Specialist Community Research Articles

Comparative Study on Physical Education Learning Quality of Junior High School Students Based on Biosensor Network

A biosensor is an innovative analytical detecting instrument utilized across many sectors due to its sensitiveness, precision, ease of use, and capability for in vivo surveillance via the internet. Biosensors provide extensive applicability in sports science, facilitating rapid physical activity tracking. This will emerge as a significant approach and technology for sports teaching and scientific study in sports. This study aims to evaluate the variations in bodily schooling mastering exceptional junior center college students underneath exceptional rearing modes and to use the specialist gadget primarily based on the synthetic neural community for analysis. The contrast index of gaining knowledge first-rate is an index gadget composed of numerous one-of-a-kind parameters. It is tough to be particular and has apparent fuzziness due to its giant variety and complicated content. There are many obstacles in fixing the contrast hassle using the skill of frequently used assessment methods. This paper proposes an assessment mannequin of junior excessive college students' bodily schooling mastering excellent primarily based on a synthetic neural community specialist system. The purpose of this method is to put processed records in a community and generate results by computation, other than by manual computing. It decreases the number of people in the comparative procedure, enhances the credibility of the assessment, and makes the comparative result more enormous and objective. However, the neural community additionally has some limitations. It can obtain international optimization by continuously editing the connection weights between neurons; however, making the community fall into neighborhood minima is convenient.

New Modes of Practice: A Framework Analysis of School Nurses' Accounts of Working With Children and Young People During COVID-19.

To identify new and accelerated modes of practice used by school nurses during the COVID pandemic. To create a quick reference infographic bringing together experiential evidence on the range and considerations regarding different modes of practice for use by the school nursing community of practice. A descriptive qualitative secondary data analysis of open-ended questions in a survey, and focus groups with school nurses. The pragmatic aim was to focus on changes in school nurse modes of practice to ensure continued engagement with children and young people, and school nurses' experience of the benefits and challenges of these modes of practice. Data were collected from 98 school nurse participants across a United Kingdom-wide survey (n78) in April to May 2022, and focus groups (n20) in June to July 2022, within the School Nursing in the Time of COVID project. Data from the seven open-ended questions in the survey and four questions from the focus group were analysed using the framework approach. Modes of practice fell into two categories: individual assessment and support (video-calling platforms, telephone contact, virtual messaging, walk-and-talks and home visits) and group support (wellbeing approaches, social media). Considerations for these modes rooted in school nurses' experience are described. Interpretations were used to create the summarising evidence-based infographic as a quick reference resource for school nurses. There was no 'one size fits all' approach. The modes used by school nurses were adopted or developed out of necessity or resource availability and in response to the specific needs of individuals or groups. The developed infographic provides a quick reference guide to deliver the expressed need for knowledge exchange within the school nursing community by participants in the original studies and can be used to inform current school nurse practice. The developed evidence-based infographic has stand-alone value. It has the potential to raise awareness of the range of different strategies that can be used to facilitate and/or enhance engagement with children and young people, equip school nurses with knowledge to foster innovative and responsive practice and aid critical reflection in a complex post-pandemic landscape. The infographic is a unique resource and is a first step in knowledge exchange based on experiential learning. The resource will be used as the foundation for future work to develop a co-created training resource for school nurse students (undertaking the Specialist Community Public Health Nurses course) and/or continuing professional development resource for established school nurses. This study has been conducted and reported in accordance with COREQ guidelines for qualitative research. A consultation group was closely involved with the planning, conduct and analysis of the original studies. This group consisted of representatives from professional organisations SAPHNA (School and Public Health Nurses Association) and the CPHVA (Community Practitioners' and Health Visitors' Association), a school nurse and a member of the public. SAPHNA have continued in their consultative role for this study and has provided content and usability feedback regarding the infographic. Early findings have been presented to the SN community of practice, and feedback invited, through presentation separately at the CPHVA and SAPHNA annual conference.

How Long Is Long COVID? Evaluation of Long-Term Health Status in Individuals Discharged from a Specialist Community Long COVID Service.

