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Background Regular exercise and physical activity can maintain function and cardiovascular health, and prevent cognitive decline, in older adults. However, studies show that there is often poor adherence to home exercise programmes (HEP). The purpose of this study was to explore how HEP are perceived by both older adults and physiotherapists. Methods A convenience sample of 28 older adults attending outpatient physiotherapy clinics were given an exercise journal to record their adherence to the HEP prescribed by their physiotherapists for six weeks. Subsequently, semi-structured interviews were conducted with a purposive sample, and the corresponding prescribing physiotherapists, to achieve maximal variation in terms of HEP adherence, age and sex. The interviews were audio recorded, transcribed, and simple content analysis performed. Results Fourteen participants returned their exercise journal. Median age was 80; half were female; median Berg Balance Score and Timed-up-and-Go-Test were 49 and 16 seconds respectively. Participants exercised a median 79.8% of the prescribed dose, or 5.6 days per week. Seven older adults were interviewed; about half had a positive attitude towards exercise. They were also moderately positive about their HEP (comments ranged from "doable" and "nothing bad about it" to "enjoyable"). Barriers included time, mood, boredom, remembering to do the HEP, and variable health status. Enablers included simple instructions and design, family encouragement, and sense of achievement. Physiotherapists (n=5) perceived that many older adults aren't compliant with HEPs, but there was some therapeutic nihilism ("you can't force them"). Their HEP instructions varied from verbal to written instructions/diagrams; one physiotherapist used individualised video content. Notably, participants with good adherence understood their HEP well in terms of content and purpose, although this may be cause or effect. Conclusion To improve compliance with HEP, healthcare professionals need to take time to motivate the recipient, simplify their instructions, and trouble-shoot potential barriers at the time of prescription. [ABSTRACT FROM AUTHOR]

Background The use of psychotropic medications and their adverse effects in frail adults has been debated extensively. However, it is unclear if antipsychotics are initiated in a nursing home or if the new resident arrives with the medication prescribed. The purpose of this study is to ascertain how many residents arrive already on antipsychotics and which factors, make them more likely to be on this medication. Methods All admission notes to the centre between 1st Jan 2018 and 31st Dec 2018 were reviewed. Inclusion criteria was any person admitted with a diagnosis of dementia. Exclusion criteria was anyone who had psychiatric diagnosis such as bipolar disorder or schizophrenia. We collected data on age, gender, referral pathway (hospital or community), MMSE, Barthel, Cohen Mansfield Agitation Inventory (CMAI) For comparisons of characteristics between the two groups (psychotropic drugs at admission: yes/no), the independent samples t-test (normally distributed data) or the Mann-Whitney U test (non-normally distributed data) was used for continuous variables and Fisher's exact test was used for categorical variables. Results There was a statistically significant relationship between source of admission and whether or not the patient was receiving psychotropic drugs on admission (p=0.017). 88.0% of patients on psychotropic drugs on admission came from an acute hospital setting. In contrast, only 4.0% of patients receiving psychotropic drugs on admission came from home Patients on psychotropic drugs at admission had higher CMAI scores compared to patients not on psychotropic drugs. Patients on psychotropic drugs at admission were younger (mean(SD): 76.2(8.7) years) than patients not of psychotropic drugs (mean(SD): 82.9(8.3). Conclusion Prevalence of prescribing antipsychotics outside of nursing homes is high with many residents being admitted already on these medications. Efforts should be put in place on admission to nursing homes to reduce and stop antipsychotics which have been initiated in the community and hospital setting. [ABSTRACT FROM AUTHOR]

