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Background Executive skills refer to a set of cognitive skills that allow individuals to engage in goal directed behavior. They encompass planning, initiation, inhibition, monitoring and flexibility in approach to tasks, and are necessary for functional competence. Executive skills are vulnerable to disruption with damage to the brain, as occurs with dementia. Methods Participants were recruited from a tertiary memory assessment and support Service. The Assessment of Motor & Process Skills (AMPS), a standardised observational assessment of occupational performance (1Fischer, 2003) was administered by trained Occupational Therapists. In addition, the EXIT-25, a pen & paper based assessment of executive skills (2Royall et al, 1992) was administered. Process scores from the AMPS, and overall score from the EXIT 25 were utilised for correlation analysis. Results 22 participants, 12 male and 10 females, age range 60-91 (mean 75.5 years), was analysed using Spearman's Rho correlation (-.2). Results did not identify a strong correlation Conclusion Dementia is commonly regarded as a disorder of memory. However, diagnosis is dependent on functional decline related to cognitive decline. The AMPS provides a formal assessment of functional skills, in terms of motor & process skills with cut off scores regarding safe independent living. The results of this study indicate that the AMPS is not associated with executive scores on formal cognitive assessments, highlighting the value of an extensive multi-component MDT approach (also incorporating history taking, imaging, bio marker testing etc.) in assessing and diagnosing a dementia. [ABSTRACT FROM AUTHOR]

Background The transition of older persons between care settings is recognised as a particularly critical and vulnerable period (Renom-Guiteras et al. 2014). Appropriate documentation and processes are key in assisting the provision of quality, safe, person-centred care when transferring older persons from residential to acute care settings. This paper reports on the design phase of a national transfer document for older persons. The objective was to inform the development of a draft national transfer document. Methods Development consisted of two phases 1) an integrative review and 2) focus group interviews with stakeholders. The review was guided by Whittemore and Knafl's (2005) integrative review framework. Data from studies using both quantitative and qualitative methodologies were extracted and thematically analysed. Using a qualitative descriptive approach, focus group interviews (n=8) were conducted with a convenience sample of key stakeholders (n=68) to establish their perspectives regarding transfer documents. Data were analysed using content analysis. Results from both phases were integrated to guide the development of the draft document. A multidisciplinary panel of experts in older persons care, reviewed and provided feedback on the draft transfer document. Results Within the review, thirty identified papers focused on transfer documentation between residential and acute care. Results indicated that using a standardised document can potentiate the delivery and acceptance of relevant person-centred information between all parties when transferring an older person between residential and acute care settings. Qualitative interview findings highlighted important aspects for consideration regarding the layout, content and format of future transfer documentation. Following collaboration with the expert panel the transfer document was developed for piloting. Conclusion Consistency and clarity of information is key for a successful transfer of older persons from residential to acute settings. Information needs to be evidence-based, current, and subject to response and change in accordance with best available international practice. [ABSTRACT FROM AUTHOR]

Background The Acute Medical Ambulatory Centre (AMAC) was established with the goals of facilitating early discharge and preventing avoidable medical admissions. 12 months post its introduction, the service was inefficient and operating under capacity. A project aimed to improve the AMAC referral processes and increase the centre's overall efficiency was undertaken. Methods Western Australia Department of Health Clinical Service Redesign methodology (a blend of Lean and Six Sigma methodologies) was used to complete the project. This involved process mapping, root cause analysis and solutions sessions with stakeholders, as well as a semi-structured phone interview with patients. Results Transition from a paper-based to an electronic referral system. Creation of an 'AMAC Quick Reference Guide' for doctors. Production of an AMAC contact card to be given to patients on discharge if they   have AMAC follow up. Letters detailing the patient review are forwarded on the day of the appointment facilitating timely feedback to GPs. An AMAC information flyer for GPs is now available on the hospital website. Conclusion Redesigning the referral process to the AMAC has improved workflow and efficiency with significant improvements in staff satisfaction. The institution is aiming to become paperless and this redesign project has led to the elimination of another paper form. The success of the project is testament to the engagement of the staff involved and demonstrates the need for doctors to not only engage their medical colleagues, but also nursing and clerical staff. The redesign project has helped refocus hospital priorities and should hopefully see further support for the centre; developing the ambulatory model of care as an integral part of the service provided. Other centres can learn valuable lessons from our experience and develop similar strategies to cope with the ever-increasing demands on the public healthcare system. [ABSTRACT FROM AUTHOR]

Background Developing age-friendly communities is a significant global policy issue. The WHO (2007) age-friendly cities and communities initiative has had a significant influence on the development of Ireland's Age-Friendly Programme. With research on such programmes still at an early stage, this paper critically examines the utilisation of the WHO age-friendly planning framework in an Irish context. It explores older adults' experience of living in two towns in an 'age-friendly' county and, in parallel, examines stakeholders' perspectives on the development of the county's age-friendly programme. This multi-perspectival approach facilitates an assessment of how the age-friendly county programme addresses older residents' needs, and illustrates how the WHO conceptual and planning framework has worked in an Irish context. Methods The paper reports on a study which employed a mixed-method, qualitative case-study research design, using a constructivist grounded theory approach to explore the lived experience of older adults, and a case-study framework for the stakeholder perspective. Results The research identifies salient social and cultural dimensions of the day-to-day lived experience of older people which, although they impact on the age-friendliness of the places in which they live, are neglected in the WHO framework. It also identifies a unique combination of economic, political, cultural, and organisational factors which have impacted on age-friendly programme development in Ireland. Conclusion In critically analysing use of the WHO age-friendly model, the paper suggests ways in which the model can be modified to better accommodate the diverse experience of older adults not only in Ireland, but also in other geographic and cultural contexts. [ABSTRACT FROM AUTHOR]

Background Frailty is a common, multi-factorial, age-related syndrome commonly observed in people with diabetes. Although older diabetics are prone to adverse healthcare outcomes and diabetes increases the risk of developing frailty, little is known about the effects of frailty on diabetes. This paper examines the association between diabetes, frailty, and mortality in Europeans aged ≥50 years. Methods Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) waves one and six. A participant's first interview was taken as the baseline and subsequent waves were used for mortality follow-up (time and cause). Frailty and pre-frailty were measured using established cut-offs using the Physical Phenotype (SHARE-FI) and a 55-item Frailty Index (FI-55). Kaplan-Meier survival analysis was used to assess the relationship between frailty and mortality in people with diabetes and significance tested using log-rank test. Cox regression was used to adjust for potential confounders (age, sex, education, income, employment, alcohol use, smoking, hypertension, hypercholesterolaemia, myocardial infarction, stroke, metastatic cancer, chronic lung disease, polypharmacy, self-perceived health and depression). Results Data from 8,954 diabetics aged 50-99 years were included with 1,598 deaths (17.8%). According to the SHARE-FI, 1,971 (22.0%) were frail, 4,183 (46.7%) pre-frail and 2,800 (31.3%) robust. According to the Kaplan-Meier log-rank test survival varied significantly across frailty strata according to both indexes (p<0.001). At 10-year follow-up, adjusting for confounders SHARE-FI frailty and pre-frailty were significantly associated with mortality, adjusted Hazard Ratio (HR) 2.19, (95% CI:1.66-2.89), and 1.38 (95% CI:1.09-1.74), respectively. Results were similar using the FI-55, HR for frailty 1.66 (95% CI:1.09-2.54). Causes of mortality were significantly different according to frailty status (p<0.05). Conclusion Frailty and pre-frailty are independent risk factors for mortality in diabetics. The identification of frailty is important for the risk-stratification and management of middle aged and older patients with diabetes and should be included in the routine assessment of these high-risk individuals. [ABSTRACT FROM AUTHOR]

