Older Persons Research Articles

Transforming Lives with Group Fitness

It is clear that clinicians transform lives in the context of rehabilitation, but how can clinicians continue to positively influence patients once they leave rehabilitation and potentially enter into fitness. Group fitness has been shown to be beneficial for older persons in many health outcomes. Clinicians have a tremendous opportunity to ensure success for their patients as they enter into fitness. In this article, we discuss considerations and tactics for clinicians to maximize the potential for their patients’ success in group fitness.

Six-year course over time and predictors of suicidal ideation in depressed older patients.

It is important to know predictors of long-term course over time of suicidal thoughts and ideation in depressed older persons. In this study, 378 depressed older persons were interviewed at baseline, and after 2 and 6 years to evaluate the presence of depressive disorder. The Inventory of Depressive Symptomatology (IDS) was administered every 6 months for 6 years. Latent Class Growth Analysis was performed on the IDS item on suicidal ideation to identify subgroups with different trajectories. Five subgroups with suicidal ideation trajectories were identified: 1) severe, transient (10.9 %), 2) severe, persisting (8.0 %), 3) mild, but increasing (14.9 %), 4) moderate, persisting (35.6 %), and 5) no thoughts (30.6 %). Mixed model analysis showed that trajectories were related to 6-year course of depressive symptoms. Yet, suicidal ideation or thoughts of loss of meaning of life were still present in 22.7 % and 17.4 % of those who remitted after 2 and 6 years. Independent of baseline depressive symptom severity, loneliness, childhood trauma, history of suicidal ideation or attempt, openness to experience, earlier age of depression onset, anxiety symptom severity and worse mastery predicted worse trajectories. 47 % dropped out at 6-years follow-up, we did not distinguish between thoughts of death and suicide, we did not assess death by suicide. Although trajectories of suicidal ideation and thoughts of loss of meaning of life were strongly related to the course of depression severity, they also appear after remission. Clinicians should be vigilant for suicidal ideation or death wish, even after remission of depression.

COMPARISON OF COGNITIVE FUNCTION AND DEPRESSIVE SYMPTOMS IN INSTITUTIONALIZED HEALTHY AND OLDER PERSON WITH ALZHEIMER’S DISEASE

Physical activity shows benefits in cognitive function and the prevention and treatment of depression in older adults with Alzheimer’s disease and healthy ones. So, the purpose of this study was to compare cognitive function and depressive symptoms in two groups: a group of older adults with Alzheimer’s disease and a group of older adults without neurodegenerative diseases, by sex and level of physical activity. The sample was 30 participants divided into two groups: 15 participants with Alzheimer’s disease and 15 participants without neurodegenerative diseases. The instruments used were the Geriatric Depression Scale (GDS) and Mini-Mental State Examination (MMSE). The results revealed that older persons with Alzheimer’s disease exhibit a more significant impairment of cognitive skills (p = .001) and a higher incidence of depressive symptoms (p = .001) compared to older persons without neurodegenerative diseases, with no differences between sex (p > .05). Results show that active older person had higher scores in cognitive abilities (p = .001) and a lower incidence of depression (p = .001). It seems that Alzheimer’s disease, typically associated with cognitive abilities decline and incidence of depressive symptoms, and physical activity influence cognitive performance and depressive symptoms in older people with Alzheimer’s disease and without dementia.

Primary Healthcare Services and Health-Related Quality of Life of Older Persons with Non-Communicable Diseases: A Narrative Literature Review

In response to the rising burden of non-communicable disease (NDC), the World Health Organization (WHO) developed tools to enable early detection and management of NCDs in Primary Healthcare centers (PHC). Globally, the prevalence of NCDs remains alarmingly high with 41 million deaths annually. Of these, 17 million people die before the age of 70, and 86% of these premature deaths occur in low-and middle-income countries. This narrative review aimed to assess the effect of PHC services on health-related quality of life (HRQoL) of older persons with NCDs, to critically analyze the potential of the existing literature in informing improvements in PHC services. We searched various databases (PubMed, Springer, Scopus, and ScienceDirect) for relevant literature. Peer-reviewed articles on the influence of PHC services on HRQoL among older persons with NCDs written and published in English between January 2013 and May 2024 were considered. The review indicates that effective PHC services are linked to good HRQoL. However, PHC services are sub-optimal and poor in low- and middle-income countries, hence more health interventions are essential to improve PHC services to enhance HRQoL of older persons.