Background Generic Prescribing is an essential component of prescribing, however it is often overlooked. Use of brand names can led to poor recognition of the correct medications. It can also led to medication error. It is part of the policy of our hospital group that generic prescribing is used at all times. We performed a similar audit in 2018 and 79% of drug kardexes had brand names used. Prescribing education is an integral part of NCHD teaching. We wished to re-audit to determine rates of generic prescribing now. Methods We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. Each drug was reviewed and if any prescription had brand names, the entire kardex was deemed non-compliant. Results 285 Drug kardexes were assessed across 14 separate wards. 41% were on surgical wards, 59% were on medical wards. 31 (11%) of kardexes had complete generic prescribing. Only 3 kardexes on the surgical ward had complete generic prescribing. Conclusion The low rates of generic prescribing remain an issue in our university teaching hospital. A similar audit was performed in 2018 with average rates of 20% of generic prescribing. This has decreased in the last year. The failure to generic prescribe puts patients at risk of medication error and also increases cost to the HSE. Education on prescribing is part of the NCHD induction, however, 9 months on there continues to be issues with compliance with generic prescribing. Education alone is not enough to improve current practice. The use of e prescribing offers the potential to alleviate this problem. [ABSTRACT FROM AUTHOR]

Background The management of non cognitive symptoms of dementia can be challenging for people living with dementia and their carers. The risks and limited benefit of antipsychotics in this setting is well documented however despite this they still are often prescribed. A previous study at our facility in 2016 highlighted a high prevalence of antipsychotic prescribing at 35% (Bambrick, et al. 2016). As a result of this, multidisciplinary psychotropic review meetings were established and are ongoing. Methods Two wards in our community nursing unit were selected. Inclusion criteria included residency > 6 months. The case notes, medication lists (admission and current prescriptions), and psychotropic review meeting notes were reviewed. Results 43 residents were included in the study. 72% (n=31) were female. The average age was 85 years. 74% (n= 32) of residents had a documented dementia diagnosis. On admission, 7 residents were taking regular antipsychotics. 5 of these medications were subsequently either reduced or discontinued. At the time of the study, 16% (n=7) were prescribed regular antipsychotics. There was a definite indication for 3 of these (schizoaffective disorder, psychosis, paranoid depression). 1 resident had a traumatic brain injury with associated distressing symptoms with harm incidents. 3 had a dementia diagnosis with associated distressing symptoms. A further 14% (n= 6) were prescribed antipsychotics on a PRN basis. 5 had a documented diagnosis of dementia with associated distressing symptoms. None of these residents received these medications in the 4 weeks prior to the study. Conclusion Significant improvements are noted since 2016 with the overall prevalence of antipsychotic prescribing decreasing from 35% to 16%, with the majority of these prescriptions having a clear indication. It is reassuring that residents are not receiving prn medications frequently. We await the national clinical guidance on "Appropriate Prescribing of Psychotropic Medication in People with Dementia" to further guide our practice. [ABSTRACT FROM AUTHOR]

Background Medication records are essential components of patient care and a source of medical error. The HSE Code of Practice for Healthcare Records Management has highlighted criteria which must be complied with in these records. In the HSE Clinical Strategy and Programmes Division, "Test your care" is used to promote a code of practice and a set of metrics which need to be adhered to. Methods We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. We assessed the drug kardexes based on 9 different metrics. (Generic names used, capital letters used, start date recorded, legible dosing, route and frequency of medication documented, minimum dosing documented, legible prescriptions and discontinued drugs crossed off) Results 285 drug kardexes were reviewed. No drug kardex was fully compliant with the 9 standards. The main deficits were in relation to use of brand names, no documentation of frequency and omission of IMC numbers. The average number of metrics met was lower on surgical wards than medical wards - 3.6 vs 4.7 respectively, and this difference was statistically significant (p<.00001; 2 sample t test). Conclusion The universal poor compliance with these standards highlights both the poor design of the current drug kardex and poor awareness with prescribers of these standards. In the current drug kardex, there is no dedicated space for frequency or IMC number and therefore these are often forgotten. The use of brand names consistently highlights poor prescribing practice and more education is required to improve this. We plan to improve current prescribing education sessions for all doctors to highlight the current deficiencies and to increase compliance with standards. [ABSTRACT FROM AUTHOR]

