which is designed to screen for high riskalcohol consumption.Results: 57 patients (53% female, 47% male) were studied with a mean age of 81 years.Alcohol consumption patterns were recorded in 33% of patients on admission. Uponpatient questioning using AUDIT-C, 42% of patients admitted to drinking alcohol atleast once a month. 37% of these were subcategorised into people with high-risk drink-ing behaviour. 42% of these high-risk drinkers had no alcohol history recorded onadmission. 66% of extremely heavy drinkers (AUDIT-C score 12) at risk of develop-ment of acute alcohol withdrawal were not identified or treated appropriately onadmission.Conclusions: An acute hospital admission remains an opportunistic time to firstly iden-tify and then intervene in patients with alcohol dependence. This may help to preventcomplications such as osteoporosis and hip fractures, cognitive impairment and decreasethe risk of potential adverse drug events.
278 EVALUATING RISK FACTORS FOR TRAUMA IN ELDERLYPATIENTS
Robbie Bourke, Marie Therese Cooney, Jessica Belchos, Rachel Doyle, John Cronin,David MenziesSt. Vincent’s University Hospital, Dublin 4, Ireland
Background: The Trauma Audit Research Network (TARN) database records patientspresenting to Emergency Departments (ED) in the UK and Ireland who present withtrauma. The database was used to ascertain if previous ED attendances and previoustraumas were associated with further events and poorer outcomes in elderly patients aswell as risk factors that could influence outcomes.Method: The TARN database in a major Dublin hospital was used to evaluate traumaticattendances over a 21-month period from September 2013 to May 2015. The databaseexamined demographic information regarding age (stratified as over 65 and under 65years), number of previous ED attendances and ED attendances with trauma over pre-ceding 2 years, and the presence of alcohol involvement. The data was collected on Exceland analysed using STATA.Results: 23% of patients over 65 years old had a previous ED attendance in the preced-ing 6 months versus 14% of patients less than 65 years old, (p = 0.0018).In patients over 65 years where alcohol was involved in their presentation, 42.9% had
a previous attendance compared to 34.2% of the group without alcohol involvement.There was an association between number of previous ED attendances over the pre-
ceding 2 years and mean length of stay (LOS) in patients over 65 years old (0 admissions= mean LOS 22.9 days, 1 previous admission = LOS 28.1, 2 previous admissions =LOS 34.7 days, 3 previous presentations = LOS 40.2 days).Conclusions: This demonstration of the high number of elderly trauma patientswith previous ED attendances and the association of these repeat attendances withincreasing length of stay is useful in terms of service and discharge planning. Asexpected alcohol use in older patients in associated with repeated ED attendances.In younger trauma patients, prior ED presentations signal a higher risk of shortterm mortality.
279 AN AUDIT OF PRESCRIPTION DOCUMENTATION IN AREHABILITATION HOSPITAL
Robbie Bourke, Michelle O’Brien, Shauna Fagan, Aaron Doherty, Lisa CoganThe Royal Hospital, Donnybrook, Dublin, Ireland
Background: The aim of this audit is to improve the documentation in medicationrecords (kardex) within a rehabilitation hospital. The HSE standard of Healthcare RecordManagement (2011) as well as local medication documentation standards were utilised.Methods: The initial audit was commenced in July 2015. The population within the hos-pital includes a long-term care, stroke and rehabilitation unit. 27 kardexes were auditedwith a total of 258 individual prescriptions analysed. At least 3 kardexes were randomlyselected from each ward from each ward.
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Results: 27 kardexes were analysed with 258 individual prescriptions reviewed. 71% ofthe kardexes analysed belonged to an over 65 age group. All kardexes had allergies docu-mented with 89% having the allergy manifestation documented. 96% of kardexes had thealert box (e.g. insulin,warfarin) filled correctly. On analysis of individual prescriptions wefound 76% were prescribed generically. 38% of prescriptions had a MCRN and 5% ofprescriptions were not associated with a signature. Overall there was satisfactory docu-mentation of appropriate route, frequency and dose (95%, 96% and 97% respectively).Start dates of medications were documented 94% of the time. 7% of prescriptions didnot have appropriate review dates documented. Overall legibility of the prescriptions was95%. Legibility was determined if the data collector (all doctors) could easily read all com-ponents of the prescription.Conclusions: The most notable area for improvement is documentation of a MCRN. Acorrectly documented prescription should be associated with both a signature and aMCRN. Generic or appropriate trade name prescribing was another area identified forimprovement. Following an education session regarding appropriate documentation, kar-dexes were re-audited.
280 A RETROSPECTIVE ANALYSIS OF THE OLDER OLDADMITTED TO THE ACUTE MEDICAL ASSESSMENT UNIT INAN IRISH UNIVERSITY HOSPITAL
Maire Rafferty, Joanna McGlynn, Siun O’Flynn, Jennifer CarrollCork University Hospital, Cork, Ireland
Background: Access to acute hospital care for the older old was traditionally via theemergency department pathway. An alternative pathway is evolving as Acute MedicalAssessment Units are developed. Our unit provides an integrated model of service provi-sion for older people delivered by a multidisciplinary team led by acute physicians includ-ing consultant geriatricians. Early appropriate assessment of older people has thepotential to improve outcomes, reduce inappropriate hospitalisation and potentiallyreduce the need for long-term care (LTC).Methods: All patients aged over 90 years assessed by the AMAU over a one year periodwere selected (139). Data were collected regarding patient characteristics, admission char-acteristics, management decisions as well as initial and 12 month outcomes.Results: 128 patient records were available to be examined. 98 (76%) were female.Age ranged from 90–101 (median 93). 48 (37%) were living alone at the time ofadmission, 46 (33%) rurally. Patients were taking between 0-10 medications, median4.5 and had 0-14 comorbidities (median 6.6) identified on presentation. 46 (37.7%)were independent with ADLs. 36 (28.3%) required the assistance of at least one per-son to mobilise. 77 (59.7%) were continent. 36 (28%) had a diagnosis of dementiaon admission.62 (48.1%) were referred by GP. 67(51.9%) were managed by the AMAU team for
the duration of the admission. Falls were the reason for admission in 25 (19.4%),infection 34 (26.5%), TIA/Stroke 13 (10.1%).Cognitive screening was documented in19 (14.7%). Advanced care planning was documented in 48 (37.3%). 26 (20.2%) weredischarged the same day. 13 (11.6%) died during their admission. 12 (9.3%) admittedfrom home were discharged to LTC, more likely if living alone prior to admission(p = 0.002). At one year 44 (34%) had been readmitted at least once. 28 (21.7%)has died.Conclusions: This research provides a unique insight into the characteristics of the olderold presenting to an acute hospital and the outcomes in this group. It provides valuableinformation for service planning and quality improvement initiatives.
281 THE INTER-RATER RELIABILITY OF THE RISK INSTRUMENTFOR SCREENING IN THE COMMUNITY (RISC): PRE AND POSTTRAINING
Elizabeth Weathers1, Rónán O’Caoimh2, Ronan O’Sullivan1, Constança Paul3,Francesc Orfilia4, Roger Clarnette5, Carol Fitzgerald1, Anton Svendrovski6,Nicola Cornally7, Patricia Leahy-Warren7, D. William Molloy11Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital,Douglas Rd, Cork City, Ireland2Health Research Board Clinical Research Facility Galway, National University of Ireland,Galway, Geata an Eolais, University Road, Galway City, Ireland3ICBAS, Institute of Biomedical Sciences Abel Salazar – University Of Porto, Porto, Portugal4Institute for Research Primary Healthcare, Jordi Gol University, Barcelona, Spain5School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy,Fremantle, Australia6UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto, Canada7School of Nursing and Midwifery, University College Cork, Cork City, Ireland
Background: Predicting risk of adverse healthcare outcomes is important to enable tar-geted delivery of early interventions. The Risk Instrument for Screening in theCommunity (RISC) measures the one-year risk of hospitalisation, institutionalisation anddeath in community-dwelling older adults and can be used to triage patients according toa five-point global risk score: Low (score 1, 2), medium (3) to high (4, 5). While validated,the effect of a standardised “RISC” training programme on its reliability is yet to beassessed. This study aimed to examine the inter-rater reliability (IRR) of the RISC beforeand after the RISC training programme for healthcare professionals.