Background Pendlebury and Rothwell's recent paper reports the incidence of cognitive impairment and dementia post stroke as 5% for TIA, 8% for minor stroke and 34% for severe stroke. 1We wanted to explore if these trends were reproducible in an Irish cohort. Methods We conducted a retrospective review of a random sample of 100 discharges from a dedicated stroke rehabilitation unit between 2017 and 2018. Diagnosis of cognitive impairment or dementia was extracted from MDT discharge documentation, along with results of cognitive assessments. This cohort required inpatient rehabilitation post stroke, so we can infer that these were severe strokes. As a surrogate marker of disability, the average Barthel Index of this sample on admission to rehabilitation was 13, indicating moderate functional dependency. Results Complete information was available for 94/100 patients. The average age was 67 years (age range 33-95 years) 37 of 94 (39%) were judged to have cognitive impairment on discharge. Demonstration of functional impairment was central to this assessment. 30 (81%) of these diagnoses were supported by abnormal cognitive tests. 3 of those judged to have cognitive impairment, were unable to complete cognitive assessment. 2 of those judged to have cognitive impairment had cognitive scores which were within the normal range. None of the discharge letters mentioned a diagnosis of post stroke or vascular dementia. Conclusion This study replicates Pendlebury and Rothwell's findings that over a third of people suffering from severe strokes will develop cognitive impairment. This is of critical importance to stroke clinicians as it should prompt frank discussions with stroke patients and their families about prognosis, recovery and future planning. [ABSTRACT FROM AUTHOR]

Background Frailty is an important marker of adverse outcomes for older people accessing the Emergency Department (ED). Older patients with frailty have a higher attendance rate to the ED, spend longer in the ED and have a higher rate of admission (HSE, 2017). Frailty Intervention Therapy Teams (FITT) are designed to screen and assess this population in the ED setting, with the aim of early assessment to help decrease length of stay or avoid admission. Two different FIT Teams have recently been formed within the Cork-Kerry region. The aim of this study was to evaluate staff's experience of these teams. Methods This was a mixed methods study. Structured surveys were developed to collect qualitative and quantitative data. The surveys were constructed using themes listed by Proctor et al. (2011) around implementation and service outcomes. Ward and ED staff were provided with paper surveys within the hospital setting and community staff were surveyed via post. Quantitative survey data was analysed using descriptive statistics and qualitative data was analysed with thematic content analysis. Results Data from 117 surveys was included for analysis (response rate 49%). Results showed that the majority of staff (89%) reported ED was a suitable setting for the FITT, with 85% reporting the information collected by the FITT impacted their involvement. Other themes emerging from staff's experience included timeliness, safety and comprehensive assessment. Conclusion Overall, staff reported the FITT provided a timely service that assisted with decision making and planning. This involved earlier comprehensive assessment, prompt identification of issues which lead to decreased workload for ward staff. It also created an increased volume of referrals to community and ward staff received in a timelier manner. [ABSTRACT FROM AUTHOR]

Background Wearable technology is a fast developing area. Often, the focus of research is on accuracy, while the practicalities of using the device may be overlooked, despite the fact that this greatly influences utility. This scoping review therefore explored the design and usability preferences of people for wearable technology for health monitoring. Methods A scoping review was conducted of literature evaluating user preferences for the design of wearable technology systems, for people aged >50 years, with good health, or chronic diseases. Results A search of relevant databases yielded 628 potential studies (after duplicates removed). Following title/abstract and then full text screening, 17 papers were included. The most commonly reported theme related to design and user interface (13 studies). Users wanted a small, unobtrusive and light device which doesn't snag on clothing or affect activities of daily living, but yet has a readable and easy-to-use interface, which may prove challenging for designers! Users were most happy to wear a device on the wrist and/or hip region, being considered the least obtrusive / most discrete. Users were open to the technology aspects of the device, but wanted specific training, or clear and readable instructions. Less commonly reported parameters included issues with privacy and ownership of data (two studies); cost (two studies); reliability and accuracy (three studies), including being accurate overnight and in the shower, etc.; and clinical usefulness, i.e. the data being effectively linked with other healthcare data. Where considered, participants didn't want to wear a device by night (two studies). Safety of wearable devices was not a theme in any study. Conclusion Overall, user needs seem to be rarely considered in the design of wearable technology for health monitoring. However, the limited studies do highlight important user concerns, which should be considered by the technology designers and prescribers. [ABSTRACT FROM AUTHOR]

Background There is an increasing number of older persons experiencing transfer episodes between residential and acute care facilities (Griffiths et al. 2014). Current transfer documentation is diverse; often only containing basic information and very little person centred patient information. The objective of this HSE National Clinical Programme for Older People funded study was to develop a national person centred transfer tool, for use during patient transfer between residential and acute services. Following an extensive literature review, focus group interviews with stakeholders and input from an expert panel, a pilot transfer document was developed. This paper reports on the pilot study of this document. Methods Researchers, in consultation with the expert panel, developed questionnaires. Questionnaires were quantitative, with three open-ended questions. Of the 28 residential settings and 3 acute settings that were contacted, 26 residential and 3 acute settings (93%) participated in the study. The pre-pilot questionnaire asked staff in residential settings their perceptions on current transfer documentation (n=875). The post-pilot questionnaire asked staff in residential and acute care settings their thoughts on the new transfer document which was used for the pilot (n=1085). Results Findings suggest that staff agree that the new transfer tool is person centred, contains relevant patient information and could help communication between healthcare professionals in these settings. Findings also indicate that the length of time to complete the document is of concern, particularly in an emergency and there were suggestions from staff in residential care services that some sections could be prepopulated. Conclusion In order to have a transfer document that is efficient, and person centred, there is a need for it to be available electronically and easy for staff to fully complete particularly in an emergency transfer. [ABSTRACT FROM AUTHOR]

Background Day care is an important service for some people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia specific day-care centres and generic centres that cater for people with dementia to various degrees. In this paper we map the geographic variation in the supply of day care services for people with dementia relative to potential need. Methods Using a national HSE survey of day care centres, we estimate the current supply of day care services for people with dementia in both generic and dementia specific centres by combining a number of qualitative and quantitative measures. To identify the variation in supply, we map day care provision at local and regional levels to the number of people with dementia in the area. To consider geographic accessibility, we map and analyse the population living outside the catchment area of the day care centres. Results There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia varies from 9 to 16 across the Community Health Organisation areas. We show that 20 per cent of people with dementia are not living within a 15km radius of a day care centre that caters for people with dementia. Conclusion Day care has a place in the menu of service for people with dementia living in the community. As the number of people with dementia grows, investment in day care centres needs to be targeted to areas of greatest need. In many parts of the country, the current day care centres have limited capacity to provide a service for people with dementia that live in their catchment area. There is considerable geographical inequity in day care provision for people with dementia across the country. [ABSTRACT FROM AUTHOR]

Background The continuing evolution of adult safeguarding legislation, policy and practice in relation to the abuse of vulnerable adults reflects a growing awareness of the nature and extent of such abuse in Ireland. The Adult Safeguarding Bill, 2017 represents a progressive step in safeguarding older people and vulnerable adults. The intention of the Bill is to put in place additional protections for adults, in particular, for those who may be unable to protect themselves, such as older people or those lacking capacity. Part 3 provides for mandatory reporting by specified/named persons/professionals. This paper sets out to critically analyse the concept of mandatory reporting within adult safeguarding using international comparators as case studies. Methods A rapid realist review of adult safeguarding reporting typologies and systems in five key jurisdictions: Australia, Canada, England, Northern Ireland and Scotland, were explored to answer the question: ' what works, for whom and in what circumstances ?' [1] Results Jurisdictions differ as to who the mandated reporters are, the scope and powers of mandatory reporting, and the types of abuse subject to reporting. Of significance is that the debate on mandatory reporting has increasingly focused on institutional settings, rather than more broadly across services. Key concepts identified are those of protection, empowerment and proportionality. Adult safeguarding legislation must therefore ensure that interventionist and compulsory measures to protect do not excessively restrict the rights of the individual. Conclusion Mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults and older people, but this could also change the dynamic of relationships within families, and between families and professionals. Ultimately, the success of any legal approach will rest with professional judgment in balancing autonomy with protection. [ABSTRACT FROM AUTHOR]