Background Illegible prescribing can lead to medication error and adverse drug reactions. The HSE Standards and Recommended Practices for Healthcare Records Management and the Practice Standards and Guidelines for Nurses for Prescriptive Authority have highlighted criteria which should be adhered to in relation to prescribing. We set out to audit compliance with these standards in relation to legibility of prescriptions in an Irish University Teaching Hospital. Methods Over a 48 hour period, drug kardexes were reviewed on 14 separate in-patient wards. Legibility was judged by a single assessor on each ward. A drug kardex was deemed legible if all of the following criteria were met: The writing was clear and un-joined, in upper or lower case text. Only approved abbreviations were used. Doses were clear, with zero preceding decimal points, and appropriate measurement units used. In cases where weight dependent medications were prescribed, the patient's weight was clearly documented. The chi squared test was used to determine the significance of the difference in proportions for categorical variables. Results 285 drug kardexes were reviewed over the 48 hour period. 41% were on surgical wards, 59% were on medical wards. The median patient age was 70 (IQR:55-78), and 56% were male. 48% of drug kardexes were deemed legible. A higher proportion were deemed legible on medical wards compared to surgical wards (68% vs 19% p<0.05). Upper case was used in 13% of kardexes, with similar proportions on medical and surgical wards. Conclusion Poor legibility of drug kardexes may increase risk of medication errors and adverse drug reactions. We plan to commence targeted prescribing education sessions to highlight the current deficiencies and improve current practice. Changes to kardex layout may also aid legibility. Long term planning for electronic prescribing would also help resolve issues in this area. [ABSTRACT FROM AUTHOR]

Background Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1) National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment and commence pharmacological therapy if indicated.(2) Methods Electronic discharge summaries of all patients with a diagnosis of fracture discharged from an off-site rehabilitation unit from 1st January 2018 to 31st December 2018 were reviewed. Patient details, location and mechanism of fracture, bone health assessment and discharge prescription were assessed. Following data collection, an education session directed at NCHDs was performed and a discharge checklist prompting bone health review and consideration of pharmacological therapy was introduced. A re-audit was performed at 4 months to assess change following this intervention. Results 74 patients had a diagnosis of fracture. 4 were excluded as fracture resulted from high impact trauma. 100% had corrected calcium measured. 93%(n=65) had Vitamin D(OH) measured. 91%(n=64) had PTH measured. 55%(n=39) were discharged on calcium/vitamin D(OH) supplementation. 33%(n=23) were discharged on Vitamin D(OH) alone. 66%(n=46) were discharged on antiresorptive therapy: 28%(n=13) bisphosphonate, 67% (n=31) denosumab, 4% others. 33%(n=23) were not prescribed any bone protection on discharge. 4 had advanced chronic kidney disease. 6%(n=4) were discharged without calcium/Vitamin D or antiresorptive therapy. A re-audit from January to April 2019 of 15 patients post NCHD education has shown an increase in antiresorptive therapy prescription 86%(n=13) Conclusion Bone health assessment and prescribing practices of antiresorptive therapy in patients undergoing rehabilitation post fracture is sub-optimal. Education of non-consultant hospital doctors can substantially improve rates of antiresorptive therapy prescription. [ABSTRACT FROM AUTHOR]

Background It is well researched that individuals in long-term care (LTC) are prescribed a greater number of medications, the leading risk factor for inappropriate prescribing, and are thus at greater risk of adverse drug reactions as a result. Many tools with explicit criteria are described in the literature for assessing potentially inappropriate prescribing (PIP) in the general geriatric population, but few have been developed to examine prescribing in LTC. Methods This was a point prevalence observational study of patients aged >65 years residing in three HSE-run LTC facilities in Cork. Demographic characteristics, medical diagnoses and medication regimes at time of admission (TOA) to LTC, and time of data collection were recorded and reviewed using STOPPFrail and NORGEP-NH criteria. Results 98 patients met the inclusion criteria, with 66% being female. The median age was 83 years (IQR 77-88 years), and median length of stay was 31 months (IQR 14-53 months). The median number of medications per person on admission was 8 (IQR 6-11), which increased to 9 (IQR 7-11) at time of review (TOR)(p<0.001). PIP was found in 70 (84.3%) patients at TOA, and 79(80.6%) at TOR using STOPPFrail, and was recorded as 81 (97.6%) at TOA, and 95(96.9%) at TOR using NORGEP-NH. Among the STOPPFrail criteria most commonly implicated were continuous use of nutritional supplements and high dose PPI therapy. With NORGEP, the most commonly implicated were use of antidepressants and antihypertensives. There was an increase in number of patients prescribed benzodiazepines, z-drugs, anti-depressants and anti-psychotics from TOA to TOR, while statins were prescribed less often at TOR (p<0.001). Conclusion Potentially inappropriate prescribing is highly prevalent in older residents of community hospitals using validated prescribing indicators. Criteria such as those used in this study could be used to highlight potentially inappropriate or futile medications in older, vulnerable patients. Regular medication review is recommended to facilitate deprescribing of such medications. [ABSTRACT FROM AUTHOR]