Methods: A descriptive correlational design was used. A sample (n = 32) of studentPublic Health Nurses (PHNs) scored six clinical cases (two low, medium and high-riskclinical scenarios), before and after RISC training. Participant scores were comparedwith expert scores for the same cases. IRR was measured with Gamma and Spearmancorrelations and Kappa statistics. Internal consistency was assessed using Cronbach’salpha.Results: The correlation between PHNs and experts RISC scores increased for eachadverse outcome, pre and post training, and was statistically significant for institutionalisa-tion (r = 0.72 to 0.80, p = 0.04) and hospitalisation, (r = 0.51 to 0.71, p < 0.01) but notdeath. The proportion of matches between PHNs and expert raters as a marker of agree-ment increased for all three outcomes. Examining risk levels separately showed that train-ing improved agreement for low-risk but not all high-risk cases. When a paired-samplesdesign was used, agreement reduced significantly post-training for cases deemed high-riskof institutionalisation (92% versus 75%, p = 0.01) and hospitalisation (88% versus 71%,p = 0.01).Conclusion: Overall, the RISC showed good IRR, which increased after RISC training.That reliability reduced for some high-risk cases suggests that the training programmerequires adjustment to further improve IRR.
282 PROGRESSIVE SUPRANUCLEAR PALSY: A CASE STUDY
Mary J Foley, Kieran O’Connor, Eavan FitzgeraldSt Finbarr’s Hospital, Cork City, Ireland
Background: Progressive supranuclear palsy (PSP), also called Steele-Richardson-Olszewski syndrome, is a neurodegenerative disease. It has a prevalence of 6.4 per100,000 of the population which suggests that there are approximately 270 patientsacross the republic Ireland diagnosed and living with PSP (PSPA Ireland). This margina-lised group often suffer in silence with inadequate supports.
This study addresses the complex palliative phase of PSP and the 3 year period frominitial presentation to the Day Hospital (Assessment & Treatment Centre, A&TC) when a75 year old Michael presented with a dysarthric voice, impaired vision, constipation, urin-ary symptoms, stiffness, unsteady gait and recurrent falls to 2015 when disease progres-sion caused his death.Methods: Qualitative Case study conducted by healthcare professionals involved in hiscare. This retrospective review includes photographs and audioclips.Results: Weekly Day Hospital attendance and timely access to the Advanced NursePractitioner, Consultant Geriatrician and Multidisciplinary Team facilitated person centredcare, responsive symptom management and identification of triggers requiring specialistpalliative care intervention. The support of healthcare professionals was required toaddress quality of life issues, assist decision making and manage family expectationsaround issues such as enteral feeding. Community liaison support reduced family burdenof care and increased confidence of primary care team. Despite life threatening risks andcomplications, Michael was cared for at home and not admitted to hospital during the 3year study period.Conclusions: This case study demonstrates patient and family resilience in the face of adebilitating chronic disease and the challenges posed by muscle rigidity, communicationand swallowing difficulties. The disease trajectory highlights the importance of a co-ordinated palliative care approach. The day hospital (A&TC) avoids unnecessary admis-sion to hospital and longterm care and is a valuable cost effective service for older adultswith complex disease and multiple co-morbidities such as PSP.
283 TIME IS BRAIN: DOOR TO NEEDLE TIME: STROKETHROMBOLYSIS PATHWAY IN ACUTE TERTIARY HOSPITAL
Elizabeth Moloney, Catherine Peters, Keith McGrath, Elaine Shanahan, Patricia Guilfoyle,Margaret O’ConnorUniversity Hospital Limerick, Limerick, Ireland
Background: The National Stroke Register was set up in 2012 to monitor the care deliv-ered to acute stroke patients, as part of a wider National Stroke Clinical Care Programmeestablished in 2010. There are annual audits of of efficiency and outcomes of acute strokeassessment and treatment. Evidence from studies indicates a benefit from IV thromboly-sis (rt-PA) with 1 fewer patient dead or dependent at 3 months per 10 people treated.This is based on administering rt-PA within 3 hours from symptom onset within strictclinical and laboratory criteria.Methods: Aims of this audit was to measure the Onset to Door Time, Door to CTTime, and overall Door to Needle Time prior to the opening of the Acute Stroke Unit inUHL in Nov 2015.
The standards which this Audit were set against are the Irish Heart Foundation StrokeThrombolysis Guidelines. Stroke register for patients attending UHL ED from January1st to December 20th, 2015 was reviewed and times for the above categories were noted.Results: 34 patients were included in this audit. Compared to previous years, Onset toDoor Time was reduced (2012: 42 minutes, 2013:90 minutes, 2014: 86 minutes, 2015: 50minutes). However, Times for Door to CT (2012: 30 minutes, 2013: 43 minutes, 2014:40 minutes, 2015: 65 minutes), and Door to Needle (2012: 69 minutes, 2013: 96 minutes,2014: 81 minutes, 2015: 118 minutes )were all increased.Conclusions: There is greater recognition of the signs and symptoms of stroke in theCommunity, and in the need for swift medical assessment. Unfortunately, for the year
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covered by this audit, delays in definitive treatment are then experienced from the time ofhospital admission. On the basis of our audit, a dedicated Stroke Registrar will commencework in July 2016 & we plan to re-audit our Stroke Thrombolysis Pathway in 6 monthstime.
284 USE OF CEREBROSPINAL FLUID BIOMARKERS INSUPPORTING A TIMELY DIAGNOSIS OF ALZHEIMER’SDISEASE
Robert Briggs1, Sean Kennelly1, Brian Lawlor2, Anne Marie Miller31Memory Assessment Clinic, Tallaght Hospital, Dublin, Ireland2Memory Clinic, St James’s Hospital, Dublin, Ireland3Irish Network for Biomarkers in Neurodegeneration, Dublin, Ireland
Background: Cerebrospinal Fluid (CSF) neurodegenerative biomarker analysis can serve asa useful support for a timely diagnosis of prodromal and atypical clinical presentations ofAlzheimer’s disease (AD). A recent interdisciplinary consensus document for CSF biomarkersin AD advises the use of three core AD biomarkers, Aβ42, total-tau and phosphorylated-tau,with standardized measurement available through a certified clinical laboratory. The aim ofthis study is to profile all referrals for CSFAD biomarkers over 12 month period.Methods: We identified all relevant referrals to the national central laboratory and col-lected data pertaining to patient demographics and biomarker results. Pathological changein all 3 CSF biomarkers is considered neurochemically compatible with a high likelihoodof AD, while abnormal levels of one biomarker confers an intermediate likelihood of ADor suggests an alternative neurodegenerative process.Results: There were 45 referrals during the study period, 39 of which had full resultsavailable. The mean age of the referred patients was 61.0 (CI 57.0-65.1) years and 51.3%were female. One fifth (8/39) involved patients aged 50 years or less. Two thirds (25/38)had a CSF Aβ42 consistent with AD (<591 pg/mL), half (19/38) had a CSF total-tauconsistent with AD (>345 pg/mL) and one third (14/38) had a CSF phosphorylated-tauconsistent with AD (>64 pg/mL). 15% (6/39) demonstrated pathological changes in allthree biomarkers. 85% (33/39) had at least one abnormal biomarker level.Conclusion: While the final diagnosis in AD must be shaped by the clinical history,neuropsychological profile, and neuro-imaging, CSF biomarkers can facilitate earlier diag-nosis or clarify an atypical clinical presentation with pathological biomarker levelsobserved up to 10 years before the onset of clinically detectable symptoms. Future ADdisease-modifying treatments are most effective when commenced early and CSF biomar-kers may facilitate this necessary earlier diagnosis.Acknowledgement: Irish Network for Biomarkers in Neurodegeneration.