Polypharmacy and Therapeutic Inertia in Extreme Longevity: A Potential Clinical Ageism Scenario Secondary to Important Gaps in Clinical Evidence.

Population aging is a global health priority due to the dramatic increase in the proportion of older persons worldwide. It is also expected that both global life expectancy and disability-free life expectancy will increase, leading to a significant rise in the proportion of individuals with extreme longevity, such as non-agenarians and centenarians. The inaccuracy of clinical evidence on therapeutic interventions for this demographic could lead to biased decision-making, influenced by age-related beliefs or misperceptions about their therapeutic needs. This represents a potential clinical ageism scenario stemming from gaps in clinical evidence. Such biases can result in 2 significant issues that adversely affect the health status and prognosis of older persons: polypharmacy and therapeutic inertia. To date, documents on polypharmacy in non-agenarians and centenarians account for less than 0.35% of the overall available evidence on polypharmacy. Furthermore, evidence regarding therapeutic inertia is non-existent. The purpose of this letter is to discuss polypharmacy and therapeutic inertia as potential clinical ageism scenarios resulting from the clinical evidence gaps in extreme longevity.

Exploring the Impact of Social Engagement on the Mental Health of Elderly Individuals in India

This study explores how social interaction plays a critical role in determining the mental health outcomes of older adults in India. Given the rapidly ageing population and changing societal dynamics, it is critical to understand how social relationships affect older persons’ well-being. This study intends to explain the complex relationship between older Indians’ mental health and social involvement through an exploratory approach. Data was gathered from a varied sample of senior citizens in various parts of Delhi the National Capital of India using a mixed-methods technique. The frequency and caliber of social encounters, feelings of loneliness, and mental health markers including anxiety and sadness were all assessed using quantitative questionnaires. By offering actual data on the importance of social engagement for senior people’s mental health outcomes in the Indian setting, this study adds to the expanding body of research on geriatrics. The results highlight the need for focused interventions and policies that support social inclusion, intergenerational relationships, and the particular difficulties faced by ageing populations in quickly evolving cultures such as India. Also, we have documented that by and large female elderly enjoy a healthy mental life as compared to males.

Can integrated community education reduce the risk of hypoglycaemia associated with glucose lowering medication in older persons living with diabetes and frailty?

Can integrated community education reduce the risk of hypoglycaemia associated with glucose lowering medication in older persons living with diabetes and frailty?

Engaging with First Line Nutrition Information - Insights from Health Care Professionals and Older Persons

Abstract Background Health care professionals (HCPs) working with older persons are often asked nutrition related questions. This study explored how first line nutrition information such as general leaflets are accessed and used by HCPs and older persons. Is there a role for video-based nutrition education? Methods HCPs working with older persons completed an online survey. An older person’s reference group participated in a virtual focus group. Participants were asked about knowledge seeking, accessing and providing nutrition information, and engaging with videos on nutrition topics. Results were analysed using descriptive statistics and thematic analysis. Results Ninety five HCPs completed the survey (44% Nursing, 27% Physiotherapy, 14% Occupational Therapy, 6% Speech & Language Therapy and 9% other (doctors, social worker, pharmacist and care needs facilitator).Eighty-eight (90%) HCPs reported being asked nutrition related questions, topics included poor appetite (n=77, 83%), weight loss (n=68, 75%) and constipation (n=66, 72%).Twenty HCPs (21%) reported confidence answering questions, while 28 (29%) reported low confidence. Forty-three (44%) had little or no awareness of available first line information and 37 (39%) rarely or never provided information. Eighty-two (86%) HCPs agreed that nutrition education videos would be used if available. Three themes emerged from the HCPs survey: (i) importance of nutrition for HCPs (ii) barriers to use of first line information and (iii) support systems. Fourteen persons (64% women, 36% men) attended the focus group. Two themes were identified: (i) access to health information and (ii) barriers to access. Discussions included difficulty in proactively seeking information, joined up sharing and that education videos would be beneficial, but the distribution needed consideration. Conclusion Timely access to information is empowering for the older person. HCPs were identified as a resource for seeking nutrition advice. The communication of and access to nutrition information merits consideration. Following these findings, nutrition videos are currently being developed.