Background Antipsychotic medications are commonly used in the management of non-cognitive symptoms of dementia (also termed behavioural and psychological symptoms of dementia), such as agitation, calling out, hoarding, or aggression. This is despite increased recognition of adverse effects, including mortality, from these medications for people with dementia. The current aim was to review the most recent evidence for the efficacy and safety of antipsychotic medications in the management of non-cognitive symptoms in dementia. Methods Relevant studies published in English from March 2015 through to March 2018 were identified by searches of 5 databases: Medline, EBSCO, PsycINFO, Cochrane DARE, and Cochrane CENTRAL. Systematic reviews, meta-analyses, and controlled trials evaluating the safety of antipsychotic medication, or comparing the effectiveness of antipsychotic medication with placebo, another antipsychotic medication, or non-pharmacological intervention, were included. Independent article review and data extraction was performed by two reviewers. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools. Results Thirteen studies were included. Benefits and harms vary among antipsychotic medications for people with dementia, however overall efficacy of antipsychotics remains modest at best. A significant number of side effects are associated with antipsychotics, not least cerebrovascular events, sedation, gait disturbances, falls, fractures, urinary tract infections, cognitive worsening, and mortality. Atypical antipsychotics have a more favourable safety profile in some respects. People with certain dementias, notably Lewy Body Dementia, may experience more severe side-effects. Conclusion The evidence reinforces caution when prescribing antipsychotic medications for people with dementia; these medications should only be considered when symptoms are severe or non-pharmacological interventions have failed. Clinicians should closely monitor people with dementia who are prescribed an antipsychotic for side effects, limiting use of these medications to short-term treatment if possible. The forthcoming national clinical guideline for appropriate prescribing of psychotropic medications for non-cognitive symptoms will support clinical decision-making in this regard. [ABSTRACT FROM AUTHOR]

Background Lignocaine 5% medicated plasters (Versatis®) are licensed only for treatment of postherpetic neuralgia. Our 2017 audit of Versatis® prescribing recorded a potential cost of €28,297/year for just 26 patients, all off-label. We noted however the limited choice of analgesics in older adults due to co-morbid conditions such as CKD and frailty. The 2017 Medicines Management Programme (MMP) directive for label-only Versatis® prescribing aimed to reduce annual exchequer costs of €30 million noting 25,000 people had prescriptions under Community Drugs Schemes (CDS) in 2016. Methods We conducted a re-audit of Versatis® prescribing on five core geriatric medical, orthogeriatric and rehabilitation wards across three inpatient sites. Indication for, duration of and patient's personal view of the plaster was recorded. Pharmacy provided medications costings. Cost per day and per length of stay were calculated. All other prescribed analgesics were recorded. Results Analgesics prescribed for 127 patients were recorded. Mean age was 81 years, 63% female. 4/127(3%) were prescribed Versatis® compared to 26/129(20%) in 2017, all off-label.Indications included osteoarthritis and spinal stenosis. All four patients were prescribed the plaster prior to admission. Cost per plaster was €3.46 compared to €2.58 in 2017. Cost of Versatis® for these 4 admissions was €346 for their combined 100 bed days. Total cost of co-prescribed paracetamol for these four patients was €45.90. Three patients noted little analgesic benefit, one felt the plaster a psychological support. Seventeen different analgesics were prescribed across 127 kardexes. Conclusion No patient was newly prescribed Versatis® during their admission. The MMP directive for the prescribing of Versatis® influenced prescribing practice across our hospital sites. Community practice for prescribing off-label is still evident for chronic pain, reflecting the difficulty of pain control in older adults. The cost of individual plasters increased by 0.88€ since 2017. [ABSTRACT FROM AUTHOR]