286 HIV AND BONE DISEASE: AN AUDIT OF COMPLIANCE WITHTHE EUROPEAN AIDS CLINICAL SOCIETY BONE DISEASEGUIDELINES
Cathal O’Broin, Liam Townsend, Niall Kelly, James Mahon, JB Walsh, Kevin McCaroll,Colm BerginSt James’s Hospital, Dublin, Ireland
Introduction: With the advent of highly active anti-retroviral therapy (HAART), patientswith HIV have similar life expectancy to the general population. It has been demon-strated in large centre trials that both HIV and tenofovir-based regimens contribute tobone ageing. 20% of HIV positive patients in our institution are over 50 years of age andrepresent an ageing cohort. The European AIDS Clinical Society (EACS) recommendsdual-energy x-ray absorptiometry (DXA)and annual vitamin D monitoring in all patientsover 50. Aim: To audit compliance with the EACS bone guidelines in HIV-positivepatients over 50 years old.Methods: In HIV positive patients >50 years old, data were collected relating to basicdemographics, immune function, vitamin D monitoring, bone treatment, and DXA results.Results: Of 314 HIV-positive patients, median age was 54 (range 50–81). Mean CD4count was 635 cells (range 291–1921). 77% were men, 23% women. 67% of patientshave had a vitamin D check, with only 33% of those in the last year. Vitamin D insuffi-ciency was present in 40% and deficiency in 9.4%. 56% (n = 178) of patients had receivedDXA scans. 23% demonstrated osteopenia, and 9% osteoporosis respectively.
82% patients were on tenofovir-based regimens, with vitamin D monitoring in 66%overall and 20% in the last year. 27% were insufficient, with 6.5% being deficient. 56% ofpatients had received DXA scans of these 23.6% showed osteopenia, and 9% demon-strated osteoporosis.Conclusion: Vitamin D deficiency, reduced bone mineral density and tenofovir use arecommon in patients over 50 years old. Further education is required to improve compli-ance with the EACS HIV and bone disease guidelines.
288 IMPROVING THE EFFICIENCY OF MEDICINE FOR THEELDERLY CONSULTS: A REDESIGNED CONSULT FORM
Amalia Ioana Costea, Cliona O’Donnell, George Pope, Riona Mulcahy, Fahd Adeeb,Georgia Merron, Ashley Lubotzky, John Paul CookeUniversity Hospital Waterford, Waterford, Ireland
Background: Inpatient referrals to medicine for the elderly frequently lack importantdetails. This results in delays and time-consuming fact-finding by Medicine for theElderly registrars. These consult forms are also not easily audited/logged and it can bedifficult to keep track of consults seen and decisions made. Our aim was to audit referralforms received to our department to determine the quality of information communicatedto us.Methods: We developed a gold-standard minimum dataset by evaluating consult formsused in other sites and consulting with experienced medicine for the elderly physicians.We then audited a random sample of 100 consults submitted to the MFTE team andcompared their content to our minimum dataset. This allowed us to evaluate the qualityof information conveyed.Results: We found that consults received by Medicine for the Elderly had significant def-icits when compared to the gold-standard minimum dataset. Long term referrals weremost problematic. Between 70–80% of forms for long term care had inadequate infor-mation about the patients’ functional baseline, 80% of forms did not contain adequateinformation about the referrer, and 30% of forms did not contain the patient’s location.Evaluation of the patient’s own wishes and capacity was also inadequate.Conclusions: We have determined that the information being submitted to the medicinefor the elderly team is insufficient to carry out a consult expeditiously and leads to delaysin seeing the patient and in decisions being made regarding their care. We feel it is timetherefore to redesign the referral form for our department to include prompts for theminimum dataset as agreed above. We intend to re-audit the referral system after this hasbeen implemented.
290 HOMELESSNESS IS ASSOCIATED WITH PREMATURE ONSETOF MULTIMORBIDITY AND INCREASED USAGE OF ACUTEHOSPITAL SERVICES
Cliona Ni Cheallaigh1, Sarah Cullivan2, Jennifer Kieran2, Joe Browne2, Fiona O’Reilly3,Kieran Harkin5, Una Geary2, Colm Bergin2, Austin O’Carroll4, Rose Anne Kenny1,Declan Byrne21Trinity College, Dublin, Dublin, Ireland2St James’s Hospital, Dublin, Ireland3Partnership for Health Equity, Dublin, Ireland4North Dublin City GP Training Scheme, Dublin, Ireland5Safetynet, Dublin, Ireland
Background: Homeless people lack a secure, stable place to live, and experience higherrates of serious morbidity than the housed population. Multi-morbidity has been definedas the co-occurrence of more than one chronic condition in an individual over time.In housed populations increased co-morbidities and increased use of unscheduledhealth care (ED visits and inpatient admissions) are driven primarily by age. It has beensuggested that the homeless populations have increased levels of psychosocial stress,poor accommodation and poor nutrition, which may contribute to premature ageing andfrailty.Methods: We analysed data on all ED visits and all unscheduled admissions under thegeneral medical take in St. James’s Hospital in 2015. The address field of the electronicrecord was used to identify homeless patients.Results: We found a striking difference in the age profile of hospitalised homelesspatients compared to housed patients, with the median age of homeless medical inpati-ents 20 years younger than that of housed patients. In housed patients, ageing was asso-ciated with increasing rates of multi-morbidity and unscheduled medical admission.Homeless patients demonstrated a premature onset of multi-morbidity, associated withincreased use of unscheduled healthcare, and these were unrelated to age.Conclusion: Homelessness represents a state of extreme socio-economic deprivation,and is associated with increased prevalence of behaviours associated with morbidity(smoking, alcohol and drug use) but also with increased psychological stress potentiallyresulting in inflammation, immunopareisis and increased biological ageing. These exogen-ous and endogenous factors appear to be so strongly associated with multimorbidity thatthe association between ageing and multimorbidity seen in housed hospital patients isovercome.
291 QUALITY IMPROVEMENT PROJECTS TO IMPROVEMULTIDISCIPLINARY COMMUNICATION AND DELIRIUMMANAGEMENT
Ciarán TrolanUlster Hospital, SEHSCT, Dundonald, UK
Background: A regional programme aimed to improve recognition, prevention andmanagement of delirium through piloting a regional care bundle; and locally-designedprojects to improve communication within clinical teams; and improve communicationbetween clinical teams and clients. This included a delirium training programme forclinicians.Our Acute Geriatric Medicine ward was selected to pilot changes. We have 19-20 beds,
average/median length of stay is 8.64/6 days. 93.4% have ≥3 coded primary diagnoseson discharge. 83% have delirium. 46% have dementia.The multidisciplinary team (MDT) “Huddles” daily at an interactive whiteboard with
focus on safe discharge and ward safety. Nurses have twice daily handovers in addition.Methods: A quality improvement method (Safety, Quality, Experience [SQE]) wasapplied to: duration of Safety Brief; duration of MDT Safety Brief; duration, start time
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and attendance at “Huddles”; “Huddle” format; implementation of regional delirium carebundle; implementation of nurse-led “Information Clinics”; “Any Questions?” client/carer communication board; and an “About Me” document detailing background clientinformation.Results: The “BURP” (Background, Update, Recommendation, Park) “Huddle” formatproved effective and well-received by MDT members. “Huddle” duration lengthenedfrom 12 minutes to 14 minutes with consistent start times. The MDT Safety Brief dur-ation fell from 1 minute 27 seconds to 45 seconds. Nursing Safety Brief durationimproved from 7 to 5 minutes. “About Me” was popular with staff, clients/carers andcompleted 69% of the time. The “Any Questions?” board was used by 33% clients andpopular with staff. The delirium care bundle provided concise documentary evidence ofassessment, preventative and management interventions. It was complicated to use, how-ever. Only two carers used the “Information Clinic”. Delirium training was welcomed bystaff.Conclusions: The SQE project format facilitated multiple, small, incremental changes inpractice to the benefit of clients, carers and clinicians on our Acute Geriatric Medicineward. “Information Clinics” were not useful in our unit.