Background Developed by Blackhall et al. (2011), the Validation, Emotion, Reassure, Activity (VERA) communication framework seeks to provide student nurses with a guide to provide person-centred care to people living with dementia. The framework aims to enable the caregiver to communicate with the person living with dementia in a respectful manner, and accept that there is both value and meaning to the person's speech and behaviour. This paper presents the findings from a small pilot control pre-post study which aimed to explore the impact of the VERA framework to promote person-centred communication between student nurses and older people with dementia in long term care. Methods A control group of six students, received standard communication training and ten students received additional communication training using the VERA framework. Data was collected using the non-participant observational tool Quality of Interactions Schedule (QUIS) and three self-assessment questionnaires to assess student nurses' confidence, dementia knowledge and communication skills. Results The results of this study found that those students who received the additional VERA communication training were observed to have a significantly (Mann-Whitney U test; p = <0.05) reduced number of negative interactions with people with dementia than those students who had received standard communication training alone. In addition, student nurses trained in the VERA framework showed a significant increase (Mann-Whitney U test; p = <0.05) in their confidence to care for people with dementia than those who had received standard communication skills training. Conclusion The study finding need to be interpreted with caution given the small sample size and the pilot nature of the study. Nevertheless, these findings indicate that the VERA framework has the potential to improve (1) person-centred communication between student nurses and older people with dementia and (2) students' confidence to care for people with dementia. [ABSTRACT FROM AUTHOR]

Background Family carers provide thousands of hours of unpaid work every year, a third of whom are men, however this group are generally under-represented in research. Comparative studies have shown that male carers experience their caring role differently to female counterparts. Social concepts related to masculinity can help to explain help-seeking behaviours of male carers, as well as their attitudes to accessing outside support. Compared to women carers, men have lower rates of uptake of formal support services. This aim of this review, therefore, was to examine accounts of male carers' experiences and perceptions of receiving formal support. Methods The study followed a meta-ethnography process starting with a systematic literature search of five electronic databases. The methodological quality of the included studies was evaluated using the McMaster checklist. Using NVivo 12 software, primary qualitative data was analysed and key themes were identified. Results were synthesised using Noblit and Hare's (1988) process of meta-ethnography, retaining direct quotes from the studies. Results Eighteen studies were included in the final paper. Three main themes were identified: 1) asserting control over the caring role 2) desire to excel in caring role and 3) coping without formal support. Conclusion For the most part, male carers expressed a desire to be competent in their caring role. Perceived loss of control within the caring relationship was a key factor when men had low trust and dissatisfaction with services. Support services that were collaborative, education-based and gender-sensitive were favoured by the men. To engage more male carers, service providers should acknowledge men's experience and capabilities as well as their wish to stay involved in decision-making around care for their family member. For men over the age of 85 male family carers outnumber females in Ireland (CSO 2016). It is important to understand male carers' experience to develop more inclusive supports and consequently increase service uptake. [ABSTRACT FROM AUTHOR]

Background 10% of people over 65 years have frailty, rising to between a quarter and a half of those over 85. Comprehensive Geriatric Assessment (CGA) is the gold standard for the management of frailty in older people; it's a process that involves a holistic, interdisciplinary assessment of the older person. Evidence shows that CGA is effective in improving outcomes for older people. The National Clinical Programme for the Older Person outlines the role of the occupational therapist in CGA. A clinical audit was completed to investigate whether the occupational therapists in the Medicine for the Older Person service are adhering to guidelines for CGA. Methods Following a literature review, a retrospective audit of occupational therapy (OT) initial assessments was completed using paper count method. Data pertinent to CGA OT assessment was collected. Audit results were presented to the OT team alongside a CGA education session. A re-audit was completed, using above methods. Results 10 inpatient initial assessment forms reviewed pre and post audit. Activities of Daily Living Assessment: Pre result: 60%  Post Result: 90% Home Environment: Pre: 80% Post: 100% Performance Components Assessment: Vision: Pre:  90%  Post: 100% Hearing: Pre: 80% Post: 100% Upper Limb: Pre: 70% Post: 100% Mood: Pre: 60% Post: 80% Cognition: Pre: 90% Post: 100% Sleep: Pre: 70% Post: 80% Social Assessment: Pre: 60% Post:90% Falls Assessment: Pre: 60% Post: 90% Drving: Pre: 60% Post: 90% Conclusion This audit identified that the occupational therapists in the medicine for the older person service were not CGA compliant. CGA training now forms an important part of our OT induction programme. We are now "playing our part" in CGA with improvements in all domains. CGA is now commonplace practice within our team, in line with international and national best practice guidance for management of frailty. [ABSTRACT FROM AUTHOR]

Background Currently, 1 in 10 people diagnosed with dementia in Ireland are aged under 65, this is termed "Younger Onset Dementia" (YOD). Though small in numbers these figures (4000 people) are increasing, and important differences exist between people diagnosed with (PwYOD) and those diagnosed with later onset dementia (LOD). As dementia is normally associated with advancing age, clinicians are not always on the alert for its diagnosis in younger people. Diagnosing YOD can be especially challenging since presentation may be atypical and there is a lack of clinical ownership in this area. Methods A structured literature review was conducted to identify optimum models of diagnostic processes and pathways for PwYOD. Two research questions were addressed: (i) what models for the diagnosis of PwYOD exist nationally and internationally, and what evidence supports these and (ii) what are the differences between diagnostic processes and pathways for PwYOD compared with PwLOD. A systematic search strategy was devised to identify all relevant scientific papers. Key databases were used, supplemented by grey literature searches. A narrative synthesis approach was undertaken to assess the literature identified. Results Pathways and processes to the diagnosis of YOD are unclear and complex and compared with LOD, diagnosis takes more time. PwYOD are more likely to have multiple referrals to different specialists, have their memory and cognitive complaints misattributed to other factors such as depression and experience longer delays in obtaining a diagnosis. Conclusion Few evidence-based best-practice models or guidelines for the diagnosis of YOD exist internationally. Increased awareness of the signs and symptoms of YOD among all healthcare professionals is necessary. There is a need for improved linkages to be developed between Geriatric Medicine, Neurology, Psychiatry, and Primary Care services and in certain instances for suspected cases of YOD to be referred to neurology-led memory clinics. [ABSTRACT FROM AUTHOR]

Background A major focus on decision making capacity (as opposed to cognitive capacity and competence) legislation in many Western countries is the integration of a human rights approach focused on self-determination and autonomy. This paper examines modern day concepts of personhood and person centred care and presents Irish and United Kingdom legal commentaries which focus on health services' and society's approaches to risky decision making. Integrating human rights into decision making capacity legislation has been central in contemporary discourses on health and welfare. Methods A literature review was undertaken charting the emergence of personhood, person centred care and human rights. Case studies of influential legal commentaries in Ireland and the United Kingdom where decision-making capacity was addressed were mapped to person centred care principles. Results Findings point to a convergence of discourses of human rights in contemporary approaches to health and social care as well as the evolution of legislation to support person centredness in fostering safeguarding and promoting autonomy and self-determination. Specific legal commentaries point to the need of health and social care to be mindful of paternalism and to conceptualise the concept of 'risk' with a particular emphasis on the inclusion and defence of the voice of the older or vulnerable person. Conclusion The intrinsic worth of each human is articulated through an implicit and explicit vindication of their human rights. The emergence of the third generation of human rights has argued the value of self-determination and autonomy, articulated through robust national legislation on decision-making capacity based on the core principles of person centred care approaches. This move from paternalism is imperative and is imbued in contemporary legislation and legal commentaries, which has noted the need for revisions in health and social care case management perspectives. [ABSTRACT FROM AUTHOR]

Background With the arrival of a super-ageing society, the use of technologies in social care is not only necessary but inevitable. However, there is a dearth of evidence to demonstrate how assistive technologies (AT) can improve standards of care while improving the working conditions of care professionals and care givers. Furthermore, little is known about users' perceptions of such technologies. The objectives of this paper are: first, to test the effects of an integrated AT system on users (both care recipients and staff) in a residential care home; and second, to understand their perceptions of such technologies. Methods We combined an infrared monitoring camera with communicative robots and a sheet-shaped body vibrometer. A 4-week pre/post intervention study was conducted, during which the evaluation was carried out before, during and after the intervention. Twenty care recipients (average age of 89.5) and 15 care professionals participated in the study. In order to measure the effectiveness of the integrated system, the care recipients' quality of life was examining using the interRAI method. Regarding the impact on professionals, stress levels were examined during night shifts. Perceptions towards use of the system were also explored by the system usability scale (SUS) and semi-structured interviews. Results After the system was introduced, the number of unnecessary visits by care professionals during the night was dramatically reduced (by 8.2 times per person on average), and staff's stress levels were also reduced. The SUS and interview data show mixed results in terms of the perceptions of care recipients and staff towards using the technologies. Conclusion Overall, the use of integrated assistive technologies yielded positive results. However, some issues were identified with regard to future implementation of such technologies in a residential care home. This study was financially supported in part by the Japanese Council of Senior Citizens Welfare Services. [ABSTRACT FROM AUTHOR]

