Integrated Care Research Articles

Integration of supportive, palliative, and hospice care with other medical and non-medical specialties

Integration of supportive, palliative, and hospice care with other medical and non-medical specialties

Exploratory Factor Analysis of a Patient-Facing PCBH Adherence Measure: The PPAQ-Patient.

Model adherence indicates the degree to which a program or intervention is delivered as intended. In integrated primary care, where mental health services are embedded into primary care clinics, appraisal of model adherence provides insight into whether these services align with key features of this unique practice environment (e.g., brief, interdisciplinary care). To date, such evaluations have emphasized system and provider factors. This study is a preliminary evaluation of whether a novel patient-facing measure, the Primary Care Behavioral Health Provider Adherence Questionnaire-Patient Version (PPAQ-Patient), can provide insight into adherence to the Primary Care Behavioral Health (PCBH) model of integrated primary care. Survey data were collected from 281 veterans who received PCBH care. Exploratory factor analyses evaluated the data structure. Results suggest that 19 items spanning three temporally-referenced subscales may feasibly capture patient perspectives on PCBH adherence at various stages of treatment. Future work is needed to refine the measure.

Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description

BackgroundInnovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point—the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated—may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care.MethodsThis qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study.ResultsTo accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system.ConclusionsWe identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems.Trial registrationClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3.

THE DEVELOPMENT OF GERIATRIC AND ANTI-AGING SCIENTIFIC SCHOOL IN UKRAINE

This manuscript explores the historical development and significance of geriatric and anti-aging research in Ukraine, emphasizing its vital role in advancing global gerontology and geriatrics.The manuscript highlights the multidisciplinary aims of Ukrainian gerontological research, including understanding the biological mechanisms of aging, developing medical treatments for chronic diseases prevalent in older populations, and addressing the social and psychological aspects of aging. It also discusses the challenges of Ukraine’s aging population, such as healthcare policy reform, improved geriatric care integration, and increased funding for aging research. A significant emphasis is placed on incorporating anti-aging studies into medical education. By updating medical curricula to include comprehensive anti-aging education, Ukraine can better prepare future healthcare professionals to meet the evolving needs of its aging population. The manuscript concludes that such educational reforms are crucial for enhancing the effectiveness and sustainability of Ukraine’s healthcare system, ultimately improving the quality of life for older adults and aligning with global trends in aging research.

EFL Students’ Perception in Indonesia and Taiwan on Using Artificial Intelligence to Enhance Writing Skills

Technological advancements in education have introduced Artificial Intelligence (AI) as a transformative tool to enhance academic writing skills in English as a Foreign Language (EFL). This study explored EFL students’ perceptions in Indonesia and Taiwan regarding the role of AI in improving their writing abilities. Using qualitative research methods, data were collected through semi-structured interviews with 20 second-year students specializing in English at an Islamic State University in Indonesia and a National University in Taiwan, who actively use AI tools in their writing processes. Analysis based on Creswell’s thematic framework revealed positive perceptions of AI, with benefits such as improved grammar, sentence structure, paraphrasing skills, vocabulary enrichment, and efficiency in topic generation. However, concerns also emerged about excessive reliance on AI, reduced creativity, and issues of plagiarism and authenticity. These findings highlighted the dual-edged nature of AI in academic writing, emphasizing the need for careful integration and risk mitigation to fully leverage AI’s educational benefits. This research enriched the discourse on technological advancements in EFL education and provides insights for curriculum developers, educators, and policymakers to optimize AI use in academic settings. The practical implications of these findings included strategies to enhance the effectiveness of AI in education and foster innovation in EFL teaching.

Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis

Abstract Background Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4. Results Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.

Integrated Care in Action: A Case Study of Collaborative Multidisciplinary Approach for Older Adults in Ireland

