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Susan Williams,1 Clíona O’Riordan,1 Fiona Steed,2 Aoife Leahy,1,3 Elaine Shanahan,3 Catherine Peters,3 Margaret O’Connor,3,4 Rose Galvin,1 Ann-Marie Morrissey1 1School of Allied Health, University of Limerick, Limerick, Ireland; 2Department of Medicine, University Hospital Limerick, Limerick, Ireland; 3Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 4School of Medicine, University of Limerick, Limerick, IrelandCorrespondence: Susan Williams, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland, Email Susan.Williams@ul.ieIntroduction: Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints.Methods: Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used. Phone interviews took place following a semi-structured interview guide. Focus groups were moderated by A-MM. Braun and Clarke’s approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021).Results: Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: 1. Pre-ESD experiences of providing and receiving older adult inpatient care, 2. Navigating discharge procedures from acute hospital services, 3. A vision for more integrated model of care and a medical ESD team.Discussion: This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints.Conclusion: This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a feasibility trial, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.Keywords: early supported discharge, older adults, hospitalised, qualitative, medical inpatient

Background Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease–related health barriers and the users’ confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management.

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.

Background Wearable technology is increasingly used to diagnose, monitor and manage neurological disorders such as Parkinson’s Disease (PD). This study aims to gain information about the views and needs of people with Parkinson’s (PwP’s) regarding wearable technology for monitoring the disease and assisting its management. Methods The study employed a mixed methods parallel design, wherein focus-groups and questionnaires were concurrently conducted with people with PwP’s in Munster. Questionnaires and topic guides were developed with significant input from PwP’s. The participants for focus-groups were purposively sampled for variation in PD stage, age (all >50 years) and sex. Questionnaire and focus-group results were analysed together, using a pragmatic triangulation protocol. Results Thirty-two questionnaires were completed by PwP’s. Four semi-structured focus-groups were held (n=24 participants). Participants were overall positive about wearable technology in PD, and perceived benefits in wearable technology for improved management of symptoms. Wearables should be user-friendly, have an appealing design, and demonstrate clinical usefulness. Comfort and discrete design were emphasised for greater usability. The value of sharing information between PwP’s and health professionals for improved outcomes was highlighted. PwP’s perceived that increased patient data in the form of reliable information from a wearable device may allow for more accurate management of PD. Participants also felt that a device could help increase physical activity, and potentially track compliance with medication. There was little focus on device safety and privacy/ownership of data. While participants anticipated that there may be challenges for some in wearing a device, they believed overall potential benefits would outweigh these. Conclusion Engagement of PwP’s in the design of wearable technology is vital for the development of devices that improve the management of PD. This study will directly inform a multi-country feasibility study of wearable devices for older people, with a particular focus on the needs of PwP’s.

Internationally, evidence-based practice (EBP) is recognised as a foundational element of healthcare professional education. Achieving competency in this area is a complex undertaking that is reflected in disparities between ‘best EBP’ and actual clinical care. The effective development and implementation of professional education to facilitate EBP remains a major and immediate challenge. To ascertain nuanced perspectives on the provision of EBP education internationally, interviews were conducted with five EBP education experts from the UK, Canada, Australia and New Zealand. Definitive advice was provided in relation to (1) EBP curriculum considerations, (2) teaching EBP and (3) stakeholder engagement in EBP education. While a considerable amount of EBP activity throughout health profession education is apparent, effectively embedding EBP throughout curricula requires further development, with a ‘real-world’ pragmatic approach that engenders dialogue and engagement with all stakeholders required.