Background Home-care robots have been developed as one of the assistive technologies, and benefits and challenges of their use have been debated in many countries. Research teams in Japan, Finland and Ireland carried out a questionnaire to explore perceptions of potential users (older people, family caregivers, and health and social care professionals (HSCPs)) towards the use of home-care robots. As part of a larger tri-country comparative study, this paper reports preliminary findings from the data collected from the online survey of HSCPs in Ireland. Methods Questionnaire was developed iteratively among the research teams in three countries. Questions related to the use of advocates in deciding whether to use home-care robots, desirable functions in such robots, and perceptions of privacy protection. Based on networks of professional and advocacy groups, HSCPs were contacted and 123 respondents took part in the questionnaire, and 46 fully completed the questionnaire. Results Out of 46 respondents (44 female, 1 male and 1 did not wish to specify), 80% answered that they are open to the use of home-care robots. Safety monitoring and alert functions were considered to be most desirable in home-care robots. 76% of the respondents placed importance on the guarantee of entitlement to receiving human care, irrespective of the use of home-care robots. 30% answered that they have a negative impression of robots, to some extent. The overall majority (N=39, 85%) felt strongly that a decision as to whether to use home-care robots should be made by the user, and that the access to data collected in any form by robots requires extra care. Conclusion While there was generally a positive perception of the use of home-care robots among Irish HSCPs, cautious attitudes were evident in the areas of decision-making and privacy. This study was funded by the Pfizer Health Research Foundation. [ABSTRACT FROM AUTHOR]

Introduction Caregiving work in 'residential care homes for the elderly' (RCHEs) has long been devalued as 'dirty work', which contributes to RCHE's acute shortages of health care staff in Hong Kong. This study aims to unearth the voice of the RCHEs workers by delineating their insider perspectives of RCHE work. Method Adopting the Photovoice method, a participatory methodology, 30 RCHEs care workers (i.e. Registered Nurses, Enrolled Nurses, Health Workers, and Personal Care Workers) were invited to take photos that showcase their perspectives of doing aged care work. Two in-depth interviews were conducted with each research participant before and after the photo-taking procedure. Thematic analysis is then conducted to analyse the visual and verbal data. Results Findings show that RCHEs care workers perceive and revitalize the nature and meaning of their work in four ways: conducting 'dirty tasks' to help the elderly; valuing and engaging in long-term relationships; learning in work; and cultural meaning of working with the elderly. Contrary to public devaluation, RCHE care workers normalize the delivery of 'dirty tasks' (i.e. handling human excreta and wounds) as being helpful to both the elderly and the family members. Besides the routine caring tasks on paper, care workers highlight that they spend a lot of unrecognized labor to build rapport and provide emotional support to the elderly and their family members in their work. They also report that learning and self-development are an important part of residential care work, both in terms of professional knowledge and personal growth. Taking care of the elderly also conveys positive cultural meanings in Chinese society. Conclusion Policy, professional and educational initiatives of geriatric care primarily emphasize the delivery of clinical tasks (caring for), while undermining the emotional and relational aspects of aged care work. The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China. (UGC/FDS16/M12/20). [ABSTRACT FROM AUTHOR]

Introduction Bowel movements are vital to decision making, but are frequently overlooked in practice due to the fast-paced nature of medical ward rounds, impacting on patient care. This was felt to be exacerbated locally by the difficulties of finding the information in the nursing notes. Aim To improve the documentation of bowel movements. Method We performed a closed loop audit examining how well patients' bowel movements are documented in nursing and medical notes across 3 wards at a district general hospital. We collected snapshot data on whether a bowel chart was present, whether bowel movements were recorded regularly and whether doctors documented bowel movements during ward rounds. We then changed the colour of bowel chart paper from white to yellow, with identical contents. This data was prospectively collected again 5 weeks later for comparison. Results The sample size included 62 inpatients. Prior to the change in bowel chart, 79% of patients' nursing folders had a bowel chart. Documentation of bowel movements in nursing and medical notes was 25% and 30% respectively. Following the introduction of yellow coloured bowel charts, 90% of patients' nursing notes had a bowel chart present, with an increase in documentation in nursing and medical notes to 74% and 69% respectively. Conclusion (s) The importance of good bowel movements is essential to management decisions and discharge planning. Locally, this has been inhibited by the difficulties of locating white bowel charts in a folder of white paper, leading to incomplete documentation and poor recognition of problems in bowel movements. Changing the colour of the bowel charts made it easier to recognise the bowel chart, allowing nurses and doctors to use the bowel chart more efficiently, hopefully improving patient care. This change has been recognised as effective and has been rolled out trust wide. [ABSTRACT FROM AUTHOR]

Background: This quality improvement project was based at The Royal Bolton Hospital across our four Complex Care wards. Introduction: We have recently transferred to electronic record keeping. At these points of transition there may be an adverse impact on the quality of patient care and safety. We recognised on our own ward there were inaccuracies between the required paper form and electronic documentation of DNACPR decisions. Consequently, we wanted to review and improve the accuracy of our DNACPR documentation to ensure safe and effective patient care. Methods: To gauge the scope of the problem we audited 87 patient’s electronic and paper notes, with no exclusion criteria. We reviewed whether each patient had a formal resuscitation decision, and if a DNACPR decision had been made whether we met our hospital policy by having: • a paper DNACPR form in the correct patient’s notes • a documented electronic decision (on the daily ward round proforma) • an electronic “Resuscitation and treatment escalation plan” 93% of the 87 patient’s had an active decision regarding resuscitation, with a DNACPR decision documented for 50 patients. Of these 50 patients only 11 had all three forms of documentation. More worryingly, there were discrepancies in the documented DNACPR decisions for 11 patients across paper and electronic records. Interventions: We escalated our concerns to the Clinical Governance team who sent out a trust wide SBAR highlighting this as an urgent clinical issue. On a directorate level we incorporated DNACPR decision documentation into our afternoon safety huddle and arranged informal teaching for medical, nursing and administrative staff. Results: Reassuringly, the subsequent re-audit of 90 patient’s notes showed only one patient to have a discrepancy between paper and electronic documentation. We saw an improvement to 98% having paper forms in the right bedside notes and 100% having a documented electronic DNACPR decision. Conclusion: Through local education and trust-wide dissemination of our expected standards we have seen some improvement. We recognise the importance of maintaining this, and importantly that there is still work to be done.The electronic “Resuscitation and treatment escalation plan” is still rarely completed and provides important information on escalation of care and thus will be the focus of a further educational intervention. [ABSTRACT FROM AUTHOR]

Introduction Constipation is a common and often overlooked problem with potentially serious consequences, including patient discomfort, urinary retention, delirium and bowel obstruction. These consequences can lead to prolonged hospital stay, increased healthcare costs and increased morbidity and mortality. Accurate stool chart documentation is an essential part of basic care that helps prevent this. The aim of the project was to increase daily stool chart documentation, including stool type, to 70% on a care of the elderly ward in a medium-sized district general hospital. Method We created a proforma to review each patients' stool chart from the previous 24 hours. Daily data was collected by measuring the number of correctly completed stool charts on the ward. Initial baseline data showed an average daily completion rate of 24%. We tested 3 separate interventions over a 6 week period using Plan-Do-Study-Act (PDSA) methodology: Intervention 1- Increase staff awareness about stool charts via email, posters and at handovers Intervention 2- Complete stool charts every time routine observations are performed Intervention 3- Complete online stool charts. Results All interventions led to an improvement in the average daily stool chart completion rate. Intervention 1 caused the most significant improvement with the average daily stool chart completion rate increasing to 77%. Intervention 2 was the least successful change, with an average daily stool chart completion rate of 39%. Intervention 3 had an average daily stool chart completion rate of 64%. Conclusion Simple interventions like staff education and prompts to help culture and behaviour change led to a significant improvement in stool chart documentation rates. Paper documentation (intervention 1) fared better than online documentation (intervention 3) most likely due to the former requiring fewer processes to complete. Intense monitoring and documentation (intervention 2) was unsuccessful and was perceived to be burdensome. [ABSTRACT FROM AUTHOR]