Abstract Background In Ireland, the healthcare landscape is evolving with frameworks which emphasize community-based care, such as Enhanced Community Care and the National Integrated Care Programme for Older Persons. Our Integrated Care Team for Older Persons (ICPOP) service exemplifies this shift by providing intensive, immediate multidisciplinary care to frail adults, aiming to maintain their independence in their homes and communities. Methods In the case study we describe service users journey with ICPOP. The case study illustrates the transition from fragmented care to a collaborative, patient-centred approach. ICPOP employs a structured process involving comprehensive assessment, goal setting, weekly multidisciplinary team meetings, stakeholder liaison, and detailed discharge reports. This approach focuses on early supported discharge and close coordination with local MDT teams, fostering effective communication and shared decision-making. Results This case study demonstrates the effectiveness of ICPOP's multidisciplinary model. Key factors contributing to this success include physical co-location, shared goals and vision, mutual trust, and established relationships among professionals. Furthermore, the integration of Allied Health Professionals (AHPs) within community teams enriches the care continuum and enhances outcomes for older adults. Conclusion To further enhance integrated care delivery, digital solutions are crucial. Implementing shared electronic health records and facilitating access to medical findings can streamline communication and improve care coordination. Additionally, prioritizing written discharge summaries for clients can ensure continuity of care and empower patients and their families in the post-discharge phase. This patient journey underscores the importance of collaborative, patient-centred care models in achieving the objectives of Sláintecare leading to better outcomes for older adults in Ireland.

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.

Implementation Of A Novel And Integrated Community Flexible Endoscopic Evaluation Of Swallowing (FEES) Service Model For Older Persons

Abstract Background FEES is a gold standard Speech & Language Therapy (SLT) led diagnostic instrument that facilitates evidence-based dysphagia care. A novel community-based FEES service for older persons’ services was recently established in Ireland's Mid-West. New pathways, integrated across divisions, were designed and implemented to complement existing dysphagia pathways within Integrated Care Programme for Older Persons (ICPOP), inpatient rehabilitation for older persons and primary care. An integrated pathway was also established with acute services (Otolaryngology). The aim of this abstract is to describe the implementation process for this novel community FEES service. Methods An SLT-led FEES team engaged with a range of community- and acute-based stakeholders across policy and practice: SLTs, Otolaryngologists, management teams, ICPOP teams, Gerontology Consultants, General Practitioners, Infection Prevention and Control (IPC) teams. Normalisation Process Theory (NPT), an empirically tested and theoretically-sound implementation science framework, scaffolded discussion across a range of implementation and consultation activities including co-design workshops and educational presentations and training, using Health Service Executive (HSE) Change Management tools. Results Stakeholders co-developed a shared understanding of current and new pathways to identify and enact implementation strategies at individual, discipline and system-levels. The project involved stakeholder mapping, communication/engagement planning, risk management, resource planning, and large-scale targeted education/training across settings and disciplines. A FEES working group was formed to coordinate, sustain, monitor, and futureproof implementation activities. Conclusion This collaborative project generated interdisciplinary vision and action to enact an innovative dysphagia care pathway for older people in the community. Articulated through an NPT lens, the project provides insights into the collaboration needed to implement truly integrated care and to identify enablers at individual, disciplinary, and organisational levels. Such knowledge is essential for enhancing integrated care and enacting change and innovation in the Irish health service.

Long Term Care As An Outcome Of Community Integrated Care Team Intervention: A Review

Abstract Background Over 65’s occupy over 55% of inpatient hospital bed days. Assessment of average length of stay for patients awaiting long term care (LTC) in the acute hospital setting was found to be 122 days. My aim is to assess the number of patients transferred to long term care (LTC) from the community post referral to an Integrated Care for Older Persons (ICPOP) service, therefore bypassing inpatient admission. Methods Retrospective analysis of patients notes managed by the ICPOP team from January 2023- January 2024. Comprehensive geriatric assessment data as to frailty markers, plus duration of engagement with service and over all discharge destination were assessed. Patients were identified based on unique identifying number but also using date of birth and name to avoid missing cases. Results 59 patients were discharged to a nursing home from the ICPOP service, mean age 80. Sex differentiation 56% female. On average at least 3 out of 8 possible frailty indicators were identified per patient. Most prevalent -67% polypharmacy, 47% memory impairment and 45% carer stress were identified as key concerns on initial assessment. 96% of cases were initially referred for complex case assessment/admission avoidance. Average length of engagement with service 5 weeks. Conclusion The ICPOP service is highly effective at managing complex cases in the community. The multidisciplinary nature of the team facilitates comprehensive assessment and patient centred care which enables a smooth transition through supportive strategies available to the patient and their family. In total 7198 bed days were saved due to direct transfer to nursing home from the community setting. If the patients care needs warrant LTC the ICPOP service is an invaluable tool which could further reduce pressure on hospitals and facilitate appropriate transfers to nursing home care.