Background Proton pump inhibitors (PPIs) are one of the most frequently prescribed drug classes in the older person. Indications for PPI use are outlined in the NICE guidelines, however they are often prescribed without an appropriate indication resulting in increased healthcare costs and increased exposure to potential adverse clinical effects. Methods To determine the rate of inappropriate prescribing of PPI's, an audit was carried out to assess the incidence of inappropriate prescribing in an Acute Rehabilitation facility pre and post Education to Hospital Doctors. An audit was carried out, pre and post intervention, on patients over the age of 65 years admitted to an acute rehabilitation hospital between 2018 and 2019. Patient's medical charts were reviewed and data was collected on PPI prescribing. Results Cycle 1-Pre Education; 83 people included in the audit. Mean age was 80.8 years[SD ±9]. 43% of patients were on a PPI, all of which were prescribed the generic form. 83.4% of patients had no indication for PPI use. Of the 16.6%, indications included GORD, Barrett's oesophagus, PUD and PPI prophylaxis against NSAID's including aspirin. 77.7% were on therapeutic dose without any indication. 100% of patients were on PPI for longer than 6 weeks. Cycle 2, Post education: 86 patients were included in re-audit. Mean age was 81.5[SD ±10]. 60.4% of patients were on PPI. Of those, 55% had no indication for PPI. Of the 44% on PPI, indications were similar to those in Cycle 1. 83% of patients were on PPI longer than 6 weeks. 56.5% were on inappropriate dose of PPI. Conclusion This audit highlighted the inappropriate prescribing of PPI's in the older person. By providing education to Doctors about NICE PPI prescribing guidelines, overall rate of inappropriate prescribing of PPI decreased by 28.4% and accurate dosing of PPI improved by 21.2%. [ABSTRACT FROM AUTHOR]

Background Direct oral anticoagulants (DOAC) are indicated for stroke prophylaxis in non-valvular atrial fibrillation, which is responsible for up to 20% of all ischaemic strokes(1). We performed a retrospective audit of all consecutive stroke patients in an Irish teaching hospital over a 1-year period to investigate the rate of incorrect dosing and any risk factors for this occurring. Methods We assessed our hospital stroke database from January to December 2017. Our research focused on DOAC prescribing in non valvular atrial fibrillation post embolic stroke. We collected data on baseline characteristics, choice of anticoagulation, dosing, and assessment of renal function, with follow up renal function if available. We reviewed electronic discharge summaries, online laboratory systems and completed a chart review. Results There was a total of 116 people with atrial fibrillation who developed an embolic stroke in our centre, of which 68 were eligible for anticoagulation using a DOAC (59). The main reasons for omission were CKD and haemorrhagic transformation. Patients were discharged on either Apixaban (32 patients), Rivaroxoban (32 patients), or Dabigatran (4 patients). Following our review, we established that 54/68 (79%) of patients were correctly anticoagulated. Over 20% of patients were incorrectly dosed and there was a clear tendency to under-dose 13/14 (93%). There were significant differences between the correct and incorrect dosing groups, with the latter group of patients being older and more at risk of polypharmacy. Renal function did not differ significantly between the groups at discharge or follow up and none of the incorrectly dosed patients were on a concurrent anti platelet. Conclusion A significant number of patients prescribed DOAC in hospital were not appropriately anticoagulated (21%), a majority of which were under-dosed. The patients who were under-dosed were older and more likely to be on 5 or more medications. [ABSTRACT FROM AUTHOR]