Background Physical activity (PA) has multiple important benefits for older adults, but many do not undertake the recommended amount. This systematic review examined the quantitative literature detailing barriers and motivators to PA in older adults: a concurrent qualitative review is underway. Previous reviews investigated younger age groups or specific diseases. Method We included adults ≥70 years, observational studies and baseline data for randomised controlled trials (RCTs); we excluded studies of specific disease groups, care home residents, and rates of cognitive impairment above population norms. We searched Medline, Embase, CINAHL and PsycINFO on 25th February 2020. We assessed risk-of-bias using ROBANS. We undertook a narrative review; meta-analysis was not possible. The protocol was registered on PROSPERO (CRD42021160503). Results We identified 35 papers (24 cross-sectional studies, eight prospective cohort studies, two studies of baseline data from RCTs and one mixed method study); n = 26,264 subjects, median age 77.7 years (range 70–101) and median percentage female 62.1% (range 0–100). Quality assessment identified low risk-of-bias overall, except two studies were identified as having a high risk-of-bias for one section (confounding variables). The most cited barriers were physical health (N = 14 studies), environmental factors (N = 12), fear of falls (N = 7) and lack of interest (N = 4). Other barriers identified were lack of company (N = 1) and urine leakage (in women) (N = 1). Key motivating factors included social aspects of PA (N = 8), intrinsic/psychological (e.g. self-determination, future orientation) (N = 8), health (e.g. doctor's advice) (N = 7) and environmental (e.g. nearby green space) (N = 4). Discussion This review identified key barriers and motivators to PA in older adults. There is a lack of evidence for the oldest old. These findings should be used to create trials of suitable interventions which enable older adults to take up and maintain recommended levels of PA. The wide range of factors we identified indicates an individualised approach may be best. [ABSTRACT FROM AUTHOR]

Introduction Despite ongoing improvement work in our hospital regarding Advance Care Planning (ACP) in the community and specialist palliative care settings, our team was concerned that ACP was underutilized for inpatients. We aimed to increase the number of ACPs (specifically focusing on re-admission avoidance) made on our geriatrics ward, and to communicate these effectively with community colleagues. Method We retrospectively reviewed 26 deaths on our ward during a three-month period, and found significant missed opportunities to discuss ACP, e.g. 54% of patients had more than one admission in the six months prior to death. We developed a novel co-morbidity score to help support our decision-making, and used aspects of the Gold Standards Framework's Proactive Identification Guidance. Our working group, led by a consultant geriatrician, focused on increasing the team's engagement with ACP, including use of an 'ACP Champion', and we worked to align our documentation with that used elsewhere in the Trust. We used a paper form, resembling a DNACPR, to prompt community teams to re-consider whether admission was necessary. We made ACPs for six patients during this four-month pilot phase, and followed them up over the next five months. Results Following our interventions, follow-up of our patients showed 83% had ACP described in their discharge letter; 33% had ACP mentioned on their Summary Care Record (SCR); 0% of patients who had died re-presented to hospital prior to death. Conclusion Our project showed that diligent attention to making ACPs for suitable patients was successful in preventing re-admission. Despite this, communication about ACPs in the discharge letters and transfer of this information to the SCR was suboptimal. This demonstrates that even with a focused team, mistakes can happen. I'm now working on a subsequent project focusing on improving understanding of ACP amongst junior doctors. [ABSTRACT FROM AUTHOR]

Introduction Over 20,000 stomas are formed in the UK annually, many for geriatric patients. However, formation both requires significant surgical intervention and leaves patients with the substantial post-operative burden of stoma care. Such is this care's complexity, 70% of all stoma patients experience complication. Patients with cognitive impairment may be at particular risk of poor outcomes following stoma formation. However, the impact of cognitive impairment on patient suitability for stoma formation is under-discussed in the literature. We conducted a preliminary literature review to identify factors for to be considered when proposing stoma formation in this patient group. Method A preliminary literature review searching several databases (PubMed, Cochrane and Embase) was conducted using pre-devised search terms. A further manual search was then performed reviewing the references of identified papers of interest. Arguments relevant to stoma formation in elderly patients with cognitive impairment were extracted. Results Little quantitative evidence surrounding stoma formation in the cognitively impaired was found. However, four key risks for these patients were identified: 1) Patients with cognitive impairment, particularly dementia, experience higher rates of perioperative complication following surgery. 2) Cognitively impaired patients are at increased risk of post-operative stoma complications, precipitated by poor stoma care. These complications are also more likely to be uncommonly advanced on presentation due to poor patient surveillance. 3) The need for regular stoma care can necessitate unwanted nursing home admission. 4) Cognitively impaired patients are particularly vulnerable to psychological distress following stoma formation due to reduced ability to adapt to and participate in their stoma's care. Conclusion This preliminary review identified several factors to be considered when determining suitability for stoma formation in a cognitively impaired patient. However, little quantitative research exploring this association was identified. Further work is required to better characterise the risks posed by stoma formation in this patient group. [ABSTRACT FROM AUTHOR]

Introduction Despite the growing prevalence of Parkinson's disease (PD), and the need to plan for future health service provision, very little is known in the Irish context about PD patients' experiences of health service access and use. Method A cross-sectional survey design, with multiple formats, i.e. online, pen-and-paper, and telephone. Data were collected from May 2020–July 2021 using a multipronged recruitment strategy. It could be completed by a person with PD, or a support person on behalf of/with the person. Survey development was informed through literature review, and in consultation with the Parkinson's Association of Ireland, and a patient advisory group (N = 10). Results A total of 1,504 individuals accessed the survey, with 1,402 meeting the eligibility criteria. Over half (53%) were male. Approx. 9% were diagnosed with young-onset PD. A minority (6%) reported attending only their GP to manage their PD, with the rest attending a specialist outpatient clinic. The mean distance travelled each-way to outpatient clinics was 45.6 km (SD = 49.4, min 1 km, max. 300kms). Most were diagnosed by Neurologists (84%), followed by GPs (8%), and Geriatricians (7%); 1% indicated 'other'. Of those diagnosed by a Neurologist or Geriatrician, most were diagnosed privately (68%); though 37% of these patients subsequently switched to the public system for ongoing management. The majority (97%) reported currently taking PD medications, but just 52% believed these were working effectively. Just over one-fifth (22%) had access to a PD nurse specialist. Access to the range of other health and social care professionals is also reported, and is universally poor for this patient group. Conclusion A number of significant gaps in PD care have been identified, which require urgent attention. A reconfigured model of PD care is necessary to accommodate the growing need for specialist, integrated care at the population level. [ABSTRACT FROM AUTHOR]

Background Early supported discharge (ESD) facilitates people with a stroke to be discharged from the hospital environment earlier than conventional care to continue their rehabilitation within the home with a multi-disciplinary team. Known benefits of ESD from Randomised Controlled Trials conducted include reducing the length of a hospital stay, long term dependency, and cost savings. There is limited qualitative evidence available on ESD. This systematic review and qualitative synthesis explored the experiences of those involved in ESD including people with stroke, family members, caregivers as well as healthcare professionals. Method A literature search was completed in 11 databases which generated 3,425 articles. Qualitative or mixed Method studies that included qualitative data on the experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service were included. The Critical Appraisal Skills Programme checklist was used to appraise the methodological quality of the papers. The findings were synthesised using the three step process for thematic synthesis. Results A total of fourteen studies were included with the methodological quality of the studies deemed good overall. Four key themes emerged: 1) ESD is experienced by people with stroke as a goal-focused and supportive process leading to positive outcomes, 2) ESD eases the transition from the hospital to the home environment but the transition from ESD to social and community services is often problematic, 3) Organisational, logistical and inter-professional factors are critical to the success of ESD and 4) The home environment enhances rehabilitation. Conclusion The findings of this qualitative evidence synthesis highlight the importance of the home environment in the rehabilitation process post stroke. Key practice implications point to the need for increased attention to periods where care transitions occur from ESD to community services. [ABSTRACT FROM AUTHOR]