Does an Inpatient Rehabilitation Admission Via the Community Prevent Hospital Readmissions in Older Adults? An Integrated Care Initiative

Abstract Background Rehabilitation interventions are essential in supporting frail older adult’s recovery following periods of decompensation and preventing future hospitalizations. Previously patients (age > 65 years) could only access inpatient rehabilitation via an inpatient stay in an acute hospital. Within the ICT (Integrated Care Team) in Dublin North West (DNW) a community rehabilitation pathway to two inpatient rehabilitation units exists. We retrospectively evaluated patients that were admitted to rehabilitation units via this pathway and measured their 90-day readmission rate to their local acute hospital. Methods 17 referrals were received from three pathways: Primary Care, the Holly Day clinic and the Frailty Intervention Team (FITT). Clinical frailty score’s (CFS), Falls risk (as per the world falls guidelines) and sarcopenia status as per the European Consensus on the definition of sarcopenia (EWGSOP) were recorded prior to admission. Readmissions within 90 days were collected from the hospital electronic database. Results CFS scores ranged from 5 to 7. All patients were identified as a high risk of falls and sarcopenic. The 90-day readmission rate was 11%. 5.5% of these were due to falls and the other 5.5% was due to the exacerbation of a pre-existing condition. All had CFS score of >6. Conclusion Readmission to acute care is not common in our patient cohort and shows the involvement of the ICT Geriatrician and Physiotherapist in identifying and referring frail older adults for inpatient rehab is successful. Ongoing development of interagency pathways and further referrals is needed to further progress this pathway and measure its efficacy in preventing readmission to an acute hospital. A 90 day and 180 day follow up and falls risk outcome measure pre and post admission would further demonstrate the success of this initiative and help measure the efficacy of this initiative in reducing the risk of preventable hospitalizations in older adults.

Medication Use and Falls Risk in Older Adults: Insights from our Integrated Care Programme for Older Person’s Service

Abstract Background Falls pose a critical public health challenge for the elderly, often resulting in severe injuries and complications. Some medications have been identified as potential risk factors for falls in this demographic. The National Integrated Care Programme for Older People has prioritised the development of specialised services targeting frailty, dementia, and falls management to address this concern. Methods We conducted a retrospective chart review of older adults to explore the relationship between medication use and falls risk. Data on recurrent falls, polypharmacy (defined as concurrent use of five or more medications), and fall frequency were extracted from medical records. Logistic regression analysis assessed the association between STOPPfall medication use and falling risk, calculating odds ratios and p-values to determine significance. Results The study cohort comprised 71 older adults, with a median age of 84 years (range 66-95 years), of whom 69% were female. Among the participants, 79% reported experiencing recurrent falls, highlighting the prevalence of this issue within the sample. Additionally, a substantial proportion (90.1%) exhibited polypharmacy, indicating the commonality of multiple medication use among the elderly population studied. Antihypertensives were prescribed to 42 patients (59%), antidepressants to 26 patients (37%), opioids to 15 patients (21%), benzodiazepines to 12 patients (17%), and antiepileptic drugs to 4 patients (6%). Logistic regression analysis demonstrated a significant association between the use of STOPPfall medications and the risk of falling, with an odds ratio (OR) of 1.84 (95% CI: 1.11-4.23, p =0.044). Conclusion These findings underscore the importance of medication review and optimization in fall prevention strategies. Targeted interventions to reduce potentially harmful medication use identified by STOPPfall criteria may aid in fall reduction among older adults. Further research is needed to explore the efficacy of such interventions.

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.

Redesigning Community Dwelling Geriatric Integrated Care Program for Better Care Co-Ordination and Health Outcomes

Abstract Background Existing health services and care models need to adapt to the increasing ageing population, multimorbidity, and frailty. Thus, diverse healthcare providers and caregivers are demanded to continue living at home. An Integrated Care Program, involving a multidisciplinary team with a patient-centred focus, is being promoted as an alternative model of care. However, uncoordinated existing services put them at risk of fragmented care, leading to adverse outcomes. This study aimed to fill gaps in previous ICP research by introducing a change roadmap into the implementation phase of the program. In addition, the study proposed evaluating the effectiveness and implementation of the pilot project together with the process evaluation. Methods The study conducted a systematised literature review to examine the outcomes and different structures of the ICP. Implementation Science was utilised to define, design, and deliver the model of change. Results A systematised literature review showed that most ICPs were led by an Advanced Nurse Practitioner with positive outcomes. SWOT analysis, stakeholders’ involvement, existing community service providers, and a population survey provide an in-depth perspective of the target population and set up contextually adapted implementation strategies. An ANP-led MDT was proposed to co-ordinate the ICP. A process evaluation to assess the care model together with health outcomes was outlined. Conclusion The study showed that ANP-led MDT, person-centred, co-ordinated care provides the best ICP implementation strategy. The study will further understand the ICP implementation process among frail older people in the community.