292 IDENTITY CONSTRUCTION IN DEMENTIA CAREGIVING:“THEM” AND “US”
Karen Matvienko-Sikar, John McCarthyUniversity College Cork, Cork, Ireland
Background: Dementia caregivers consistently report high levels of stress and impairedwell-being. Implementing and maintaining appropriate supports for dementia caregiversis essential; online forums provide one such resource. Examining how caregivers discusscaring on forums can provide insight into the construction of care-giving needs, experi-ences and identity. This will provide an insight into how best to support those caring forindividuals with dementia.Methods: Data were obtained from the Carers UK dementia forum, following permis-sion and approval of the study. Sixty-seven topics were randomly selected during an 18-month period. Nineteen topics relating to care homes were selected in this analysis; theseincluded 134 individual posts from 48 forum members. Posts were analysed using a dis-cursive psychological approach. Interpretations of the functions of discursive featureswere generated through this process.Results: Online dementia support forums are constructed as a necessary, useful ‘place’for giving and receiving advice and sharing information. Caregivers discursively createonline and offline communities, positioning themselves as members of a distinct onlinegroup. Individuals and/or institutions discussed as presenting disagreement or tensionwith caregivers are constructed as a distinct negative out-group.Conclusions: Online dementia caregiver support forums are a useful and necessaryresource for caregivers. The findings of this study highlight the need to meet exist-ing caregiver needs for support in an offline context. They also point to the import-ance of negotiating tensions to reduce caregiver distress and improve care-givingexperiences.
294 CLARITY ON SOCIAL MEDIA? AN APPRAISAL OF AVAILABLEINFORMATION REGARDING DEMENTIA ON SOCIAL MEDIAWEBSITES
Clare Mac Mahon, Desmond O’NeillAMNCH Tallaght, Dublin, Ireland
Background: To determine if the available information on dementia on social media isrelevant, useful or informative for those diagnosed with dementia and their families andcarers.Method: Using a methodology previously used to explore the utility of social media con-tent for incontinence (1), we performed a search on Facebook, Youtube and Twitter ofthe word “dementia” and documented the first 30 results in each. We categorised theseinto resources from a healthcare professional supported website, personal blogs and newsarticles. They were broadly divided into informative or not informative.Results: On Twitter 12/30 were “informative” articles, 4 were from an official healthcaresource, 12 were opinion pieces, 13 were news articles. On Facebook overall 14/30 wereinformative, 4 from a healthcare source, 4 opinion pieces and 22 news pieces. OnYoutube 28/30 were informative videos, 11 of these were a healthcare source, 11 werepersonal/opinion and 4 were news videos.Conclusion: There is a huge amount of information on dementia available throughsocial media but many with little medical support and with low representation fromsources associated with healthcare professionals. A search for information using socialmedia may result in an overload of information and difficulty in finding the best advicefor people living with dementia and their carers: healthcare professionals and advocacygroups need to work together to provide useful wayfinding for useful information ondementia in social media.References:1. Sajadi KP, Goldman HB. Social networks lack useful content for incontinence.
Urology 2011; 78: 764–7.
295 INTRODUCTION OF FRAILTY TEAM IN AN ACUTE GENERALHOSPITAL: CONNOLLY HOSPITAL EXPERIENCE
Keneilwe Malomo, Derry O’Loan, Warren Connolly, George Jefferies, Jackie Convery,Caroline Stapleton, Eimear Lawlor, Niamh Muldoon, Jennifer Kane, Basil Sullivan,Shirley Long, Melissa Ryan, Elaine Dunne, Basim Muhamed, Marie O’Connor,Eamon Dolan, Orla Donohue, Siobhan KennellyFrail Elderly Team, Medicine For The Elderly, Connolly Hospital, Blanchardstown, Dublin 15,Ireland
Background: We have established a frailty pathway that encompasses a multidisciplinaryteam (MDT) service with front-door response. The service has been developed to pro-vide timely, appropriate and effective comprehensive geriatric assessment (CGA) to olderpeople.Methods: The pathway was commenced in January 2016. Referral criteria to pathwayincluded- all nursing home residents and those over 75-years with one or more of the fol-lowing: acute/chronic confusion, falls and reduced mobility for over 24 hours. Patientswere screened for appropriate MDT input and consultant geriatrician provided input ona consult basis.Results: A total of 305 patients (15 under 75, 129 aged 75-85 and 161 over 85 years)were assessed over the initial 3 months. Of all referrals 27% had functional, 17% cogni-tive, 16% falls, 13% social, 12% swallow/speech and 15% other, impairments.
The mean clinical frailty scale was 6.4 with mental test score of 2.4 and early warningscore of 2.2. On 4AT score, delirium was detected on 60% of patients. Initial 2 monthsdata revealed mean length of stay (LOS) of 8.9 days on those admitted. Overall 31%were discharged the same day, of which 74% were discharged to nursing homes.
In March 2015 versus 2016, the mean hospital LOS for those aged 75-79 years was21.34 vs 9.69 days, with 61 vs 88 admissions and those aged ≥80 years, 21.96 vs 14.03days, with 118 vs 117 admissions. In April 2015 versus 2016, the mean LOS for thoseaged ≥80 years was 22.47 vs 12.37 days with 137 vs 161 admissions.Conclusion: Even though patients seen were quite frail and acutely unwell, a high per-centage was discharged the same day following a CGA with appropriate follow up careand early supported discharge mechanism using day hospital. For those requiring admis-sion, there was a swift referral to MDT for review and reduced LOS.
296 THE PREVALENCE OF FALLS AMONG OLDER ADULTS WITHINTELLECTUAL DISABILITY IN IRELAND
Sinéad Foran2, Philip McCallion3, Mary McCarron11Trinity College, Dublin, Dublin, Ireland2Waterford Institute of Technology, Waterford, Ireland3University at Albany, New York, USA
Background: Falls are a significant concern for society with 1 in 3 adults over the age of65 years experiencing at least one fall each year with serious consequences. Within theintellectual disability (ID) population falls are of even greater concern often resulting insignificant activity restriction, reduced quality of life and significant changes in living cir-cumstances. The present study set out to establish the prevalence of falls among Irisholder adults with ID.Methods: The sample was drawn from The Intellectual Disability Supplement to TheIrish Longitudinal Study on Ageing. Data was collected from 753 participants across alllevels of ID, which included sociodemographic variables and a number of falls items.Ethics was granted by Trinity College Faculty Ethics committee and by all service provi-ders involved in the study.Results: Overall, 26.7% (n = 200) of the participants reported a fall in the previous 12months, 14.5% (n = 94) experienced one fall, with 16.3% (n = 107) reporting 2 or morefalls. Females were more likely to fall than men, 29.3% versus 23.6%. Those living in aresidential setting were more likely to report multiple falls (OR 3.0, CI 1.4–6.7) than thoseliving at home or living independently. Considering age, those within the 50–64 year cat-egory were twice as likely (OR 1.6, CI 1.0–2.5) to fall than those aged 65 and older.Interestingly those with Down syndrome (DS) were less likely to fall (p = 0.026) thanthose without DS.Conclusion: The findings from the study demonstrate that the prevalence of falls amongolder adults with ID is concerning and that multiple falls are considerably higher than inthose without ID. Targeted health education and promotion among people with ID andtheir carers is critically important. Further studies are required to investigate why peoplewith ID are falling.
297 DEMENTIA IS COMMON AMONG OLDER PEOPLEPRESENTING TO THE EMERGENCY DEPARTMENT: A LARGE,SINGLE CENTRE, PROSPECTIVE STUDY
Dawn O’Sullivan1, Noeleen M. Brady1, Emma O’Shea1, Niamh A. O’Regan1,Edmund Manning1, Síle O’Grady2, Suzanne Timmons11Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork,Ireland2Mercy University Hospital, Health Service Executive, Cork, Ireland
Age and Ageing abstracts
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Background: We have previously reported that almost 30% of older people admitted toacute hospitals have dementia (Timmons et al., 2015), often un-diagnosed, but the preva-lence of dementia in older people presenting to the Emergency Department (ED) is lesswell known.Method: Trained researchers assessed consecutive ED attendees in Mercy UniversityHospital, aged ≥70 years, for delirium and dementia using the Delirium Rating Scale–Revised 98 (DRS-R98; cut-off 18); standardised Mini- Mental State Examination; andInformant Questionnaire on Cognitive Decline in the Elderly (cut-off 3.5). An expertlater reviewed data and assigned diagnoses using DSM-V criteria.Results: Of 706 potentially eligible ED attendees, 187 were excluded as follows: criticallyill (n = 24), “re-presenting” (n = 83), medical isolation (n = 16), non-English speaking (n= 5); an additional 100 were rapidly discharged or moved from ED, 51 refused participa-tion, and 5 had missing data. Of the 424 included patients, family were present for collat-eral history in just 48% (collateral obtained by telephone, often delayed by hours/days).Approximately half of older ED attendees were female (50.8%); median age was 77 years;91.1% were home-dwelling; 26% presented by ambulance. In total, 21.5% (n = 82) haddementia, but only 5.6% had a previous history of dementia documented in medicalnotes or GP letter. Of those with dementia, 49.4% had co-existing delirium. Older peoplepresenting by ambulance had significantly more dementia (35.2% versus 17.5%,p < .001) and delirium (28.1% versus 11.2%, p = 0.001). Dementia and delirium werealso significantly more prevalent in those aged ≥80 years (p = 0.001).Conclusions: Dementia is common in older people attending ED, particularly in thosepresenting by ambulance and over 80 years old, and half have co-existing delirium. Mostcases have not been previously diagnosed. This reinforces the need for cognitive screen-ing in Irish EDs, and supports the need for dedicated dementia/delirium or more genericgeriatric multidisciplinary team input in ED.