Background: Post COVID-19 syndrome or long COVID (LC) is a novel fluctuating condition with a protracted course in some patients. Specialist LC services have been operational in the UK since 2020 and deal with a high caseload of patients. Aims: To evaluate long-term outcomes in patients discharged from a community-based LC specialist service. Methods: A service evaluation study that included patients who were well engaged in the services [completed the standard Patient Reported Outcome Measures (PROMs) and received intervention from clinician(s)] and had been discharged for at least 3 months from the service. They consented to the study and completed standard PROMs: COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), EQ-5D-5L and National Institute for Health and Care Excellence (NICE) criteria for myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS). Results: Out of 460 patients contacted, 112 (average of 37.6 months since infection and 9.8 months post-discharge) completed the PROMs. Of these, 90.2% patients continued to experience LC symptoms and disability and had not returned to their pre-COVID-19 health status. The average EQ-5D-5L index score was 0.53 (SD 0.29), highlighting a significant disability and that LC had become a long-term condition (LTC) in the majority of patients who responded to the survey. Of these patients, 43% met the criteria for suspected ME/CFS. Conclusions: A proportion of LC patients develop persistent long COVID (PLC) consistent with a LTC and had a significant overlap with ME/CFS.

Amplifying Influence: Unveiling the Dynamic Role of Speech and Language Therapists within ICPOP Specialist Community Teams across Ireland

Abstract Background Integrated Care Programme for Older People (ICPOP) provide services for people with complex needs requiring specialist community multidisciplinary assessment and intervention. This national programme aims to shift care from hospitals, toward communities. As of October 2023, 23 of 30 planned ICPOP teams have been established (Butler, 2023). The Irish Association for Speech and Language Therapists, recommend speech and language therapists (SLT) be included on all frailty intervention teams across all service areas, ensuring equal access regardless of geographical area. Currently 10 ICPOP teams have an SLT in post. The contribution of SLT within these teams remains unstudied. Understanding the role of SLTs within ICPOP, exploring similarities and differences, is essential for informing professional clinical guidelines and practice. Methods This study utilised an anonymous, non-experimental, cross-sectional survey design. The survey design incorporated the Tailored Research Method to enhance response rates. Survey Monkey (http://www.surveymonkey. com) was used to create and disseminate the open survey. All SLTs working on ICPOP teams were invited to participate. Results Findings highlight the diverse roles and responsibilities of SLTs within ICPOP. While some commonalities were observed in services provided by SLTs, such as dysphagia assessment and communication support, variations existed based on team location, setting, and individual professional experience. The majority of SLTs participated in non SLT specific activities such as triaging, conducting assessments and administrative duties. Rural SLTs faced challenges related to resources and coordination of care. Urban SLTs had greater access to specialist instrumental assessments. Conclusion This study underscores the importance of recognising and addressing the varied roles of SLTs within ICPOP teams to guide professional guidelines and promote consistency. By understanding the unique challenges and opportunities faced by SLTs in different geographical and organisational contexts, policymakers and healthcare leaders can better support professionals to meet the diverse needs of older individuals across Ireland.

Community Specialist Team for Older Adults - Who Do You Think We Are? Co-Design Of A Patient Information Leaflet

Abstract Background Navigating care pathways can be challenging and confusing for patients and caregivers. With the emergence of several new clinical specialist teams, we identified the need for accurate, clear and relevant information, provided as a printed leaflet and available at referral stage for both older adults and referring practitioners. Methods A draft Patient Information Leaflet (PIL) was developed with contributions from all members of the Community Specialist Team for Older Adults (CSTOA) explaining the purpose of the service. A review of referral sources was undertaken to identify those key stakeholders from whom feedback should be sought to ensure content validity. The draft PIL and a feedback questionnaire were distributed to patients and their caregivers who have had intervention from the CSTOA in addition to General Practitioners and Community Health Network colleagues. Results There were 27/35 responses to the questionnaire. Data was collated and analysed. All respondents reported that from reading the PIL, they understood clearly what the service provides, and all agreed that the leaflet accurately describes the service. Details such as what to expect from intervention of the team and advice to bring a family member to the initial appointment were mentioned as particularly useful content. Supplementary feedback commended the co-location and accessibility of the service compared to a hospital setting. It was suggested that other services should be included in the CSTOA. Based on survey responses, minor edits were made to the PIL to meet stakeholder satisfaction. Conclusion Feedback from this survey helped endorse the provision of a printed PIL to be provided at referral stage. Additional commentary gathered, re-enforces the need for continuous interaction and information sharing with service stakeholders. Next steps include making this PIL available electronically to allow for real time updates and translating to other languages to ensure inclusivity.