“What Matters To Me?” Responses from Older People in the Acute Setting

Abstract Background The ‘What Matters to Me’ question has been used in many areas of the healthcare. In the context of older persons, the focus is typically on improving patient-centred care in long stay settings or in people living with dementia. It is also synonymous with end-of-life decisions. The question is contextual in itself and can elicit a wide range of responses. In this abstract, it was included in the Comprehensive Geriatric Assessment (CGA) in a section about future care and responses were anticipated to be relevant to that subject. Methods The Older Person Specialist Nursing Team developed a CGA document for use in acute care. The “What Matters To Me?” question was included with the intention of discovering and recording older persons’ end of life plans and wishes. The responses to this question were extracted from a random 30 completed CGAs. Results A total of 24 responses were gathered, some participants provided multiple answers. Not documented n=6, 3 themes were identified from the responses; Home; Free time and Worries/Concerns. Return home was the most frequently expressed response; n=13. Other responses identified were enjoyment, pass times and pets; n=9. Worries/Concerns were identified in broad terms; “I’m worried out the future” n=7. Conclusion “What matters” in this context was a broad query and responses may have been influenced by participants current health status, location and fear of the future and the subjectivity of the question and the practitioner. Participants did not mention dying a concern but did allude to the future in a broad context. The “What Matters To Me” question will now be in the social information section and the Older Person Specialist Nursing Team are considering a targeted question related to end-of-life plans and wishes.

Skip The Dip For Urinary Tract Infection in over 65s. A National Initiative To Reduce Antibiotic Prescribing In Older Persons

Abstract Background Urinary tract infection (UTI) is the most common reason for antibiotic use in older persons in residential care. Dipstick urinalysis for UTI is an ingrained practice. Inappropriate use of dipstick urinalysis can lead to inappropriate antibiotic prescribing, contributing to adverse effects and antimicrobial resistance. The ‘Skip the Dip for UTI in over 65s’ quality improvement initiative (QI) aims to raise awareness of best practice for diagnosis and management of suspected UTI to reduce unnecessary antibiotic use. It supports implementation of national guidance stating dipstick urinalysis is not recommended for assessment of evidence of UTI in people 65 years and over. Methods Focus groups with nursing staff in older persons residential care facilities (OPRCFs) identified barriers and facilitators for implementing national guidance on dipstick urinalysis for UTI. Supporting resources developed included a resident leaflet on UTI, staff handbook and webinar recording, hosted on www.antibioticprescribing.ie. Antimicrobial pharmacists delivered workshops on improving assessment of suspected UTI in the HSE OPRCFs from September 2023 to March 2024. Monthly monitoring of antibiotic use for UTI was established in all 119 HSE OPRCFs. Surveys to establish dipstick urinalysis practice in the OPRCFs were administered in March 2023 and March 2024. Results A baseline survey in 2020/21 indicated 98% HSE OPRCFs (133/135) performed dipstick urinalysis for residents with symptoms of UTI, reducing to 53% (57/107) in March 2023, and 24% (25/103) in March 2024 following this QI. Prevalence of antibiotics for treatment of UTI in the HSE OPRCFs decreased by 38%, from a baseline of 2.6% (114/4,446 residents) in 2020/21, to 1.6% (66/4,222 residents) in March 2024. Conclusion The ‘Skip the Dip for UTI in over 65s’ QI has resulted in a change in practice, with the majority of HSE OPRCFs now reporting dipstick urinalysis is not performed for UTI assessment, with a considerable reduction in antibiotics prescribed for UTIs.