299 A MIDPOINT REVIEW OF THE IMPACT OF THE SYSTEMATICIMPLEMENTATION OF ADVANCE CARE DIRECTIVES ANDPALLIATIVE CARE EDUCATION PROGRAMME ON QUALITYOF CARE AT END OF LIFE IN LONG TERM CARE SETTINGS
William Molloy, Ronan O SullivanUniversity College Cork, Cork, Ireland
Background: The evaluation of the impact of the systematic implementation of advancecare directives and palliative care education programme on quality of care at end of life inlong term care (LTC) settings HRB funded project began in March 2015.Method: The project team educates staff on the theory behind Advance CareDirectives (ACD) as well as the practicalities of completing the Let Me Decide ACDbefore appointing a champion in each LTC setting to administer the project. The ‘LetMe Decide’ ACD enables a person to record their healthcare wishes in advance sothat these are known should a time ever come when the person can no longer com-municate or decide for themselves. For long-term care residents who have alreadylost the ability to make or communicate these decisions, it is important that the med-ical team involves the resident’s family in the care planning process so that what isknown about the resident’s values, beliefs and wishes about healthcare can be takeninto account when deciding on the most appropriate treatment. The project alsoinvolves the collection of data on staff learning needs, healthcare utilisation of health-care by residents, quality of death and dying as well as staff perception of end of lifeexperience.Results: To date 3 (intervention) long term care institutions have benefited from the pro-ject (3 control homes beginning implementation in January 2017).Conclusion: It is important that we understand the value and impact of advance caredirectives and advance planning in long term care settings prior to supporting a nationalpolicy on standard implementation.
302 MEDICINE FOR THE OLDER PERSONS DAY HOSPITAL, ACHANGING SOCIAL WORK SERVICE: 2006 V 2014
Background: The National Care of the Elderly Programme (2012) recommends eachhospital receiving acutely ill older adults must have an onsite day hospital capable ofmeeting the needs of the catchment area population. An audit of social work practice(2006 and 2014) in a Dublin acute hospital’s day hospital was carried out to assesswhether the social work role has adapted to meet the changing needs of and theresources available to, the elderly population in the hospital’s catchment area.Methods: Social work records on the Hospital Information System for all day hospitalreferrals to social work in 2006 and 2014 were analysed and categorised under type(s) ofintervention.Results: The study showed there was an increase in referrals from 2006 to 2014. Therewas an increase in interventions relating to accessing long term residential care.Applications for home care packages increased and applications for home help decreased.There was an increase in the need for familial carer support.
Conclusions: Comparison over 8 years demonstrated the ability of social work to adaptthe intervention depending on the changing context of needs and resources. Despite noadditional social work resources being allocated to the day hospital the social work ser-vice dealt with more referrals and the nature of the interventions demonstrates theincreasing dependency level of older people living at home in our catchment area andthe correlating complexity of interventions required to support the older person andtheir carer.
303 ORTHOSTATIC HYPOTENSION AND SELF REPORTED SLEEPDYSFUNCTION
Triona McNicholas, Susan O’Callaghan, Rose Anne KennyTrinity College Dublin, Dublin, Ireland
Background: Both Orthostatic hypotension (OH) and sleep are linked to the autonomicnervous system and share many common risk factors such as chronic pain, polypharmacyand depression. The prevalence of sleep disorders, particularly insomnia, increases aspeople age and deep sleep duration shortens. OH also increases in frequency with age.The aim of this study is to examine whether there is any association between OH andself reported sleep quality.Methods: Data from wave one of The Irish Longitudinal study on Ageing was used.Beat-to-beat blood pressure during active stand lasting 110 seconds was measured. 4463participants over the age of 50 had active stand data that was suitable for analysis.Sustained OH was defined as a drop in systolic BP >=20 mmHg or a drop in diastolicBP >= 10 mmHg that was sustained at 30, 60, 90 and 110 seconds. Participants wereasked questions in relation to sleep quality during a computer aided personal interview,including “How likely are you to doze off during the day”, “How often do you have trou-ble falling asleep” and “How often do you have trouble with waking up too early and notbeing able to fall asleep again”.Results: Participants with sustained OH at 110 (OR 1.625, 95% CI1.21-2.12 ), 90 (OR1.562, 95% CI 1.18 – 2.07), 60 (OR 1.457, 95% CI 1.14 – 1.84) and 30 seconds (OR1.29, 95% CI1.09 – 1.52) were more likely to report trouble falling asleep than partici-pants without evidence of sustained OH on active stand. There was no significant associ-ation between OH and likelihood of dozing off during the day or likelihood or waking uptoo early.Conclusions: There is a significant relationship between OH and self reported troublefalling asleep. Further analysis is required to assess whether this relationship persists inde-pendent of common risk factors.
304 AN AUDIT OF ACUTE STROKE PATIENTS AND ACCESS TOSTROKE SPECIALIST PHYSIOTHERAPY IN SELECTED ACUTEHOSPITALS IN IRELAND
Claire Prendergast1, Aoife O’Neill2, Helen Kavangh3, Julie O’Connell4, Fiona Kinsella4,Anna Donohue5, Mary Walsh6, Gillian Harte7, Suzanne Ryan7, Karen O’Sullivan21Our Lady Of Lourdes Hospital, Drogheda, Co. Louth, Ireland2Mater Misericordiae Univeristy Hospital, Dublin, Ireland3St James’s University Hospital, Dublin, Ireland4Beaumont University Hospital, Dublin, Ireland5St Vincent’s University Hosptial, Dublin, Ireland6Royal College of Surgeons, Dublin, Ireland7Tallaght University Hospital, Dublin, Ireland
Background: A collaboration of senior stroke physiotherapists from the Dublin AreaTeaching Hospital and Louth Hospital groups liaised to audit their treatment activitywith the acute stroke population. This comprised 6 acute hospitals and a total of 341patients.Methods: All acute stroke patients referred to physiotherapy between March 1st andMay 31st 2015 were included in the audit. Age was dichotomised as 65 and over or under65. Stroke type was characterised as haemorrhage, ischaemic stroke or clinical stroke. Theprimary outcome was defined as having an average of at least one treatment per workingday during admission to the service and receiving an average of at least 45 minutes treat-ment per day. NICE Clinical Guideline (1.2.16).Results: The total group population was 341 patients, 172 male and 169 female. Therewere a total of 251 patients with an infarct, 50 patients with haemorrhage and 40 with aclinical stroke. Patients with haemorrhage required more physiotherapy. There were 125patients (37%) were discharged home either without need for follow up physiotherapy (n= 66) or with community physiotherapy (n = 59). Median workdays in the service was 7days and the primary outcome was achieved by 12% (n = 42). The average number ofminutes of treatment per day 27 mins.Conclusion: The NICE Guidelines are met in only 12% of patients. There was a rela-tionship between duration of rehabilitation and discharge destination and receiving theprimary outcome. Those that received the primary outcome spent an average of 8.28days (95% CI 3.02-13.5) less in the service than those who did not receive the primaryoutcome. The recent AVERT analysis suggests that more frequent mobilisation after earlyacute stroke is associated with more favourable outcome.