Background Evidence suggests that the current management of behavioural and psychological symptoms of dementia (BPSD) in general practice is sub-optimal. Non-pharmacological strategies are recommended first-line but uptake of these strategies is low. Despite their adverse effects and minimal effectiveness antipsychotics are frequently employed to manage BPSD. The aim of this study was to explore general practitioners (GPs) knowledge of and attitudes towards the management of BPSD with a view to informing future interventions. Methods A questionnaire was adapted from existing study. Additional questions were included, informed by the findings of a qualitative study previously conducted by the authors. The questionnaire was piloted with 3 GPs and was posted to a census sample of all GPs in county Cork and county Kerry in the south of Ireland. Statistical analysis was performed using SPSS. Results Of the 456 questionnaires sent 168 completed questionnaires were returned (36.8% response rate). The sample was representative of GPs nationally in terms of years of practice (p<0.0001). 62.5 % (105/168) of respondents had a nursing home commitment. The majority of GPs (60.7%) agreed that they required more training to improve their management of BPSD. 'Lack of resources in the primary care team' was cited as the main barrier to GPs recommending non-pharmacological strategies in the community. Nursing staff were identified as the group of people that most influenced the GPs prescribing of antipsychotic medications in a nursing home setting. The majority of respondents (84/168) did not monitor their prescribing of antipsychotics to people with dementia. 63.1% (106/168) of GPs were concerned that withdrawing these medications would negatively impact on the quality of life of the person with dementia. Conclusion This study identified several factors that influenced the management of BPSD in general practice. These findings will be used to guide future interventions in this area. [ABSTRACT FROM AUTHOR]

Background Biologics are a key component of the treatment armamentarium for inflammatory arthritis (IA). Questions remain surrounding the prescription, efficacy and safety of biologics in the older population. This study aims to describe the use of biologics in older patients with IA and compare it to younger patients. Methods This was a retrospective cohort study of patients with a diagnosis of IA who were receiving a biologic. Data was collected from medical charts at rheumatology outpatient clinics. Patients were divided into two groups: younger group (age 45 – 65) and older group (age >70). Results Each group had 30 patients (total n=60). 58% were female and the mean age overall was 65 years. Rheumatoid arthritis was the most common diagnosis (57%). 8 patients had active disease, and these were mainly older patients (n=6). 8 different biologics featured; the majority of patients received the standard dose of biologic (87% of younger, 80% of older). The incidence of biologic discontinuation due to drug ineffectiveness was the same for both groups (16%). 1 older patient had a biologic discontinued due to a serious adverse event. Infections requiring hospitalisation were not common (total n=5) but were more frequent amongst older patients (n=4). 47% of younger and 60% of older patients received concomitant therapy; most received a disease-modifying antirheumatic drug (DMARD) (72%), and those who received a steroid (n=6) were more likely to be older (n=5). Conclusion Biologic prescribing was similar between both groups with regard to the dosage administered, but there were differences in the types of biologics prescribed to each group. Rates of significant infection were low overall, however they were more prevalent amongst the older population. More older patients had active disease, and more were prescribed concomitant steroid therapy, which may represent under-dosing of biologic therapy in this older cohort. [ABSTRACT FROM AUTHOR]

Background The variable indicator of placement (VIP) tool is designed to identify patients at risk of frailty. The risk of harm in a frail older person increases as the number of prescribed drugs increases. Polypharmacy may be either appropriate or inappropriate. Deprescribing, aims to withdraw inappropriate medication under supervision, in order to improve outcomes. Methods 50 consecutive patients, attending an emergency department, were triaged with the VIP tool, triggering a single interdisciplinary assessment (SIA) by an integrated care team member. The SIA identified polypharmacy. Drugs which may be causing harm, may no longer be of benefit or were potentially interacting with other drugs, were identified. The Anti-cholinergic Burden (ACB) Score was calculated. Appropriate medication changes were made following interdisciplinary and patient/carer discussion. Patients were selected for one to one pharmacy and patient/carer liaison, which was followed through into their community setting e.g. long term benzodiazepine usage. Results The drugs which were identified for gradual withdrawal or cessation were benzodiazepines (n=6), opiates (n=4), genitourinary (n=2), digoxin (n=2), hyoscine (n=2), domperidone (n=2) and amitryptilline (n=1). The total ACB score for 50 patients was 95 pre-assessment and 65 post-assessment. This represented a 32% reduction in anti-cholinergic burden alone for this frail older adult cohort. Conclusion The VIP tool if used to trigger an SIA, can target those patients at risk of the adverse effects of polypharmacy. The calculated ACB score can trigger meaningful discussion with patients and carers around what matters to them. A system for supervised deprescribing is necessary to ensure successful reduction in ACB. [ABSTRACT FROM AUTHOR]