Community Integrated Care Team- Detention Order Outcomes And Indications

Abstract Background Detention orders are the inherent jurisdiction of the high court. Only mechanism to support treatment in those lacking capacity and refusing care. Considered a last resort. Integrated care for older persons teams (ICPOP) often engage with complex cases who require this intervention. I aim to review detention orders enacted on ICPOP patients within 1 year. Methods Retrospective review of notes on all patients who required a detention order for transfer of care from March 2023- March 2024. Assessing on review patient’s primary diagnosis, expressed wishes, interventions implemented by the ICPOP team to avoid detention and then reasons for detention order and finally patient outcome. Results 7 patients. 6 female. Every patient expressed a wish to remain in their home. All 7 patients had dementia. Implemented interventions included, Medical social work, home care packages, Memory resource and technology room referrals, meals on wheels plus family support groups, and legal supports, ward of court and decision-making representatives. Interventions where however unsuccessful and reasons for detention ranged from- Night-time wandering x3. Road safety concerns x 3. Family neglect and abuse x 3. Fire safety x1 and Accidental poisoning/malnutrition x1 and Alcohol excess x2. All bar one patient settled without need for medication or specialist unit when transferred to nursing home. Conclusion Outcomes were positive in all cases of detention order being implemented. All 7 patients received better care and avoided serious risk to health. The one patient who required significant intervention to maintain transfer was a behavioural fronto-temporal dementia who required a locked unit and psychotropics. In all cases family supported the decision and patient quality of life improved. Where autonomy and liberty remain paramount concerns for all individuals this review confirms that in some cases doctors must act in the best interests of their patients even if this act is against their wishes.

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.

Proximal Humerus Fractures In The Older Adult: A Retrospective Review Of Proximal Humerus Fractures In The Emergency Department

Abstract Background This study aimed to describe the epidemiology and outcomes of older adults diagnosed with proximal humeral fractures (PHFs) in an Irish adult emergency department (ED). Methods A retrospective chart review was conducted on all patients (>65) who had a diagnosis of a PHF, in 2022 within an ED of a large suburban academic teaching hospital in Dublin. Assessment by the Frailty at the Front Door (FFD) team (older adults >75) for those with a PHF was also analysed. Results A total of 53 older adults (>65) were identified within the study period with a PHF while 43 patients (<65) were identified. In the >65 group, seventy-nine percent (N=42) were female. The mean age was 75.6 years of age (Range 65-95). Only 21% (N=11) had operative management. Two-thirds of PHFs in the >65 group required admission to hospital (N=24) (P<0.001). The mean length of stay (LOS) was 12.9 days compared to only 4.5 days in those under the age of 65 (P= 0.14). There were 26 older adults (>75) diagnosed with a PHF. The FFD team assessed 49% (N=11) of older adults (>75) with a PHF. Only 31% (N=8) presented to ED within FFD team operational hours. The average Clinical Frailty Sale was 5 (N=11). The FFD team completed 22 inpatient MDT referrals, four HSCP community referrals, one Public Health Nurse Referral and one application for increase in home care package. Conclusion PHFs tended to occur in older female patients. The majority of PHFs in older adults do not have operative treatment and were associated with higher LOS. FFD teams can play a pivotal role in the assessment and treatment of older adults with a PHF. This may represent opportunities to develop integrated care pathways to maximize an individuals’ independence, to support people at home with PHFs.