Supporting Complex Severely Frail Patients at Home with Community Specialist Team Intervention

Abstract Background The Community Specialist Team for Older Persons (CST-OP) was created to support older people to live well at home. The team primarily aims to reduce ED presentations and admissions into acute facilities for over 65s. The team became the first fully staffed CST-OP in Q3 2022. Referrals are responded to within 24-48 hours and each referral has a comprehensive geriatric assessment completed. Interdisciplinary assessment is used to identify interventional needs which the team then addresses. This abstract specifically examines the success of supporting people with a Clinical Frailty Score (CFS) of 7 and above to remain at home. Methods The team consists of a senior 1 WTE Social Worker, Physiotherapist, Therapy Assistant, Consultant Geriatrician, Advanced Nurse Practitioner and Clinical Nurse Specialist. The team also has 0.5 WTE Senior Speech and Language Therapist and Dietician. Referrals are accepted from the FIT team, GPs and Older Persons OPD clinic. The team operates on a 100% domiciliary based assessment. A comprehensive geriatric assessment is completed with each referral. A care plan is generated, and interdisciplinary intervention carried out. Results From September 2022 to December 2023 69 patients with a CFS of 7 or above were reviewed by the CST-OP. 60 remained at home, 7 transitioned to LTC and 2 RIP. These figures represent an 86% success rate. Conclusion Evidence suggests older people living with severe frailty can be supported to live well at home by Community Specialist Teams via timely interdisciplinary assessment and intervention and appropriate utilisation of community supports.

To Print or Not to Print - Sustainable Practice in Geriatric Integrated Care Clinics

Abstract Background The Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric medicine and is frequently carried out in integrated care clinics using a paper document (1). The expansion of integrated care services occurs alongside climate change, an increasingly challenging public health crisis at a local and national level (2). Paper waste is a contributor to deforestation and carbon emissions. We aimed to assess the environmental impact of paper use within our geriatric integrated care service. Methods 12 months of Geriatric Integrated Care attendances were included between 1st January 2023 to 1st January 2024. We measured the number of CGAs performed and A4 pages used in documentation. Environmental impact was evaluated based on carbon emissions per A4 page (3). Results A CGA was completed on 780 patients in a 12-month period which included in-hospital, frailty at the front door and 2 community specialist teams' assessments. This resulted in 11,700 pages of A4 paper in documentation. Estimated carbon emissions are 70.2kg CO2 emissions for the 12-month period. Extrapolating this solely to the 32 ICPOP teams in geriatric medicine in Ireland it would result in the equivalent of 22 trees per year, emitting 1,123.2 Kg of CO2 emissions per year from these assessments alone or equivalent to driving 8028.6km (4). Conclusion The benefits for patients and staff of integrated digital healthcare records are well established. The environmental impact of how we provide healthcare is not. Paperless solutions are required for both patient safety, seamless record keeping and environmental sustainability in keeping with UN sustainable development goals.

Evaluation of an Occupational Therapy led Cognitive Stimulation Therapy Programme in an Integrated Care Programme for Older Persons

Abstract Background Cognitive Stimulation Therapy (CST) is a non-pharmacological, evidence-based approach specifically designed to support people with dementia to maintain their cognitive functions e.g. reminiscence, higher executive skills, sensory integration, orientation, memory strategies and day-to-day activities. Methods Participants referred to a community specialist ICPOP team were identified for CST following Comprehensive Geriatric Assessment (CGA), where cognitive impairment or dementia was identified. Inclusion criteria: Rockwood Clinical Frailty Scale ≤5, Barthel Index of Activities of Daily Living ≥11, Lawton Brody Instrumental Activities of Daily Living Scale (IADL) ≥4, Montreal Cognitive Assessment (MoCA) ≥10, and ability to consent to participate. Addenbrooks Cognitive Examination (ACE-III) scores were obtained pre and post CST, alongside post CST feedback questionnaires. Results 5 CST programmes of seven weeks duration were conducted over a ten-month period. 31 (male=16, female=15) participants completed the programme. 3 participants dropped out due to lack of transport/interest. The average ACE-III score pre-CST was 68.3 +/- 14.31; post-CST was 76.1 +/- 11.4. 28 participants completed feedback questionnaires. Positive feedback included “Got a great sense of achievement with each session, and eagerly looked forward to the coming weeks”, “Each session topped the previous session” “Gave me a reason to get out, a routine to my week”. 45 % commented that they felt safe sharing difficulties/problems with the group. 71% reflected that CST provided an opportunity to meet others in a similar situation. 100% would recommend CST to others. Conclusion Experience of CST was overwhelmingly positive demonstrating benefit not only from a cognitive perspective but from informal peer support and connections made in group settings. Participants commented on lack of follow-on programmes, identifying the need to develop maintenance CST programmes led by trained community stakeholders which would sustain these benefits long-term as well as increasing awareness and knowledge of dementia within communities.