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Age and Ageing 2016; 45: ii57–ii60doi: 10.1093/ageing/afw172
AAbdelhaq, R. 144Adamis, D. 39, 40Adeeb, F. 288Agar, M. 159Age Action Galway Glór Group 176Ahern, E. 26, 64Akasheh, N. 268Akuffo, K. O. 200Alcock, M. 120Alexander, E. 230Allen, A. P. 82Almutairi, H. 174Altamero, D. 138Amir, K. 198Angelov, D. 257Arenella, K. 154Armstrong, J. 124, 169Aspell, C. 187Asri, N. A. M. 148Austin, N. 272, 271
BBabiker, A. 22Bambrick, P. 66, 59Barro, N. 224Barry, P. 112, 159, 165Basit, M. 203, 212Beatty, S. 32, 34, 41, 88, 200Beaumont, C. 302Beck, E. 41Begley, E. 41, 185Bejleri, J. 219, 245, 258, 266Belchos, J. 278Bennett, C. 46Bennett, G. 179, 109Bergin, C. 286, 290Berigan, A. 150Bermingham, M. 97Bernard, P. 230Betamor, M. 261Betts, A. 38Bieber, A. 86Blanco-Campal, A. 80Boccaletti, L. 237Boers, P. 251, 249Bolger, K. 64Bollard, E. 94Bourke, R. 132, 278, 279Boyle, G. 187Boyle, M. 230Bracken-Scally, M. 93Brady, Amanda 250Brady, Anne 197Brady, A.-M. 93Brady, N. M. 104, 297Brady, S. 62Brar, I. 175Breathnach, C. 20Breathnach, O. 51Breen, C. 201Brennan, Damien 24, 152Brennan, Deborrah 195Brennan, J. 185Brennan, Maeve 143Brennan, Michelle 3Brent, L. 26Brewer, L. 84, 222Briggs, R. 12, 13, 58, 124, 169, 272, 271, 284Broda, A. 86Brosnan, M. 89Browne, Joe 290
Browne, John 154Browne, Joseph 101, 144, 171, 268Bruen, S. 147, 149Bruzzi, J. 61Buckley, M. 136, 262, 275Burke, E. 127, 128Burke, P. 147, 149Burke, T. 55, 80Byrne, C. 187Byrne, Colm 269Byrne, D. 19, 193, 268, 290Byrne, M. 108, 183Byrne, Sinead 141Byrne, Stephen 77, 92, 141
CCaciula, I. 237Cahalane, J. 159Canning, K. 237Cannon, J. 261Carew, S. 217, 234Carey, B. 46Carey, T. 99Carney, P. 72Carroll, C. 212Carroll, J. 63, 280Carroll, M. 183Carroll, R. 127, 229Carson, R. 29Casey, A. 178, 196, 216Casey, M. 265, 248, 274Casey, M. C. 101, 107Casey, T. 199Cashel, A. 67Cassarino, M. 205Cassidy, T. 121, 133, 151, 239Chacko, S. 183Chan, J. 208Christensen, S. 306Chytilova, E. 260Ciblis, A. 93Clancy, M. 251Clare, J. 106, 116, 118, 120, 170Clarke, G. 82Clarke, P. R. 41Clarnette, R. 281Clifford, A. M. 76, 78Coakley, G. 204, 209Coary, R. 213Cochrane, A. 70Coe, Á. 44Coen, R. 88Coffey, A. 154Cogan, L. 27, 114, 206, 207, 211, 260, 279Cogan, N. 150Coghlan, M. 51Collins, O. 259Collins, R. 124, 169, 213, 262, 263, 271, 272Coman, L. 78Comerford, C. M. 219Condon, M. 52Connolly, A. 271, 272Connolly, S. 208Connolly, W. 219, 245, 256, 258, 266, 295Convery, J. 295Conway, Aidan 91Conway, Aifric 71Conway, M. 238Conway, R. 19Cooke, J. 143, 214Cooke, J. P. 288Cooney, A. 264Cooney, M. T. 133, 132, 259, 278Copperthwaite, A. 139
Corcoran, G. 42Corish, C. A. 167Corkery, L. 120, 193, 226Cornally, N. 154, 281Cosgrave, S. 137, 138, 253Costea, A. I. 288Costello, M. 147, 149Costello, R. W. 109Costelloe, A. 217, 221, 234Costigan, M. 66Coughlan, F. 248Coughlan, Tara 124, 169, 213, 262, 271, 272Counihan, Timothy 61Cournane, S. 19Cox, J. 114Crawford, A. 9Creagh, A. 179, 235Crean, A. M. 85, 87Cronin, A. 150Cronin, C. 118Cronin, F. 112, 158, 159, 165Cronin, J. 132, 278Crosbie, O. 275Crowe, M. 27, 133, 211, 263Cryan, J. F. 82Cullinan, S. 77Cullivan, S. 290Cummings, B. 228Cummins, H. 167Cunneen, S. 230Cunningham, N. 251, 249Curran, C. 63Curran, E. 82Curtin, D. 193, 226, 273Cushen, A. M. 63, 139Cushen, B. 109Cvoro, V. 23
DDahly, D. 15Dalton, C. 183Daly, L. 93Daly, T. 140, 255Danaher, D. 94Davey, N. 214Davis, A. 28, 30, 95, 138Day, M. R. 68, 69, 154de Siún, A. 58, 96Delaney, C. 172Demirdal, D. 21Devlin, R. 38Dey, A B. 168Diaz-Orueta, U. 80Dillon, C. 15Dinan, T. G. 82Doherty, A. 279Doherty, J. 271Doherty, John 213Dolan, E. 219, 245, 258, 266, 295Donald, M. 139, 230Donegan, C. 63, 84Donnan, P. 23Donnelly, J. 172Donnelly, M. 70Donnelly, N.-A. 75Donnelly, S. 185Donoghue, O. 179, 223, 235Donohue, A. 304Donohue, D. 27, 183Donohue, G. 62Donohue, O. 295Donovan, K. 122Dooley, S. 54, 71Doran, E. 51
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Dowling, C. 115, 196, 216Dowling, Michael 111Dowling, Maura 79Doyle, F. 75Doyle, M. 143Doyle, N. 63Doyle, R. 54, 71, 129, 132, 227, 228, 239, 278Drumm, Breffni 99, 121, 138, 253Drumm, Brian 113, 114, 117, 202, 207, 211Duffy, R. 101Duggan, J. 57, 59, 94, 113, 255Duggan, Á. 82Duignan, E. 272, 271Dukelow, T. 159, 165, 166Dunlea, S. 228Dunleavy, C. 56Dunne, Elaine 295Dunne, Elizabeth 183Dunne, P. 229Dunne, S. 150Dyer, A. 12, 13
EEgan, S. 102Evans, W. 89
FFagan, S. 279Fahy, E. 266Faichney, N. 214Fallon, A. 124, 169Fallon, N. 101, 107, 265, 248Fan, C. W. 180, 187Farrell, A. 20Farrelly, A. 107, 172, 274Fealy, G. 163, 153Feeney, J. 200Fennelly, L. 115, 196Ferguson, L. 302Finnerty, J. 68, 69Finucane, C. 175, 180, 187Fitzgerald, C. 281Fitzgerald, D. M. 194Fitzgerald Eavan, 282Fitzgerald Eilis, 4Fitzgerald, J. 39, 40Fitzgerald, K. 136, 166Fitzgerald, N. 144Fitzgibbon, L. 175Fitzhenry, D. 150, 271, 272Fitzpatrick, D. 103Flanagan, D. 94Flannery, A. 147, 149Fleming, A. 92Flynn, M. 154Fogarty, P. 143Foley, M. J. 67, 282Foran, S. 298, 296Forde, G. 102, 125, 199Fox, S. 68, 67, 69Freeman, J. 272, 271Furlong, M. 70
GGabr, A. 148Gaffney, L. 264Gallagher, A. 252Gallagher, C. 151Gallagher, E. 273Gallagher, P. 58, 65, 275Galvin, R. 92, 263Galvin, T. 61Gaynor, E. 59