Introduction Aged care workers in residential care homes of the elderly (RCHEs) are socially devalued as less skilled, low-paid, and doing 'dirty work'. Care workers' insider experiences with the meaning of residential aged care work are largely absent from the community and the literature. Method A qualitative study was conducted to examine the self-perceived meaning of work (MOW) among care workers in RCHEs in Hong Kong, an East Asian metropolis with a rapidly aging population, and unique socio-cultural meanings of elderly care. Adopting the Grounded Theory Method, in-depth interviews with 27 care workers in 6 RCHEs were conducted. Results Findings suggest that regardless of the job requirements of carrying out 'dirty tasks' and shared experiences of public devaluations, RCHE care workers find positive meanings in their work including: contributing to the greater good of helping the elderly; establishing meaningful relationships; forming a professional identity of geriatric care; achieving personal growth; ensuring job security and benefits in the aged care job market. Care workers find their work meaningful primarily because it is essential to maintain the elderly's health and quality of life, which echoes with the Chinese cultural values of 'accumulating fortune' and 'respecting the elderly'. Engaging in residential care work allows care workers to build long-term relationships with the elderly, through which they found joys and knowledge of life such as letting go. Care workers propose that geriatric care is highly skillful and professional, requiring communication, coordination, and chronic illness care skills. Care workers identify several inhibitors of attaining MOW, including heavy workloads, manpower shortage, and dehumanizing bureaucratic practices. Conclusion Care workers offer counter-narratives of public devaluation and reframe the meaning of care work in RCHEs. These findings have broader implications on policy, professional, and education interventions in promoting the public recognition of aged care work. The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (UGC/FDS16/M12/20). [ABSTRACT FROM AUTHOR]

Background Advance care planning (ACP) is an ongoing conversation where healthcare professionals explore patients' and families' wishes in order to act within their best interests. The COVID19 pandemic continues to highlight the importance of timely ACP, namely while our patients have capacity. We noted that despite advancing age, accumulating co-morbidities and high clinical frailty scores (CFS); ACP discussions were not taking place within our elderly department. We aimed to increase ACP conversations and ensure documentation on ReSPECT forms to allow continuity within primary care. Methods 10 patients per ward were randomly selected. 69 patients met inclusion criteria (over 65 with CFS ≥5 or any patient with dementia). We reviewed electronic and paper records and defined evidence of ACP as ReSPECT form including preferred place of death (PPoD), or discussion with patient or relative in medical notes. We randomly selected a pilot ward and applied interventions over 4 weeks: • Small group teaching to junior doctors • Visiting ward MDTs to identify appropriate patients for ACP • Presenting baseline data to geriatricians • Visual aids from the palliative care team and prompt sheets for doctors. Results Prior to our interventions, 22% of our sample had evidence of advance care planning, 33% of discussions documented on ReSPECT form. Following our intervention period we reviewed medical notes on our pilot ward. 58% patients now had evidence of ACP, with 66% documented on a ReSPECT form. Conclusion We achieved a significant increase in advance care planning within our elderly medicine department, and are therefore better equipped to provide personalised care alongside our patients' wishes and values. Next steps: • Expanding teaching across the multi-disciplinary team • ACP 'champions' to highlight appropriate patients • Expansion of initial interventions across the department We hope to embed and maintain this change through education, training and inspiring others. [ABSTRACT FROM AUTHOR]

Introduction Patients with hip fracture and depression are less likely to recover. This review aimed to identify prognostic factors of depression up to one year after hip fracture surgery in adults. Secondary aims were to determine whether identified factors are modifiable or non-modifiable and describe proposed underlying mechanisms for their association with depression. Methods We searched MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection databases for published studies as well as grey literature. We did not impose any date, geographical, or language limitations. Two reviewers independently screened studies against predefined eligibility criteria to identify relevant papers. We included observational studies investigating prognostic factors of depression up to one year after surgery in adults surgically managed for non-pathological hip fracture. Two reviewers independently extracted data (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist) and completed quality appraisal (using Quality in Prognosis Studies tool). Results 3,402 studies were identified; 2,915 studies were excluded leaving 13 studies included in this review. 3,769 patients were included across all studies with a mean age ranging from 76.21–81.82 years. A total of 39 prognostic factors were investigated and most studies failed to identify a primary prognostic factor of interest. Most of these factors were patient factors with only a few being process or structure factors. Conclusion Various potential prognostic factors of depression after hip fracture were identified however, Methodological quality and heterogeneity between studies limited the certainty of which prognostic factors were the strongest. High-quality research investigating prognostic factors using the same study design, Methodology and measurements is warranted to allow for comparisons of the predictive power of factors. As well as future research into the underlying mechanisms of prognostic factors. [ABSTRACT FROM AUTHOR]

Introduction Anticoagulation of elderly patients with Atrial Fibrillation (AF) and falls remains a domain of contention amongst clinicians. There is limited evidence to guide long-term anticoagulation decision in such patients. We performed a systematic-review and meta-analysis to guide anticoagulation decision. Methods We conducted a prospectively registered systematic-review and meta-analysis (PROSPERO: CRD42021228661). Studies investigating patients >65 years of age anticoagulated for AF at risk of falls were included. Outcomes included were stroke/systemic embolism (SSE), CNS bleeds, major non-CNS bleeds, and mortality. CENTRAL, MEDLINE, PsycINFO, CINAHL, DARE, Web of science and Scopus were searched. Two authors performed paper inclusion/exclusion, data extraction, risk of bias and GRADE assessment. Data was pooled quantitatively using random-effects models and expressed as Odds Ratio (OR) and 95% Confidence Intervals (95%CI). Results Nine studies were included and five were combined quantitatively. Studies had low to moderate risk of bias. Anticoagulated fallers were at higher risk of SSE (OR = 1.73, 95%CI:1.21–2.47, p = 0.003), CNS bleeds (OR = 1.67, 95%CI:1.25–2.23, p < 0.001), major bleeds (OR = 1.87, 95%CI:1.66–2.11, p < 0.001) and mortality (OR = 1.96, 95%CI:1.71–2.25, p < 0.001) compared to anticoagulated non-fallers. Anticoagulated fallers were at higher risk of major bleeds compared to fallers not on anticoagulation (OR = 1.69, 95%CI:1.03–2.77, p = 0.04). However, there was no statistically significant difference in SSE, CNS bleeds or mortality. In fallers, Direct Oral Anticoagulants (DOACs) have lower risk of CNS bleeds (OR = 0.19, 95%CI:0.09–0.041, p < 0.001) and major bleeds (OR = 0.78, 95%CI:0.60–1.01, p = 0.06) compared to warfarin. There was no statistically significant difference in SSE or mortality between the anticoagulants. Conclusion: (s) Falling on anticoagulation is associated with increased risk of complications. However, only risk of major non-CNS bleeds increases when anticoagulating fallers. In fallers, DOACs appear safer than warfarin for bleeding complications. There remains paucity of evidence about anticoagulation in fallers (GRADE certainty = very low—moderate). Further evidence is needed to help clinicians and patients regarding anticoagulation. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable.This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods: Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity. Results: Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions. The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention. Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability. Conclusions: Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status. [ABSTRACT FROM AUTHOR]

Introduction: In contrast to other medical specialties, trainees in Geriatrics have historically provided an increased contribution to clinical workload in General Internal Medicine and a reduced output of academic achievements. More recently, development of non-clinical skills has been recognised to have similar importance to clinical skills and the South East (SE) London Geriatrics Training Programme has thus supported trainees in applications for Out of Programme (OOP) opportunities to optimise career progression. Methods: Doctors who had undertaken specialist registrar training in the SE London Geriatrics Training Programme at any time between 2011 and 2019 were sent a questionnaire to assess whether they had completed time OOP and whether they had been awarded research grants, published papers in peer-reviewed journals, had abstracts accepted for presentation at conferences, and/or published book chapters during their training programme. Chisquared and Wilcoxon rank-sum tests were used to compare data between registrars who had completed time OOP and those who had not taken time OOP. Results: 77 (24 male; 53 female) registrars completed training in the SE London Geriatrics Training Programme between 2011 and 2019. 71 registrars (92%) completed the questionnaire, of whom 31 (44%) completed time OOP. In total, registrars were awarded 15 research grants, published 86 papers in peer-reviewed journals, had abstracts accepted for 184 conference presentations and published 20 book chapters. A notably increased proportion of registrars who took time OOP had an output of research grants, papers published in peer reviewed journals, abstracts accepted for presentation at conferences and/or book chapters respectively compared with registrars who had not taken time OOP (23% vs 5% ; 61% vs 23%; 84% vs 33%; 45% vs 5%). This equated to a combined academic output in 94% of registrars who completed time OOP compared with 48% who did not (p <0.001). Conclusions: A very strong association existed between registrars in Geriatrics taking time OOP and academic achievement substantiating the training programme’s aspiration to support development of non-clinical skills that may be helpful to trainees in their future careers. It would be worthwhile further work being undertaken in this area in other regions. [ABSTRACT FROM AUTHOR]