Enhancing Physiotherapy Services within a Community Specialist Team for Older Adults: An Evaluation Study

Abstract Background An aim of Community Specialist Teams (CSTs) is to provide integrated multidisciplinary services to older people closer to home. Physiotherapy is a key component of this service. This evaluation aims to describe current physiotherapy practices within a specific CST and identify potential areas for improvement. The CST under examination maintains a physiotherapy staffing level of 1.2 Full-Time Equivalents. Methods An evaluation was completed of the physiotherapy input provided to 71 older adults who underwent a Comprehensive Geriatric Assessment (CGA) with the CST between July and December 2023. Data encompassing service user demographics and physiotherapy specific information were anonymised and analysed using Microsoft Excel. Results The median age of clients was 84 years (range 66-95), with 84.5% aged over 75 years. 70% were female. The median Clinical Frailty Scale (CFS) was 5 (range 3-7), with 75% being classified as frail. The reasons for referral were community rehabilitation (43%), admission avoidance (20%), early supported discharge (17%) and other (20%). Median time to CGA was 18 days (range 1-64 days). 64 (94%) patients were referred to physiotherapy and received an average of 4.4 sessions. Time to physiotherapy assessment following CGA ranged from 0-41 days with a median of 6 days. 83% of clients had physiotherapy intervention in their homes, 14% attended community hubs and 3% both. Analysis of delayed discharge revealed a range of 0-99 excess days beyond the estimated discharge date, with a median delay of 6 days. Conclusion This evaluation underscores the prevalent need for physiotherapy input among the service users engaged with this CST. Concerns arise regarding the breach of the of the National Integrated Care Programme for Older Persons (NICPOP) guideline for CGA timing (2 weeks) and target discharge date (6 weeks). The findings of this review will inform future service planning and the development of integrated physiotherapy pathways for older people.

Unexpected Journeys: Investigating Urgent and Emergency Care Trends of Patients Attending a Community Specialist Team for Older Adults

Abstract Background Transitions of care for older people via ICPOP and Urgent and Emergency Care (UEC) pathways are becoming more complex. Demand for unscheduled care for older adults with complex care needs will increase with an ageing society, requiring proactive case management and practical realisation of integrated care pathways. Methods Retrospective analysis of UEC presentations of older patients attending a community specialist team (CST) who underwent Comprehensive Geriatric Assessment (CGA) between January-July 2023. Demographics and functional status [Clinical Frailty Score (CFS), Barthel Index (BI), Lawton-Brody Score (IADL), Montreal Cognitive Assessment (MOCA)] were extracted, along with UEC presentations post-CGA until March 2024. Results 356 patients underwent CGA and 42% (n=148) had subsequent unscheduled care attendance(s). Of those with an UEC attendance 36% (n=54) lived alone. Median functional scores were: CFS 5, BI 17, IADL 3, MOCA 17. Median time to UEC presentation was 100 days since CGA. There were 283 UEC interactions in total. 39% (n=58) had >1 interaction. 73% (n=206) of interactions resulted in acute hospital admissions, 21% (n=58) were ED visits, and 6% (n=19) were Pathfinder interactions. Falls (31%) and infection (19%) were the leading causes for presentation. Of 206 admissions, 61% were admitted under medical specialties, 26% under Geriatric Medicine, and 13% under Surgery. Average hospital stay was 13 days. 65% (n=134), were discharged home, 11% (n=22) to transitional care beds, 7% (n=15) to rehabilitation, 7% (n=14) to nursing home, 3% (n=5) transferred to other hospitals, 7%(n=15) died. Conclusion Over half of patients attending a CST had an UEC presentation, reflecting the complexity of this cohort and their level of healthcare utilisation. Case management roles that complement and pull together existing elements of the older persons pathway are lacking across healthcare settings and are fundamental to successful implementation of a patient-centred age friendly health system.

Community-based Geriatric Assessments: Is There an Urban/Rural Divide?