A Pathway for Advance Care Planning Co-Developed by Service Users and Interdisciplinary Healthcare Professionals in Older Persons Mental Health

Abstract Background Advance Care Planning (ACP) has been recognised as an effective mechanism for decision-making, maintaining autonomy, and ensuring that end-of-life care is aligned with an individual’s will and preference. However, healthcare professional's (HCPs) lack of confidence and knowledge has been cited as a barrier to practice. Furthermore, there are currently no widely accepted guidelines for ACP in health service settings (Barnett et al., 2024[1]). A key aim of the second stage of a three-stage action research study was to co-design a pathway to support ACP practice in a Mental Health Service for Older Persons. Reference [1] Barnett, M.D., Bennett-Leleux, L.J. & Guillory, L.A. (2024) End-of-life treatment preferences and ACP among older adults, Death Studies, 48:2, 95-102. Methods The pathway was developed through cooperative inquiry (CI), a collaborative research approach. The CI group involved three service users (one with dementia family carer experience), and six interdisciplinary HCPs coming together as co-subjects and co-researchers. Five in-person CI meetings were convened. Results The CI group co-developed a person-centred pathway encompassing a tiered approach to ACP, which would be a source of guidance and support for service users, family carers and HCPs. Key components include training and education for HCPs to enhance confidence and skills; a Padlet online platform to host resources for service users and family carers; and facilitated interventions based on the individual needs of service users, including potentially additional accompanying documentation to capture mental health needs. An interdisciplinary approach to facilitating ACP engagement, with social work taking a lead role was also suggested. Conclusion The pathway was identified as an effective approach to embedding ACP practice in older persons mental health, through a tiered person-centred framework catering to the needs of both service users, and the training needs of staff. The pathway is proposed as potentially adaptable to other older persons services to support ACP engagement.

A Summary of Videofluoroscopy Findings Compared with Chest X-Rays of Older Persons in a Model 3 Hospital

Abstract Background Oropharyngeal dysphagia (OD) is increasingly prevalent among the older population. OD may give rise to complications such as aspiration pneumonia, malnutrition and/or dehydration. Videofluoroscopy is a gold standard tool for the management of dysphagia. Videofluoroscopy is a moving x-ray of the swallow in which aspiration can be directly visualised. Videofluoroscopy is only a ‘snapshot’ and the swallow function can improve or decline over time. Not every aspiration event leads to respiratory complications. There is a lack of diagnostic criteria for the diagnosis of Aspiration Pneumonia. It is challenging for Speech and Language Therapists (SLTs) to determine clinical outcomes. Despite this, the primary reason for referral to SLT in acute care is to assess for aspiration risk. The aim of this review is to compare patients’ Chest X-ray findings with Videofluoroscopy results. Methods Results Conclusion Aspiration pneumonia is a diagnostic challenge - further research in the area of dysphagia associated aspiration pneumonia in Older persons is required. The focus of dysphagia management in Older Persons should move towards the person's nutrition, hydration, oral hygiene, quality of life as well as possible dysphagia related respiratory implications.