Geary, U. 290Geoghegan, S. 139George, T. 260, 261Gill, D. 230Gilmartin, D. 136Gorey, S. 224Greaney, A.-M. 48Gregorevic, K. 134Grey, T. 145Griffin, D. 17Griffin, L. 238Grogan, L. 51, 241Guidon, M. 52Guilfoyle, P. 218, 238, 283Guthrie, B. 23
HHadbavna, A. 192Hally, M. J. 150Hannigan, O. 107Hannon, E. 120, 269Hanrahan, H. 147, 149Hapca, S. 23Harbison, J. 263Harbison, J. A. 306Harkin, E. 6Harkin, K. 197, 290Harnedy, N. 273Harte, G. 157, 304Hartigan, D. 53Harty, J. 116, 170Haswadi, H. 306Hayden, D. 117Hayes, B. 134, 135Hayes, M. 136, 166Healy, E. 154Healy, M. 32, 34Healy-Evans, S. 256Heckman, G. 175Heffernan, L. 147, 149Hegarty, J. 154Henman, M. 174, 184, 270, 298Hennelly, N. 142Hennessy, B. 51Hennessy, M. 61Heywood, S. 238Hickey, A. 75Hickey, L. 137Hoare, J. 183Hogan, K. 57Holland, R. 122Hopper, L. 55, 86Hopper, T. 54Horan, L. 83Horgan, A. 51Horgan, F. 141, 263Horgan, N. F. 15Hosford, O. 112, 159Howlin, R. 74Hsieh, A. 193Hughes, G. 50, 121, 225Hughes, S. 55Hughson, R. 175Humphries, N. 75Hurson, C. 26, 129, 228Hussein, H. 287Hutchinson, A. 135Hutton, S. 154Hynes, G. 93
IIgoe, A. 57Irving, K. 86, 55, 80
JJefferies, G. 177, 295Jennings, A. 151Jones, B. 143Joyce, A. 147, 149Joyce, R. 86Judge, M. 137, 138
KKadzik-Bartoszewska, A. 237Kane, J. 177, 295Karpinski, S. 111Kavanagh, C. 183Kavangh, H. 304Kearney, P. 82Kearney, P. M. 77, 92, 108, 112Kearns, R. 275Keely, E. 53Kehoe-O’Sullivan, M. 48Kelleher, U. 129Kelly, D. 123, 143Kelly, F. 91Kelly, K. 138Kelly, N. 286Kelly, P. 117Kennedy, B. 268Kennelly, B. 93Kennelly, S. 272Kennelly, Sean 12, 13, 58, 124, 145, 169,
262, 284, 295Kennelly, Siobhan 53, 177, 267, 295Kenny, L. 68, 69Kenny, R. 187Kenny, R. A. 32, 34, 168, 179, 180, 182, 188, 190,
191, 197, 200, 223, 235, 290, 303, 306Keogh, A. 74Keogh, B. 93Keogh, F. 186Kernohan, G. 67Kevans, D. 144Khalil, D. 203Kidney, R. 268Kieran, J. 268, 290Kieran, M. 256Kilkenny, E. 99Killane, I. 109, 179, 235Kilroy, S. 215Kinsella, F. 304Kumar, P. 168Kyne, L. 255Kyne, N. 147, 149
LLafferty, A. 153, 163Laird, E. 32, 34Lanigan, J. 157Lannon, Rosaleen 107, 172Lannon, Rose 274Laurola, H. 237Lavan, A. 65Lavery, P. 198Lawlor, A. 244Lawlor, B. 284Lawlor, E. 295Lawson, S. 271Layte, R. 188Leahy, A. 114, 202, 207Leahy-Warren, P. 154, 281Lee, A. 126, 130Lee, H. 99Lee, SKK. 84, 222Lee, Y. 49Lim, W. K. 134, 135Livingston, S. 159
abstracts Age and Ageing
ii58
Long, S. 295Loughlin, E. 98Lowe, F. 232Lubotzky, A. 288Lunn, M. 53Lynch, J. 61Lynch, M. 41, 67Lynch, N. 46Lynch, O. 203, 212Lynch, S. 232Lynch, T. 117, 76Lyons, C. 42Lyons, D. 3, 251, 148, 217, 218, 221, 234, 238, 249
MMac Mahon, C. 294MacDonald, O. 6Mackay, N. 97Maguire, F. 179, 109, 235Maher, B. 154Maher, N. 107, 265Maher, S. 193Mahon, J. 101, 107, 265, 248, 274, 286Malik, Y. 275Mallett, V. 51Malomo, K. 219, 245, 258, 266, 295Maloney, P. 230Manning, E. 104, 297Mannion, E. 147, 149Mansfield, M. 62Marrinan, A. 228Martin, A. 126, 130Martin, M. 44Martin, R. 134, 135Masojada, M. 241Matvienko-Sikar, K. 292Maughan, A. 147, 149Maughan, K. 40Maxwell, S. 222Maybin, C. 198Mc Carthy, C. 254Mc Carthy, F. 187Mc Carthy, F. 256Mc Creery, C. 239Mc Gann, C. 27, 183Mc Gillicuddy, A. 85, 87Mc Hale, C. 150Mc Inerney, E. 74Mc Mahon, M. 260, 261Mc Nally, S. 74McAdam, B. 287McAuliffe, E. 163, 153McCabe, D. 263McCabe, J. 49, 241, 243McCabe, J. J. 19McCabe, R. 54McCallion, P. 24, 127, 152, 229, 298, 128, 270, 296McCaroll, K. 286McCarroll, K. 101, 107, 248, 274McCarron, L. 60, 102McCarron, M. 24, 93, 127, 152, 229, 232, 298,
128, 270, 296McCartan, D. 84McCarthy, B. 79McCarthy, C. 21McCarthy, F. 66, 181, 192, 202McCarthy, G. 41McCarthy, J. 118, 292McCarthy, S. N. 167McCausland, D. 152McCullagh, R. 15McDonagh, R. 306McDonnell/Naughton, M. 264McDonough, A. 38McElligott, J. 29McGeough, D. 212McGilloway, S. 70
McGlade, C. 67McGlynn, J. 106, 116, 118, 120, 170, 280McGrath, Kay 154McGrath, Keith 122, 166, 238, 283McGreevy, C. 252McGuinness, V. 250McHale, C. 272, 271McHugh, Sheena 108, 112, 158, 159, 165McHugh, Sinead 64McKenna, M. 228McKiernan, M. 122McMahon, M. 147, 149McManus, C. 107, 274McNicholas, T. 303McNulty, M. K. 248McShane, N. 212McSorley, A. 45McSweeney, A. 43Meagher, D. 39, 40Meagher, M.-K. 121, 133, 239Meaney, J 306Meldrum, D. 204, 209Mello, S. 16, 20Menzies, D. 132, 278Merron, G. 288Milianata, S. 237Miller, A. M. 284Miodrag, A. 171Mitchell, G. 94Molloy, A. 32, 34, 230Molloy, D William 82Molloy, D. 123, 138Molloy, D. W. 39, 40, 70, 147, 149, 281Molloy, W. 41, 299Moloney, D. 107, 274Moloney, E. 238, 283Moloney, P. 133Monaghan, B. 255Monaghan, C. 186, 72Monaghan, T. 61Moneley, D. 241Moola, R. 124, 169Mooney, C. 272, 271Mooney, C. 150Moore, A. 42, 75, 243Moore, M. 54Moore, Z. 267Moran, R. 32, 34, 200Moriarty, E. 158, 112, 159, 165Moriarty, J. 197Morris, M. E. 76Morris, P. 51Muhamed, B. 295Mulcahy, R. 88, 143, 214, 288Muldoon, N. 177, 295Mulkerrin, E. C. 17Mulkerrins, L. 107, 274Mullen, E. 57Mulpeter, K. 16Mulpeter, R. 171Mulroy, M. 203, 212Mulryan, N. 229Murnane, L. 84, 222Murphy, C. 57, 100, 275Murphy, J. 138Murphy, K. 22, 53Murphy, L. 138Murphy, P. 264Murphy Rosemary 112, 158, 159, 165Murphy Rebecca 24Murphy, Sarah 41, 74Murphy, Seán 117, 252, 263Murphy, Stephen 133