Abstract Background There is a paucity of literature describing urban/rural differences in baseline demographic factors and patterns of referral for those undergoing community based comprehensive geriatric assessment (CGA) in Ireland. We analysed differences in baseline demographics, referral sources and referral reasons among older persons who underwent CGA with a community specialist team, which accepts referrals from one predominantly rural community health network (CHN) and one predominantly urban CHN. Methods Data including baseline demographic characteristics, reasons for referral, referral sources, clinical frailty score (CFS), prevalence of polypharmacy (more than 10 prescribed medicines) and location of CGA was prospectively collected on all persons referred to an older persons' integrated care service from February 2023 to March 2024 and who underwent CGA. Data was stored on a secure database. Persons were categorised as either urban dwelling or rural dwelling, based on their local CHN. Descriptive statistics were used to describe differences between the urban and rural cohorts. Results 235 persons characterised as urban underwent CGA and 191 persons characterised as rural underwent CGA. There was a higher median CFS score amongst rural persons (CFS = 5, IQR=2) compared to urban persons (CFS=4, IQR=2). Urban persons were more likely to be referred by their G.P. (81% of total referrals) compared with rural persons (67%). Rural persons were more likely to be male (48% vs 37%) and experience polypharmacy (33% vs 27%) than urban persons. A similar proportion of persons underwent initial CGA in their home (20% rural vs 19% urban). Conclusion Here we describe the characteristics of urban and rural users attending an integrated care service. Future research should examine how these differences might affect healthcare utilisation and outcomes and provide opportunity to inform regional health and social care planning.

Community Specialist Teams: Are We Making an Impact? Insights from General Practitioners

Abstract Background Within our catchment area, General Practitioners (GPs) are the primary source of referral to community specialist teams (CSTs) for older adults and are key stakeholders in supporting the integrated care pathway. We sought to evaluate their experience to inform service development. Methods GPs across four healthcare networks were invited to complete an online questionnaire evaluating their experience of the CSTs for older adults. Results Twenty-eight GPs responded. Of these, 85.7% (24) found the referral criteria clear, and 89.3% (25) reported ease of access to the service. However, 50% (14) were uncertain about when to refer patients to primary care alone versus the CST. A significant majority, 96.5% (27), felt the service positively impacted the health and well-being of referred patients, and 92.9% (26) were satisfied with communication regarding patient care plans and progress. Identified strengths of the service included the multidisciplinary approach to providing comprehensive, patient-centered care and effective communication with both GPs and patients. Areas for improvement included enhancing access for specialist teams to community radiology and increasing staffing levels to ensure timely assessments. Regarding the impact on unscheduled and emergency care, 71.4% (20) reported a reduced need to refer to the acute medical unit, and 35.7% (10) reported a reduced need to refer to the emergency department due to the ability to refer to CSTs. Conclusion GPs value the CST service for the quality of assessment and intervention their patients receive. Targeted areas for operational and clinical improvement include provision of diagnostics and role distinction from primary care teams. This survey also suggests CSTs are providing an alternative care pathway and point of contact for older patients in crisis, resulting in a reduction in unscheduled and emergency care utilisation. The role of the CSTs should be supported and enhanced and warrants more detailed exploration.

Frail Patients Referred to a Community Specialist Team- What Were Their Frailty Scores?

Abstract Background Frailty is synonymous with older patients, where multiple body systems slowly lose their reserves and lead patients to become more vulnerable. When developing the inclusion criteria for our integrated care programme for older persons (ICPOP), the limited resources and large geographical area played a role. In order to maximize the outcomes for patients we targeted those with a Rockwood Clinical Frailty Score (CFS) between 4 and 6. We perceived that these patients would benefit from multidisciplinary intervention. Methods All patients referred to ICPOP were reviewed from November 2022 to April 2024. Our electronic patient database records information on ICPOP patients. Using this database we searched for the word “frailty” in the reason for referral field. We also correlated this with any patients who had a CFS recorded. The level of frailty in older patients with the scores ranging from 1 (very fit) to 9 (terminally ill) was recorded. Results 182 patients were found during the database search. 55 patients were referred for frailty alone, 64 patients were referred for frailty with balance/mobility issues, 47 patients were referred for frailty with falls, 16 patients were referred for frailty with memory issues. CFS were available for 132/182(73%) patients. 119/132(90 %) patients with a CFS score were classified as scoring between 4 and 6 on the Rockwood scale. 3/132(2%) scored 2, 6/132(5%) scored 3 and 4/132(3%) scored 7 on the CFS. Conclusion The national ICPOP framework prioritise improving care of frail older patients. A measure of a persons’ frailty level is subjective and dependent on clinical judgement along with a good understanding of the term “frailty”. Overall, our findings highlight that the referrers to our service have a good knowledge of frailty as a term. Our ICPOP hub is also effectively targeting the appropriate cohort of patients as per our inclusion criteria.