Background Community Health Organisation Area 1 has the highest age dependency in Ireland (37.5 vs 34.5) and the highest proportion of its population engaged in unpaid care (4.7%)1. Social prescribing is a novel tool used by the Integrated Care Team for the Older Person in Sligo to address social determinants of health such as social isolation and to minimise the impact of carer burden. The study aim is to quantify social needs and carer burden in this acutely frail group and describe interventions to address this. Methods A descriptive study compiled from Comprehensive Geriatric Assessment of patient care profile and social prescribing from June to December 2018. Results 50% of patients studied did not have a supportive, able person living with them. 1 in 4 had no local support while 1 in 5 were supported only by neighbours or friends. 53% were not receipt of home help while 24% paid for private care or cleaning services. Carer burden was reported in half of cases with a 2.2 times increased risk with a patient co-morbidity of cognitive decline and a 1.8 times increased risk with a complex medical needs patient. Intervention increased community service usage such as the public health nurse from 70% to 86% and home help applications by 26%. Social prescribing increased day centre use from 18% to 46% and Meals on Wheels usage by 50%. Dementia specific social prescribing was made in 26% of those with cognitive difficulties. 33% received information for carers while 11% were informed of respite options. Conclusion In this acutely decompensated and vulnerable group social isolation and carer burden are a significant issue. Our study indicates the potential for the use of a social prescribing model to address this at an earlier point in frailty development at a primary care level. [ABSTRACT FROM AUTHOR]

Background Prescription of Potentially Inappropriate Medications (PIMs) is common in older adults and is associated with adverse drug events, hospitalisation and mortality. Less well described are the patterns and predictors of PIM usage in patients with Alzheimer's Disease (AD), a patient group who may be particularly vulnerable to polypharmacy and medication associated adverse events. Methods Secondary analysis of the NILVAD trial, an international phase three trial of Nilvadipine in mild/moderate AD. The v2 STOPP/START criteria were individually applied by a physician to each participant's medication list and cross-reference with their medical history to identify PIM usage. Predictors of PIM usage were modelled using binary logistic regression. Results Five-hundred and ten patients with AD were included (mean age 72.8 +/-8.3 years; 62% female). The median number of prescribed medications was 5 (IQR 3-7). Over half (55.5%) were prescribed at least one PIM, whilst a minority of patients (14.8%) were prescribed three or more PIMs. The most frequent PIMs were benzodiazepines >4 weeks without indication (n = 55), long-term Proton-Pump Inhibitor (PPI) use without appropriate indication (n = 49), use of non-steroidal analgesics without use of PPI (n=19) and antimuscarinic use in dementia (n= 18). On multivariate analysis, significant predictors of PIM use were higher total number of medications (p=0.001; OR 1.52; 1.36-1.59) in addition to greater AD severity, as rated using the Clinical Dementia Rating Scale Sum-of-Boxes (CDR-sb) (p=0.024; OR 1.18; 1.02-1.35). Conclusion The majority of older patients with AD were prescribed at least one PIM. Usage of PIMs was associated with greater number of medications and increased dementia severity. Particularly concerning is the potentially inappropriate use of benzodiazepines and anti-muscarinic agents in this population, given recent evidence for the adverse cognitive profile associated with these medications. De-prescribing and medication review interventions aimed particularly at patients with AD are warranted. [ABSTRACT FROM AUTHOR]