NNabeel, S. 12, 13Ní Bhriain, O. 76, 78
Ní Bhuachalla, B. 203, 212Ní Cheallaigh, C. 268, 290Ní Chorcoráin, A. N. 43, 82, 91Nicholson, G. 9Noel, S. 71Nolan, C. 214Nolan, E. 60, 83, 102Nolan, H. 180, 190, 191Nolan, J. 32, 34, 88, 200Noone, I. 121, 133, 151, 239Normand, C. 35Nouman Shakoor, M. 106, 116, 118, 170
OO Boyle, M. 250O’Brien 67O’Brien, E. 258O’Brien, E. 268O’Brien, H. 182, 191, 197O’Brien, J. 91O’Brien, M. 185, 237O’Brien, Michelle. 50, 51, 121, 279O’Brien-Olinger, S. 237O’Broin, C. 286O’Callaghan, A. M. 273O’Callaghan, S. 133, 303O’Caoimh, R. 61, 147, 149, 154, 281O’Carroll, A. 290O’Connell, C. 68, 69O’Connell, J. 304O’Connell, Juliette 184, 270O’Connell, M. 168, 190, 191O’Connnor, K. 226O’Connor, A. 199O Connor, E. 53O’Connor, K. 112, 122, 136, 154, 158, 159, 165, 166,
193, 282O’Connor, Marie 219, 245, 266, 295O’Connor, Mark 151O’Connor, Michael 97, 269, 273O’Connor, Margaret 3, 148, 217, 218, 221, 238, 249,
251, 283O’Connor, P. 42O’Connor, S. 83O’Donnell, C. 288O’Donnell, J. 147, 149O’Donnell, M. 61O’Donnell, Martin M. 247O’Donoghoe, P. 113O’Donoghue, C. 21O’Donoghue, M. 42O’Donoghue, P. 59, 117, 252, 255O’Donoghue, Y. 49, 243O’Donovan, F. 273O’Dwyer, C. 180O’Dwyer, E. 183O’Dwyer, M. 174, 184, 270O’Dwyer, M. 298O’Farrell, D. 4O’Flynn, S. 280O’Grady, S. 104, 297O’Halloran, A. 32, 34, 35O’Halloran, A. M. 200O’Halloran, D. 66O’Hare, A. 241O’Hare, C. 182O’Hare, L. 136O’Keeffe, G. 165O’Keeffe, J. 50, 225O’Keeffe, S. 17O’Leary, L. 183O’Leary, N. 182, 188, 223O’Loan, D. 177O’Loan, D. 295O’Mahony, A. 154O’Mahony, D. 65, 77, 273O’Neill, A. 125, 304
Age and Ageing abstracts
ii59
O’Neill, D. 272, 271O’Neill, Des. 54, 103, 111, 169O’Neill, Desmond. 12, 13, 58, 124, 145, 157, 262, 294O’Neill, J. 266O’Neill, M. 143O’Regan, A. M. 97O’Regan, N. 39, 40O’Regan, N. A. 104, 247, 297O’Reilly, C. 230O’Reilly, F. 290O’Reilly, L. 147, 149O’Reilly, S. 53, 267O’Riordan, D. 19O’Riordan, Y. 230O’Rourke, K. 117O’Shea, A. 49, 243O’Shea, D. 50, 99, 100, 121, 123, 137, 138, 153, 163,
225, 239, 253O’Shea, E. 58, 72, 104, 142, 186, 297O’Shea, P. 17O’Sullivan, A. 275O’Sullivan, C. 166, 193O’Sullivan, D. 104, 297O’Sullivan, E. 177O’Sullivan, F. 148O’Sullivan, K. 78, 304O’Sullivan, L. 153, 163, 165O’Sullivan, Liz. 112, 159O’Sullivan, N. 129, 227O’Sullivan, R. 281, 299O’Sullivan, Sean 67O’Sullivan, Sinead 143O’Toole, R. 57, 59, 66, 94, 113, 115, 117, 196, 216,
252, 254, 255O’Tuathail, C. 79O’Tuathail, M. 137, 138Obi, I. T. 29Okpoko, F. 287Olearnik, J. 273Orfilia, F. 281Orr, J. 188Osman, A. 106, 116, 118, 170Osuafor, C. 140, 181
PPapa, J. 260Parsons, C. 65Passmore, P. 305Pathak, O. 171Patton, D. 267Paul, C. 281Perttu, S. 237Perumal, S. 27Petch, S. 171Peters, C. 3, 148, 217, 218, 221, 238, 249, 251, 283Phelan, A. 153, 163Phillips, S. 9Poff, A. 84, 126, 130Pope, G. 143, 214, 288Power, C. 101Power, D. 57, 59, 113, 115, 196, 216, 224Power, R. 88Prendergast, C. 304
QQuigley, D. 144Quinn, C. 22Quinn, S. 237Quirke, O. 89
RRaae-Hansen, C. 77
Rafferty, M. 107, 274, 280Rahman, H. 61Ramiah, V. 254Ramos, A. S. 273Randles, M. 269Reardon, M. 6Reilly, E. 229, 232Reilly, R. 179, 235Reilly, R. B. 109Reyes, J. D. 17Reynish, E. 23Rhoda, J. 232Richard, G. 306Riordan, D. O. 92Robinson, D. 38, 62Robinson, D. J. 247Robinson, G. 183Roche, H. M. 167Roe, C. 118Roe, L. 35Ronayne, S. 250Rothwell, D. 144Rothwell, P. 273Rowan, C. 100Rowan, S. 250Roy, E. T. 140, 256Ryan, D. 306Ryan, F. 78Ryan, J. 4Ryan, James 21Ryan, M. 295Ryan, S. 304
SSahm, L. 154Sahm, L. J. 77, 85, 87Salawu, A. 181Saunders, J. 78Savage, E. 154Scarlett, S. 182, 190, 191, 197Setti, A. 205, 208, 223Shanagher, D. 41Shanahan, E. 3, 148, 217, 218, 221, 234, 238,
249, 251, 283Shanahan, J. 76, 78Sheehy, T. 217, 221, 234Sheil, O. 147, 149Shekleton, A. 203Sheridan, S. 302Sherin, B. 261Shiels, P. 257Short, E. 53Silke, B. 19Sinclair, O. 42Sinnott, C. 92, 108Sinnott, K. 99Small, C. 61, 147, 149Smith, D. 107, 248, 274Smith, M. 206, 260, 261Smith, N. 120Smithwick, O. 61Smyth, A. 17Smyth, H. 257Smyth, M. 64Smyth, S. 117Soh, J. 121, 225, 227, 228Soraghan, C. 187Spencer, P. 59, 94, 113Spooner, L. 147, 149Stack, J. 200Stafford, J. 125Stallard, G. 147, 149Stapleton, C. 177, 295Stapleton, T. 44Stassen, P. 248Steen, G. 101, 107, 265, 248
Stevenson, M. 70Sullivan, B. 177, 295Sundanum, S. 213Svendrovski, A. 281Sybring, M. 180Szarata, A. 83
TTang, K. 198Teahan, Á. 153, 163Teeling, M. 29Teeling, S. P. 57Teh, H. L. 262Thavarajah, K. 148, 238Thornton, J. 49Tiedt, L. 62Tiernan, C. 27, 114, 206, 207, 211, 260Tierney, E. 234Timmons, S. 15, 39, 40, 58, 67, 68, 69, 104,
108, 112, 297Tiwari, S. C. 168Tobin, F. 271Tomasiuk, T. 56Toolan, S. 259Townsend, L. 286Tripathi, R. K. 168Trolan, C. 291
UUzomefuna, N. 287
VVan Der Kamp, S. 228Verhey, F. 86Volpe, D. 76
WWade, R. 157Waldron, E. 201Wall, J. 82Wall, M. 49Wall, O. 108, 112, 158, 159, 165Wallace, B. 138, 227Walsh, J. B. 101, 107, 248, 265, 286Walsh, J. Bernard, 127, 128Walsh, M. 244, 263, 304Walsh, S. 6Walsh, T. 201, 61Walshe, M. 54Weafer, J. 41Weathers, E. 281Williams, D. 49, 51, 63, 139, 241, 263, 287Windrim, C. 100Wong, D. 158