Malnutrition Risk Screening and Dietitian Intervention within an Integrated Care Team for Older Persons

Abstract Background Malnutrition in older adults increases the risk of frailty. Nutritional interventions can improve frailty. A Senior Dietitian joined our Integrated Care for Older Persons Community Specialist Team (ICPOP-CST) in 2022. Our Complete Geriatric Assessment (CGA) form was redesigned in early 2023 which included the Malnutrition Screening Tool (MST). We commenced measuring handgrip strength (HGS) in late 2023. We measured the prevalence of malnutrition risk among our patients, audited MST use and explored dietetic service provision. Methods Data from the first 101 patients with a completed (new) CGA form were obtained from the service’s electronic patient database. Patients with a MST score of 0 or 1 were considered to be at low risk of malnutrition and those with a MST score of 2 or more were considered to be at risk of malnutrition. Results The mean age was 84.8±5.3 years and 65% were female. Malnutrition risk was identified in 39 (38.6%) patients. The MST was completed for 96 (95%) patients and completed correctly in 67 (69.8%). The total score was not summed in 26 out of 29 incorrectly completed screening tools (89.7%). Half (51, 50.5%) of the group of older adults received dietetic assessment and intervention. High protein, high calorie advice was provided for 38 (74.5%) of those seen by the ICPOP dietitian and for 29 (93.5 %) of those at risk of malnutrition. Onward referral to primary care dietitians was made for 14 (27.5%) of those seen by the ICPOP dietitian. HGS measurement was performed in 20 patients - 15 (75.0%) were identified to have probable sarcopenia – 11 (73.3%) of these were at risk of malnutrition. All received dietetic intervention in relation to protein and sarcopenia. Conclusion Malnutrition risk and probable sarcopenia are common among older adults referred to our ICPOP-CST team. The MST screening tool is practical and identifies those requiring dietetic intervention.

Chronic Kidney Disease and Frailty: Insights from a Cross-Sectional Study in Older Adults

Abstract Background Chronic Kidney Disease (CKD) and frailty are prevalent conditions among older adults, contributing to increased healthcare utilisation and adverse outcomes. The aim of this study was to examine CKD prevalence and associated factors in older adults attending a Community Specialist Team (CST) for older persons for Comprehensive Geriatric Assessment (CGA). Methods A cross-sectional study was conducted of all adults aged ≥65 years who had a CGA from October 2023 to March 2024. Variables recorded on an Excel spreadsheet included age, gender, Clinical Frailty Scale (CFS) score, Modified Barthel Index (mBI), presence of probable sarcopenia, Malnutrition Screening Tool (MST) and Dementia Screening Interview (AD8) outcomes. CKD was defined as estimated Glomerular Filtration Rate (eGFR) <60ml/min/1.73m2. The presence of frailty was defined as CFS ≥4. Functional impairment was defined by mBI<15 and MST ≥2 defined malnutrition risk. Regression analysis was used to identify associations. Results Ninety-one patients, 59 (64.8%) female and 32 (35.2%) male, with a mean age of 81.83 (SD=7.19) years were included. The prevalence of frailty was 90% (n=82) and of CKD was 53.8% (n=49). Age was a significant predictor of CKD and with each additional year, the odds of having CKD increased by 10% (p=0.004). Twelve (24.5%) of the CKD group had MST ≥2 compared with 17 (40.5%) without CKD (p=0.120). The odds of having probable sarcopenia was non-significantly higher (OR=1.09, p=0.8444) in CKD compared to without CKD. The odds of a positive AD8 was also non-significantly higher (OR=1.24, p=0.605) in CKD compared with no CKD. There was no difference in prevalence of functional impairment between the 2 groups (p=0.466). Conclusion CKD is common chronic condition in frail older persons referred to a CST. It is frequently unrecognised. Identification of CKD through CGA should facilitate an integrated interdisciplinary approach to care which may contribute to better overall health and quality of life.

What Are the Perspectives and Experiences of Older Adults of Existing Integrated Care Services in the Mid-West Region of Ireland?