Introduction: Constipation is a widely prevalent issue in older adults that may result in complications such as urinary retention, delirium and bowel obstruction. Previous studies have indicated that while stool charts are well completed by nursing staff, they are infrequently monitored by doctors. This project aimed to improve the documentation of bowel movement by doctors on ward rounds to 85%, by the end of a 3-month period. Methods: Formulation of the project was achieved using group work and a fishbone diagram which focussed on how doctors can improve on documenting bowel movements. Baseline data were collected from inpatient notes on weekdays over a three-week period on a geriatric ward inNorthern GeneralHospital, Sheffield. Interventions of posters and stickers of the poo emoji were placed on walls and in inpatient notes respectively as a reminder. Postintervention data were collected on weekdays over two weeks, and then repeated a month later to assess for a sustained change. Results: The data on bowel activity documentation were collected from 28 patients. The baseline data showed that bowel activity was monitored daily on the ward 56.25% of the time. There was a significant increase in documentation of 85.75% following the interventions.The sustainability study showed that bowel activity was documented on the ward 59.09% of the time. Conclusions: This study shows how a strong effect on behavioural change can be accomplished through simple interventions such as stickers and posters. As most wards currently still use paper notes, this is a generalisable model that other wards can trial. However, this study also shows the difficulty in maintaining behavioural change over extended periods of time. Further PDSA cycles should examine the reasons behind the difficulty sustaining the change and implement new changes that aim to overcome them. [ABSTRACT FROM AUTHOR]

Introduction: Comprehensive Geriatric Assessment (CGA) improves outcomes for frail patients; at FVRH this is delivered by the Frailty Intervention Team (FIT) comprising of senior nurses, allied health professionals (AHPs) and doctors. Faced with COVID-19, we took the opportunity to digitalise CGA documentation to preserve these benefits for patients whilst facing greater acuity, staffing and time pressures. An electronic solution was adopted to reduce paper-usage in COVID-receiving areas. Prior to COVID-19, CGA was recorded within case-notes, presenting challenges when patients were readmitted out-ofhours as these were stored off-site and not accessible out-of-hours. Method: Trakcare is the patient-management system in many Scottish hospitals. The Electronic Patient Record (EPR) was used to record pro-forma against admissions which were accessible and updatable for any patient 24–7-365. Patients meeting the Healthcare Improvement Scotland (HIS) Frailty criteria were considered “frailty-positive”, with an e-alert added- reappearing on any re-admission. Providing no HIS-exclusion criteria, an electronic-CGA (e-CGA) was recorded or updated. The pro-forma designed contained information not immediately available to clerking practitioners. This evolved following discussion amongst the FIT to include information such as escalation-status, medicationarrangements and baseline cognition. Results: Over 13 weeks, 116 EPRs were reviewed. During weeks 1–3 (n=8, 12, 7 respectively), e-CGA completion averaged 31%. Following FIT collaboration, this rose to 82% (n=9) by week 12. Qualitative feedback from the MDT indicated that FIT, downstream wards and night-staff felt that having access to previous escalation-plans made immediate-management easier to determine, and discussions with familiesmore productive for patients. Conclusions: Development of the FVRH e-CGA is ongoing, with an electronic frailtyscreening tool being implemented to improve frailty-identification on admission to ensure correct streaming of patients to the FIT. We have demonstrated a cost-neutral method for improving access to CGA for patients using existing IT systems whilst protecting staff time, preserving patient care during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction NICE guidelines recommend for healthcare professionals to give patients both verbal and written information when explaining how to prevent further falls at home, how to cope with falls and where they can seek further advice or assistance. Most of the patients seen by the Frailty Assessment Service (FAS) at Northumbria Specialist Emergency Care Hospital (NSECH) will remain at a high falls risk even on discharge. An emphasis should be made on educating patients about how best they can manage their risks at home to prevent further falls. Method Over a six month period, data on patients seen by the FAS team was collected by reviewing electronic case notes and the daily patient list to identify presenting complaint and whether a falls leaflet was given on discharge. Results Following three cycles of intervention, the rate of falls leaflet distribution to patients discharged following a fall increased from an initial 0% to 24%, then to 55% and finally to 72%. Interventions included, in order; educating all frailty nurse practitioners, amending the daily patient list to include a separate column to prompt ticking if a falls leaflet was given, and notifying all frailty consultants to consider including “falls leaflet” as part of their post-take management plans. Conclusion Having a paper information leaflet can be invaluable to patients as it allows them to go away with concrete bits of information that they can always refer back to. This ensures that elderly patients do not face the risk of forgetting any advice given to them verbally during a consultation and written communication would only help to reinforce this instead. In future, it may be helpful to identify if there are reduced rates of re-admission to hospital in patients discharged with a falls leaflet compared to patients discharged without one. [ABSTRACT FROM AUTHOR]

Local Problem: A multidisciplinary team comprising a consultant geriatrician and nurse consultant reviews all patients aged ≥70 years who have an emergency laparotomy at Royal Derby Hospital. Anecdotally there is a high incidence of delirium but retrospective casenote audit found only 19% of patients admitted for emergency laparotomy July 2018–July 2019 were identified as having delirium by the surgical team. Method: A first PDSA cycle showed that the 4AT was feasible for use by healthcare assistants on the surgical assessment unit (SAU). A second PDSA cycle, described here, sought to develop a rationale for implementation of the 4AT as part of surgical assessment by comparing true prevalence of delirium using 4AT, with the prevalence detected using methods currently mandated by our hospital. All patients aged ≥65 years admitted as part of the surgical pathway had 4AT completed by a member of our improvement team on admission, with daily review until discharge. Results: Data were collected for 111 consecutive emergency surgical admissions. Mean (SD) age was 78.3 (7.7) years. Of these, 1 and 3 were categorised as having delirium and dementia respectively using existing hospital screening tools. Using 4AT, 36 (32%) of patients were identified as having delirium. When supplemented by clinical history, true prevalence was 40 (36%). Average (SD) length of stay was 7 (5.6) days for the whole cohort, 10 (6.5) and 5.3 (4.3) days for those with and without delirium respectively. Conclusions: 4AT was 92% sensitive for delirium in our cohort. The existing hospital tool was underutilised to the point of being useless. Patients with delirium had a longer length of stay. We have developed a modified 4AT paper tool and training materials and are now piloting routine use in SAU. [ABSTRACT FROM AUTHOR]

Introduction: Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT; www.the4AT.com) is a short (<2 min) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection. Methods: We searched the following electronic databases through Ovid: MEDLINE, Embase, and PsycINFO. Additional databases were searched: CINAHL (EBSCOhost), clinicaltrials.gov and Cochrane Central Register of Controlled Trials from 2011 (4AT publication) until 21 December 2019. Inclusion criteria: older adults (≥65) across any setting of care except critical care; validation study of the 4AT against a delirium reference standard (standard diagnostic criteria or validated tool). Two reviewers independently screened abstracts and papers and performed the data extraction. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model. Results: 17 studies (n = 3,701 observations) were included. Various settings including acute medicine, surgery, stroke wards and the emergency department were represented. The overall prevalence of delirium was 24.2% (95% CI 17.8–32.1%; range 10.5–61.9%). The pooled sensitivity was 0.88 (95% CI 0.80–0.93) and the pooled specificity was 0.88 (95% CI 0.82–0.92). The methodological quality of studies was mostly good. Conclusions: The 4AT is now supported by a substantial evidence base comparable to other well-studied tools such as the Confusion Assessment Method (CAM). The strong pooled sensitivity and specificity findings for the 4AT in this meta-analysis along with its brevity and lack of need for specific training provide support for its use as an effective assessment tool for delirium. [ABSTRACT FROM AUTHOR]