Níos Fearr Le Chéile/Together is Better: ICPOP Case Review of Intervention for an Older Carer of a Referred Patient

Abstract Background The Integrated Care Programme for Older Persons (ICPOP) aims to implement integrated services and care pathways for older adults with complex health and social care needs. The aim is to place patients at the center of their healthcare decision making and to support them to live well in their homes and communities. A Comprehensive Geriatric Assessment (CGA), which is the gold standard for the management of frailty in older persons, is carried out on all referred patients at the initial home visit. It is often as an ICPOP assessor delves deeply into the family unit that frailty makers such as decreased mobility, declining cognition, poor appetite, polypharmacy is identified in the non-referred cohabitating person who is also over 65 years of age (Potier et al., 2018). Methods The purpose of this poster is to demonstrate how a holistic approach to care within a household led to the incidental finding of frailty in a family carer who was also an older adult. This case review will illustrate how the referral of one half of a married couple led to opportunistic multi-disciplinary intervention for the second person. Following discussion, at MDT level, of both the referred patient and their spouse, a request for a formal referral to ICPOP for the second person was made to the GP, as it is a referral criteria for ICPOP referrals. Results ICPOP intervention ultimately led to home supports being put in place for both parties along with medical reviews, rationalisation of medications and assistive technology supports, this enabled both patients to live well and safely at home. Conclusion A comprehensive geriatric assessment using a holistic approach resulted in intervention for both parties with a positive outcome for the entire family.

“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit

Abstract Background Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation. Methods A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel. Results Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p<0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3). Conclusion Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.

Evaluation of New Frailty at the Front Door Service in a Model 3 Hospital

Abstract Background Frailty at the Front Door (FFD) is a key component of integrated care for frail older persons who attend an Emergency Department (ED). This service was established in a model 3 hospital in 2023. Variable Indicative of Placement (VIP) was used to screen patients aged ≥70 years for frailty. Interdisciplinary assessments and interventions were provided by a Senior Physiotherapist and Senior Occupational Therapist (OT). Methods All assessments by the FFD team from June 2023 to February 2024 inclusive, were included. The variables analysed were age, gender, modified Barthel Index (mBI) score, 4AT score, Clinical Frailty Scale (CFS) score, discharge status, length of stay (LOS), referral pathways and re-presentation within 28 days. Data was analysed in Excel. Results There were 490 assessments over the 9-month period, 217 (44%) male and 273 (56%) female, with a mean age of 80 (SD±7.77) years. The median CFS was 5 (range 2-8) and median mBI was 17 (range 4-20). The 4AT score was ≥4 in 44 (9%) cases (indicating possible delirium and possible cognitive impairment). One hundred and eighty-four (38%) patients were discharged home from ED. Seventy (14%) patients re-presented to ED within 28 days. Acute hospital admission was required for 306 (62%) with a mean LOS of 11 (SD±0.5) days. There were 213 referrals to community services for those patients discharged home. These included Dietetics (36%), Physiotherapy (22.5%), ALONE (18%), Delirium Clinic (9.4%), OT (6%) and others (8.1%). There were 238 referrals to acute services for admitted patients, including Physiotherapy (59%), Dietetics (18.5%), OT (17%) and Speech and Language therapy (5.5%). Conclusion This evolving FFD service is a positive step towards improving older persons’ care in ED. Recognition of frailty in ED leads to early identification of care needs and timely referral to alternative pathways in the community and acute services as appropriate.

Taking the Piss? Using Lean to Review the Process for Provision & Delivery of Continence Disposable Products

Abstract Background Urinary incontinence (UI) is the unintentional passing of urine. Its impact on older people varies from a diminished quality of life, to social isolation and frailty. Pads or diapers are commonly employed tools in the care of older people with incontinence. Incontinence is largely underreported and poorly managed among older people in community care settings (Yan et al., 2022). This work reviews the process map of the provision and delivery of continence disposable products in the community by the Health Service Executive in Ireland. Methods Lean is a quality improvement approach that consists of the elimination of waste to improve the flow of people, information or goods. We reviewed the process map baseline assessment; captured steps that added value to the patient and the impact on staff in the community. Results The initial assessment tool consists of five pages. There are 28 possible steps presented in the process map. There is a gap in the presentation on connectors to associated processes. Eight people are involved in the ordering, approval and delivery process to the older person. The initial assessment and education add value to the patient. If adverse skin or complaints arise an older person can be referred to a continence advisor or the ADPHN. The patient feedback loop is missing following delivery no check-in for education is provided following initial use. Unclear who is the point of contact for the patient to raise issues. The only noted key performance indicator is the processing of a request to order is inputted in one working day. Objectives are not SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound.) Conclusion Further in-depth research is required to review if the right staff are making the approvals. Need to review KPIs throughout to improve process and SMART objectives. Perspectives of older people and GP supports require further investigation.