Prevalence of Osteoporosis and Indications for Bone-Treatment In Older Adults Living with Frailty Enrolled in a Local Integrated Care Programme

Abstract Background Osteoporosis is estimated to affect more than 250,000 adults in Ireland, with 29.4% (€463.3 million) of the total healthcare cost attributable to osteoporosis-related fracture management, resulting in significant health and economic impact.(1,2) As such, early identification of osteoporosis and addressing associated risk factors are crucial steps in reducing osteoporosis-associated morbidity and mortality. This retrospective audit aims to assess the prevalence of osteoporosis and indications for initiating bone treatment among older adults living with frailty enrolled in the Limerick Integrated Care Programme for Older Persons (ICPOP). Methods All older adults attending ICPOP between 01/06/2023 to 29/02/2024 were included in the data collection. Data collected included patient age, gender, presence of vitamin D deficiency (<50), presence of osteopenia or osteoporosis via DEXA scan results, history of fragility fractures, and bone health treatment and its indication. Results A total of 310 patients (192 female, 118 male; age 70–98) attended ICPOP during the specified time period. DEXA scans identified osteopenia in 109 patients and osteoporosis in 69 patients. 86 patients experienced a history of fragility fractures, of which 30 were confirmed to have osteoporosis on DEXA. 93 patients (30.3%) displayed vitamin D deficiency, with the majority (81.7%) not previously receiving vitamin D supplementation. 151 patients were in receipt of bone treatment, of which 86 patients (56.9%) were newly commenced on bone treatment following interaction with ICPOP. The indications were osteoporosis on DEXA scan (44 patients), history of recent fragility fracture (20 patients), and high FRAX score (22 patients). Conclusion The increase in detection of risk factors and presence for osteoporosis, and initiating bone health treatment, achieved by way of an integrated care programme for older persons highlights the importance of proactive screening and timely initiation of treatment.

To Investigate the Prevalence of White Coat Hypertension in Community Dwelling Older Adults Referred for a Falls Assessment

Abstract Background Falls and frailty are the main focus in our integrated care programme for older persons (ICPOP). Office blood pressure (OBP) measurements are commonly used in practice although out of office recordings are proven to be a better predictor of cardiovascular risk (Myers et al, 2018). The European Society of Cardiology guidelines (ESC, 2018) have proposed BP values for the classification of hypertension (HTN). Methods We retrospectively completed a chart review on older adults’ who attended ICPOP with a referral for a falls assessment from November 2021 to April 2024. OBP were obtained after the patient was in the hub for approximately one hour following their comprehensive geriatric assessment (CGA). The OBP was documented following a supine period of 5 minutes. We compared the OBP and ambulatory blood pressure monitor (ABPm) average readings to assess the prevalence of HTN based on the ESC guidelines. Results 75 charts were reviewed. 3 ABPm recordings were unsuccessful due to cognitive impairment or not tolerating the ABPm. These were excluded from the audit. No patient had hypotension on either their OBP or ABPm recordings. On their OBP recordings, 29/72 (40%) had a normal reading while 43/72 (60%) had HTN. On their ABPm 54/72 (75%) had a normal reading while 18/72 (25%) had HTN. When we looked at antihypertensive medication use in those who had a normal reading on their ABPm, 47/54 (87%) were on antihypertensive treatment. All patients with HTN on their ABPM were on antihypertensive treatment. Conclusion Our findings suggest that OBP readings greatly increase the numbers of patients diagnosed with HTN compared to ABPm (60% versus 25%). Therefore, we suggest that all patients should have an ABPm as a gold standard to falls assessment to avoid over-treating white coat HTN.

Exploring the contribution of cancer palliative care development toward alleviating the human crisis of suffering in low- and middle-income countries: A framework synthesis protocol.

Inadequate access to cancer care, high mortality, and out-of-pocket expenditure contribute to health-related suffering in low- and middle-income countries, making palliative care a relevant option. How palliative care development has alleviated suffering is not systematically studied, necessitating this review's conduct. The objective of this systematic review with a framework synthesis approach is to identify and map the dimensions and indicators of cancer palliative care development and the components of integration between cancer and palliative care in LMICs. Uni- and multi-disciplinary databases like Cochrane, MEDLINE (PubMed), EMBASE, CINAHL Complete, and PsycINFO will be systematically searched for eligible studies exploring cancer palliative care development in LMICs and their contribution to alleviating health-related suffering in the cancer context. Our selection process will encompass countries classified by the World Bank as low-income (26 countries), lower-income (54 countries), and upper-middle-income (54 countries). Review findings will be synthesised and analysed using a best-fit framework synthesis method using 2 frameworks (the WHO model of components and indicators for palliative care development and integration elements between oncology and palliative care), and the findings will be developed as themes and subthemes, and patterns interpreted using these 2 models. This review will analyse the development of cancer palliative care in LMICs. It will identify gaps in provision, solutions derived at the regional level to address them, and best practices and failed models with reasons underpinning them.