Abstract Background Substantial investment has been provided by the HSE in the form of The Integrated Care Programme for Older People (ICPOP) Community Specialist Teams (CSTs) for older people. These teams aim to provide timely specialist multi-disciplinary assessment and intervention to help maintain older adults’ independence and ability to live well at home. Little is known about older adult’s views or experiences of this service. This study aimed to resolve this research gap by exploring older adults’ experiences of CSTs within the Irish Healthcare context. Methods A qualitative descriptive research design was employed to explore this research area and a semi structured topic guide was developed. Purposive non-probability sampling was used to recruit 13 older adults who had completed intervention with the CSTs. Individual semi-structured interviews were completed with each participant and were transcribed verbatim. A reflexive approach to thematic analysis was used to guide analysis of the generated data. Results Four themes were identified, older people had limited knowledge of the service and experienced accessibility issues in attending CST within a HUB setting (Theme 1). Older people experienced positive and co-ordinated care by CST (Theme 2). Older people described that they valued the self-management education and support from attending CST that enabled to manage their long-term conditions effectively and maintain their independence (Theme 3). Once discharged from CST older people described positive emotional and physiological impact of CST that enabled them to be more confident to manage daily life at home (Theme 4). Conclusion It was evident from the data that CST had a positive impact on supporting older people to remain independent at home and increased their confidence in self- management of their long-term conditions. Further research would be beneficial to address ways to improve the delivery of care for the complex needs older persons within CSTs as they describe accessibility issues in attending the service.

Can A Swallow Screen Score Be Used To Prioritise Dysphagia Assessments By A Speech And Language Therapist?

Abstract Background Dysphagia refers to any difficulty or discomfort associated with eating or swallowing. The prevalence is 10-50% in older persons and is associated with increased dependency and mortality. A non-validated Swallow Screen (SwSc) is used by a Community Specialist Team (CST) for older persons during Comprehensive Geriatric Assessment (CGA) to identify patients requiring Speech and Language Therapy (SLT) referral. The SwSc comprises 7 questions with “yes” or “no” answers. “Yes” answers score 1 point and “no” score 0. The SwSc score is the sum of these points. Higher scores indicate the presence of more symptoms of dysphagia. Patients with a SwSc score ≥1 are referred to an SLT. This study aimed to investigate if a higher SwSc score might indicate more severe dysphagia requiring more urgent assessment by an SLT. Methods This was a retrospective cohort study of patients ≥64 years referred to SLT by a CST from June 2023 to April 2024 inclusive. The SLT assessment included a Dysphagia Outcome Severity Scale (DOSS) score. The DOSS score ranges from 1-7, a lower score indicating a more severe dysphagia. Data was entered onto an Excel database and analysed. Biographical and CGA data was analysed using descriptive statistics. The SwSc and DOSS scores were ranked and compared using Spearman’s Rank Correlation Coefficient. Results Thirty-nine patients attended an SLT assessment. The mean age was 78, (SD=8.04). The mean Clinical Frailty Score 5 (SD=1.16) and mean modified Barthel Index score 16 (SD=3.75). There was a negative correlation between the SwSc and DOSS scores, r (37) = -.438, p=.005. Higher SwSc scores were associated with lower DOSS scores, indicating more severe dysphagia. Conclusion The SwSc can be easily administered by non-SLT clinicians. It may be used by an SLT to aid prioritisation of patients for assessment. Further research with a larger sample is required to establish its validity.

The Effectiveness of a Community Specialist Team for Older Persons in Preventing Emergency Department Attendances 30 and 90 Days Post-Intervention

Abstract Background Population ageing is prevalent throughout Ireland and its impact is evident particularly in acute hospitals with long Patient Experience Times (PETs) in the emergency department. A Community Specialist Team for Older Persons (CSTOP) was established in our area in 2018 with expansion under Sláintecare in 2022. The main goal is to improve access in the community to age attuned services, and thus prevent Emergency Department (ED) presentations and admissions and improving health outcomes for older people. The team provides a comprehensive geriatric assessment and resultant interventions required for each patient. The cohort of patients includes (Frail Intervention Team) FIT referrals from the ED, Geriatrician referrals from Outpatient clinics and GP referrals. Many of these patients have either presented to the Emergency Department or are at risk of same. Methods Data for all CSTOP patients is recorded including medical record numbers. All medical records for patient admitted in 2023 were analysed using the integrated patient management system (IPIMS) in our local hospital. ED presentations and admissions were reviewed at 30 and 90 days post intervention. Results 232 referrals were received in 2023. 42 (18%) had an ED presentation 30 days post discharge and 48 (21%) had a presentation 90 days post discharge. 11 RIPs. Conclusion This study shows the effectiveness of the CSTOP team at preventing ED presentations and resultant admissions. The number of bed days is estimated at 2000. One limitation to our study is data could only be analysed from our hospital system, patients could attend other public or private hospitals during the follow up period. Our results are found to be in keeping with reviews by similar services. Our team provide a rapid access interdisciplinary assessment and intervention to people who may otherwise experience fragmented care within primary care services.