Background and Objectives: The socioeconomic burden of dementia is very high and on the rise. Currently there is no cure for dementia; therefore, it is key to identify the modifiable risk factors for this condition.The association between adiposity and dementia is not yet convincingly established. This systematic review aimed to critically appraise the quality and to synthesise the findings of recently published longitudinal studies examining the association between adiposity and the development of dementia. Methods: A comprehensive literature search on longitudinal studies published between 2013 and 2018 was conducted across MEDLINE, EMBASE, PsycINFO and SCOPUS. The quality of selected papers was assessed using the Newcastle-Ottawa Quality Assessment Scale for cohort studies (NOS) and PRISMA-IPD checklist. The results of the included studies were qualitatively synthesised. Results: Of the 1,370 citations identified and reviewed, 10 completely met the inclusion criteria.Of the 10 included studies, 9 were high quality cohort studies, scoring an average of 8.4 out of 9 for NOS. One study was an individual patient data meta-analysis study (IPD). The IPD had high scientific rigour and largely adhered to the PRISMA-IPD checklist. In total, the 9 cohort studies included more than 2 million subjects, with 3 cohorts recruiting exclusively men. The IPD contained data from 39 cohorts and 1.3 million participants. 4 studies were conducted in highly selective cohorts. Apart from European male populations, the other populations were markedly under-represented. All studies used body mass index (BMI) as a proxy for adiposity. None of the included studies did a sample size calculation. Only half of the included studies were able to produce significant results, suggesting insufficient sample size and lack of power. The included studies reached contradictory results, with half of the studies favouring a protective effect of adiposity. Conclusions: In view of the results and quality of the studies, this review found that there was insufficient evidence to establish the association between adiposity and dementia. Current evidence suggests an association between mid-life obesity and dementia development in late-life. Longer studies were more likely to conclude that adiposity was detrimental to health.The inconsistent conclusions could be the result of reverse causality. To conclusively establish the link between adiposity and dementia, more research with robust methodology is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. However older people are both more vulnerable to changes in function and often prioritise function over survival. There is limited published research examining function outside of context of sexual or urodynamic function following gynaeoncology surgery but a large body or research exists examining health-related quality of life (HrQOL) both as a pre-operative risk factor for survival and as a post-treatment outcome measure in its own right. HRQOL tools may report on physical function as a subcomponent within composite tools. This systematic review and narrative synthesis describes functional recovery after gynaeoncology surgery with respect to baseline characteristics which - if identified – could enable pre- or post-operative risk reduction. Methods: Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974-2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria: • Mean/median age >60 • Gynaeoncological treatment includes surgery (RCTs, observational or mixed methods studies). • Any measure of functional ability as defined by WHOICF classification section D1–D7 inclusive, D855, D860-79 and D9 using validated tool. • Minimum pre-operative and one post-operative measure. Results analysed and presented using narrative synthesis. Results: Sixteen studies identified (7 Endometrial, 2 Ovarian, 2 Vulval, 6 mixed cancer types). 1/16 used a standalone functional assessment tool, 15/16 used Health-Related Quality of Life tools (EORTC QLQ C30 (10), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline (n=11) than incomplete recovery (n=5 including 2 reporting age as a negative association). Recovery was more likely and occurred faster in minimally-invasive surgery. 1 study demonstrated failure to recover baseline functional independence by 12 months. [ABSTRACT FROM AUTHOR]

Introduction: There are multiple drivers to move healthcare into community settings, including people’s own homes. Traditional healthcare training, particularly medical training, is largely hospital-based, and hospital-based models of care. Few professions have explicit training in how best to assess an individual at home, and the additional elements to examine when visiting an induvial in their own home. To meet this training need Croydon Health Services were successful in a bid for funding to develop training to meet this gap. With this funding, a programme was developed and after attempts at simulation home visits in the simulation centre, a virtual reality (VR) home visit scenario was devised and filmed in the community using a professional actor to simulate a housebound individual. The recording was then professionally edited by a specialist VR team tomaximise its effectiveness including interactive educational elements. Methods: A pilot study examining the acceptability of the virtual reality home visit scenario was designed. A user group of medical staff with limited community experience participated in undertaking the virtual reality scenarios, delivered via SamsungNote 8 devices combined with Samsung Gear VR headsets. Feedback was received from participants by standardised paper-based surveys. Results: 7 responses were obtained. 100% of respondents described the scenario as easy to use, as well as agreeing that the same experience could not be gained from watching a standard video of the same scenario. 100% of respondents felt that the on-screen information was helpful. Feedback on areas for improvement suggested a desire for greater interactivity of other aspects of home assessment, and a desire to improve interactivity with the simulated patient, including history taking. Conclusions: Virtual reality home visit simulations are an acceptable and effective tool to introduce new concepts to staff. Further development should aim to maximise interactivity in the scenario and explore options for greater interaction with the simulated patient. Further role out of the virtual reality is planned for local and regional training sessions. [ABSTRACT FROM AUTHOR]

Introduction: Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes, yet 30–50% of prescribed medicines are not taken as recommended [1]. Polypharmacy and medication errors are common. Evidence suggests that there is a linear increase in medication errors with the number of medications a patient is prescribed. This paper describes an approach to identity and address inappropriate polypharmacy and safety concerns in Buckinghamshire care homes. The workforce used was: primary care and care home pharmacists, technicians and geriatricians. Methods: A successful business proposal enabled a new interdisciplinary model of care to be established. This was delivered in 2768 Buckinghamshire care home beds (63% of Bucks ICS bed capacity). The CCG pharmacists, GPs and pharmacy technicians reviewed medication for all residents followed by a medication and clinical review by a geriatrician for the most complex individuals. Other community specialist teams were included as part of a Multidisciplinary team as needed. Data on reviews, medicines stopped and safety were collected from 2013–2018. Results: Overall 2134 medications were stopped for 1268 residents of 2102 reviewed, with 505 interventions to reduce falls risk. 942 safety issues were identified and resolved. Total savings on medicines optimisation, waste and non-elective admission prevented was £619,000. System wide safety included: community psychiatric nurse to support dementia diagnosis, specialist enteral feeding nurse reinstated and a new website to share and disseminate good practice standards. Conclusions: Future direction of this work focuses on system wide improvements to promote multi-organisational interdisciplinary healthcare and social services professionals work in care homes. NHSE Pharmacy integrated funding has provided extra pharmacists and technicians to support the 37% of the care home beds not yet covered by March 2020. [ABSTRACT FROM AUTHOR]

Introduction: Constipation has a high prevalence of 30-40% in those aged over 65. It can lead to complications including delirium, faecal impaction, stercoral ulceration, and bowel obstruction. Although stool charts are used in geriatric wards to monitor bowel movements to guide management of constipation, they are often inconsistently recorded. Similarly, regular laxatives are often not prescribed for constipated patients due to ward pressures or unawareness regarding their importance. Aims: Our aims were to audit the rates of recording on stool charts and laxative prescription in a geriatrics department, and to assess whether amultifactorial intervention aimed at both doctors and nursing staff improved these rates. Methods: Two independent assessors audited the recording of stool charts, and rates of constipating medications and laxative prescription in two geriatrics wards in a tertiary UK hospital. A multifactorial intervention was implemented, consisting of didactic sessions for doctors and nurses, healthcare assistant champions to promote the recording of stool charts, and consolidation of bowel movement recording onto a single paper stool chart by the bedside rather than multiple charts. After the intervention, the data was re-audited on the same wards. Descriptive statistics and frequency tabulation were used for data analysis. Results: Data was collected from 33 patients. Pre-intervention, stool charts were recorded daily in 13 patients, 10 patients had no stool chart record, 20 patients were on at least one constipating medication, 12 patients were prescribed at least one laxative, and 5 out of 7 patients with opiates had laxatives co-prescribed. Post-intervention, stool charts were recorded daily in 21 patients, all patients had a stool chart record, 20 patients were on at least one constipating medication, 23 patients were prescribed at least one laxative, and 2 out of 4 patients with opiates had laxatives co-prescribed. Our intervention improved daily recording on stool charts by 24%, resulted in all patients having a current stool chart and improved prescription of regular laxatives by 34%. Conclusions: A multifactorial intervention based on educational sessions, healthcare assistants acting as champions, and consolidation of recording of bowel movements into a single chart, improved stool chart recording and prescription of regular laxatives in a tertiary geriatrics department. Future auditing will extend the sample size and generalise the intervention to other hospital departments. [ABSTRACT FROM AUTHOR]