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.

Audit of Geriatric Emergency Medicine-Unit staff compliance in providing care in line with the Age Friendly Health Systems Conceptual Framework

Abstract Background The Geriatric Emergency Medicine Unit (GEMU) in University Hospital Limerick (UHL) is in the Emergency Department for the assessment of those over the age of 75. The unit is staffed by a multi-disciplinary team with specialist skills in older person’s care. The aim of this audit was to determine assessment and documentation compliance with the Age Friendly Health Systems conceptual framework for older persons who present to GEMU. Methods A retrospective documentation review took place from patients who attended GEMU between January-March 2023. Medical record numbers were selected at random from the Health and Social Care Professionals (HSCP) team data management system with individual patient records subsequently retrieved from the Therefore Emergency Medicine (EM) patient management system. Patient records were reviewed by SW, which included Nursing, EM Doctors documentation and HSCP documentation. Results 15 charts were reviewed. Compliance varied across all areas from 0-100%. Compliance was greatest in the domains of the EWS score, mobility assessments, falls history and 4AT. Hydration and the documentation of ‘What Matters’/patient care preference were both 0%. Otherwise, compliance broadly was >50%. The first re-audit of 15 charts took place from December 2023-January 2024. Improvements were noted across all assessments, with 100% compliance additionally achieved in CFS, cognitive status, co-morbidities and nutritional intake. A second re-audit of 15 charts took place from March-April 2024, with further improvements seen in terms of lying and standing blood pressures and polypharmacy assessments. Conclusion Results demonstrate the continued improvements made amongst the team in adhering to the Age Friendly Health Systems Framework. Efforts are ongoing to focus specifically on the care preference component, with structured QIPs in place and a view to re-auditing in Q4 2024.

Characterisation of Patients with Self-Neglect – `Room to Improve' with a New Potential Geriatric Giant?

Abstract Background Self-Neglect is an under-reported and often veiled diagnosis which is defined as ‘an adult’s inability due to physical or mental impairment or diminished capacity to perform essential self-care tasks. Self-Neglect is an independent risk factor for death and is associated with morbidity, heavy utilisation of healthcare services and safeguarding issues. Self-Neglect affects more older persons and is more commonly seen in people with cognitive deficits and social isolation. Methods Using HIPE data, patients were selected for a Descriptive Retrospective Chart Review with a diagnosis of Self-Neglect and under the care of a Consultant Geriatrician within a 2-year timeframe from April 2022 to April 2024. Data was compiled and demographics were collated. Charlson Co-Morbidity Index, Adult Comorbidity Evaluation-27 and Clinical Frailty Scores were employed. Results Twenty patient's charts were reviewed retrospectively. Of the twenty patients 65% were male, 40% are rural dwelling and 70% live alone. 95% of patients have an underlying cognitive impairment, and over 90% have a current or remote history of substance abuse. All 20 patients had significant concerns highlighted about their housing and 60% of patients required alternative accommodation while their home was updated or cleaned. All 20 patients required discharge planning with many requiring complex multi-disciplinary input regarding their safe discharge and had prolonged inpatient stays. Conclusion Recognition and resourcing ‘Self Neglect’ pathways will remain an issue in the health service in Ireland and worldwide. Patients presenting to hospitals with Self-Neglect are multi-morbid, socially complex and tread the line between autonomy and public health issues. Creating a service pathway that puts this vulnerable cohort at the centre and that could span both inpatient and community streams would be beneficial to the over-stretched health service but most importantly to the patient.

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.