Evaluation of a Nutrition and Exercise Group Intervention for Older Adults with Frailty and Probable Sarcopenia

Abstract Background The prevalence of probable sarcopenia in frail older adults attending a Community Specialist Team (CST) is 52%. Resistance exercise and optimising nutrition are recommended interventions. The aim of this study was to evaluate a nutrition and exercise group for frail older adults with probable sarcopenia. Methods Adults aged ≥65 years, with probable sarcopenia identified through Comprehensive Geriatric Assessment (CGA) by a CST over 18 months were included. At CGA (baseline), sarcopenia infographics and 2 attendances at Dietetic and Physiotherapy group were offered. Group intervention comprised nutrition and exercise information and individualised goal setting. Clinical Frailty Scale (CFS) score, grip strength and 5 Times Sit-to-Stand (5TSS) were measured. Participants' needs and perceived changes in knowledge were evaluated using open questions and Likert Scales. Data was analysed using thematic analysis, descriptive and inferential statistics. Results Intervention was offered to 82 people. Twenty-nine (35%) attended an initial group (18 women, 11 men), with mean age 80.7 years (SD=7). Nine (30%) attended the second group. Participants were significantly less frail (median CFS 4, IQR 4, 6) than non-participants (median CFS 6, IQR 5, 7) (p= 0.002). Male grip strength improved significantly from baseline (mean 22kg, SD=4.21) to first group (mean 27.8kg, SD=4.36) (p=0.007) and to second group (mean 29kg, SD=4.21) (p=0.012). Female grip strength increased non-significantly from baseline (mean 12.6kg, SD=3.38) to first group (mean 14.5kg, SD=5.85), (p=0.127) and to second group (mean 14.83kg, SD=4.21) (p=0.890). Participant’s 5TSS did not change significantly (mean 19.75 sec, SD=6.38 to mean 20.78 sec, SD=7.73) (p=0.782). Nutrition and exercise knowledge improved significantly (p=0.004, p=0.003 respectively). Access to clear information was an identified theme. Conclusion Educational resources and tailored plans within group interventions can improve grip strength and knowledge in older adults living with very mild frailty. Further research is required to design an accessible intervention for more frail cohorts.

Outcomes of Dementia Pathway Referrals Post Comprehensive Geriatric Assessment by a Community Specialist Team for Older Persons

Abstract Background The Model of Care for Dementia in Ireland (2023) outlines targets and recommendations for a Dementia service. A Dementia pathway was developed from a Community Specialist Team (CST) for Older Persons service to a local Memory Clinic service and this was evaluated with reference to the model of care. Methods All adults aged ≥70 years, who received a Comprehensive Geriatric Assessment (CGA) by a CST in 2022, and were referred to a Memory Clinic service, were included. Data including dates of referral and Memory Clinic attendance, age, gender, Clinical Frailty Scale score (CFS) and diagnosis were entered into Excel. These were analysed using descriptive statistics. Results Seventy-nine patients were referred to the Memory Clinic. Twenty-eight (35.5%) attended, with 51 (64.5%) non-attendances. Twenty-seven (34%) cancelled, 13 (16.5%) did not attend, 7 (9%) died before receiving an appointment, and 4 (5%) appointments were deferred at patient request. The mean age of patients referred was 82.39 years (SD=6.876). The male to female ratio of attendees was 1:1.3 and non-attendees was 1:1.9. The median CFS score of both attendees and non-attended was 5 (range 3-7). Eight (21%) of those who did not attend had moved to long term care, representing 10% of total referrals. The median waiting time for attendees was 10.5 months (Range 2-21). Thirteen (46%) patients received a diagnosis of Dementia, 3 (11%) Mild Cognitive Impairment (MCI), 2 (7%) Acquired Brain Injury and 10 (36%) received no memory diagnosis. Conclusion This Dementia pathway does not meet target 14 of the Model of Care. The waiting times exceed 6 weeks, resulting in missed opportunities to provide supports. Timely access to the pathway and supports to attend may increase attendance. A dedicated Memory Assessment and Support Service will address this deficit.