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Background Statins are frequently prescribed in older patients for prevention of cardiovascular disease and treatment of hypercholesterolemia. However, there is little evidence to indicate that statins have any benefit in older patients with life expectancy less than 10 years and of those patients in long term care whose average life expectancy is approximately 3-5 years. In addition, statins are associated with significant adverse side effects and contribute to the burden of polypharmacy in older patients. Methods Patients residing in a long term care facility were reviewed and data was collected from their medical notes and medication records in order to; (1) Quantify the proportion of patients on statin therapy (2) Review the indication for statin therapy (3) Investigate the inappropriate prescribing of statins in nursing home patients. Results 55 patients were included in the study. Of the 55 patients, 7 [12.7%] patients were on a statin. Average age of patients on a statin was 77.8 years[SD 9.4]. Of the 7 patients, 2 were on a statin for primary prevention and 5 patients were on for secondary prevention. Average cholesterol in primary prevention group was 3.3mmol/L, average LDL was 1.3 mmol/L. Of the 7 patients on statin for secondary prevention, indications included ischaemic stroke[n= 4] and ischaemic heart disease [n=3]. Average Total cholesterol in secondary prevention group was 3.8 mmol/L and average LDL was 1.91 mmol/L. The average Rockwood Clinical Frailty Scale Score of the patients on statin therapy was 7. Conclusion Firstly, this study highlights the incidence of inappropriate prescribing of statins for primary prevention in frail older patients in long term care. It also raises the question surrounding the indication of statin therapy in secondary prevention where cholesterol level are within target range highlighting the need for further studies examining the benefit of statins in frail older patients in LTC. [ABSTRACT FROM AUTHOR]

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

Background Reduced ability to perform instrumental activities of daily living (IADLs) can lead to a difficult transition from hospital to home, increased dependence and diminished quality of life (1). A novel IADL group for frail older adults 'Ready Steady Home' was completed to facilitate transition from hospital to home. Methods A single centre prospective study was undertaken in a Post-Acute Orthogeriatric Rehabilitation Care unit. A sample of convenience was recruited over a 3 month period. All subjects invited to participate had been referred for Physiotherapy and Occupational Therapy, medically stable, able to give consent, mobile with/without an aid and had a goal of community ambulation and IADLS. The one hour intervention consisted of a car transfer, outdoor mobility on a busy footpath, road crossing, negotiating a busy shop, completing shopping task and financial management. A self-reported modified Client Satisfaction Questionnaire (CSQ-8) was completed by all subjects post intervention. Data was analysed using descriptive statistics. Results Twelve participants (female (12); mean age 83.7 years, mean LOS 32.75 days) completed the intervention and were included in the data. All were frail with a Clinical Frailty Scale score ≥ 5, mild (n=4), moderate (n=7) and severe frailty (n=1). Primary diagnosis was femoral fracture (n=7), hip surgery revision (n=2), deconditioning (n=2) and pelvic fracture (n=1). All used a unilateral (n=5) and/or bilateral mobility aid (n=7). The mean CSQ-8 score was 27/32 indicating high satisfaction with the intervention. No adverse events occurred. Common themes reported were improved confidence with community ambulation, preparation for home and re-integration into the community. Conclusion This study indicates that an interdisciplinary intervention addressing community based IADLS was feasible, safe and effective in a frail Orthogeriatric inpatient cohort. Further research is required to evaluate the effectiveness of this therapy intervention in improving hospital to home transition and potential reduction in LOS. [ABSTRACT FROM AUTHOR]

Background Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2). The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination. Methods A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel. Results Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores. Conclusion All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects' in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population. [ABSTRACT FROM AUTHOR]

Background: orthostatic hypotension (OH) is a physical sign that reflects a final common pathway of various forms of disordered physiology, which is the hallmark of geriatric frailty. Fried et al. recognise three increasing frailty phenotypes in older people, based on measurements of weight loss, exhaustion, grip strength, walking speed and physical activity. Orthostatic haemodynamics have not been considered as markers of frailty in older people.Objective: to classify a community sample of older people into three increasing frailty phenotypes and compare their orthostatic haemodynamics.Design: cross-sectional study.Setting: geriatric research clinic.Subjects: a total of 442 subjects (mean age 72, 72% females) without dementia or risk factors for autonomic neuropathy.Methods: the sample was classified according to modified Fried criteria. Orthostatic systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) responses were monitored during an active stand with Finometer®.Results: one hundred and ninety-eight subjects (44.8%) were classified as non-frail, 213 (48.2%) as pre-frail, and 31 (7.0%) as frail. Across groups, there was a significant increasing gradient in baseline HR (P = 0.008) and decreasing gradients in Delta HR (i.e. maximum HR within 30 s—baseline HR) (P < 0.001) and maximum HR by 30 s (P < 0.001). On average, by 30 s after stand, non-frail subjects had recovered 98% of their baseline SBP, while pre-frail and frail subjects had recovered 95 and 92%, respectively (P for trend = 0.064).Conclusions: the orthostatic HR response and, to a lesser extent, SBP recoverability, appear impaired in frailty. Orthostatic haemodynamics may be useful markers of frailty. [ABSTRACT FROM AUTHOR]

Background: Ireland is at 53°N, and its population risk of vitamin D deficiency is high. Previous Irish studies suggested a significant seasonality of serum 25-hydroxyvitamin D [25(OH)D] and a beneficial effect of supplementation in raising 25(OH)D levels. However, in Irish older people, little is known about the magnitude of the supplementation effect and whether supplementation affects 25(OH)D seasonality.Design: cross-sectional observational.Setting: outpatient clinic.Subjects: five hundred and forty-six community-dwelling subjects (mean age 73.0, SD 7.4; 68.5% females) were assessed between September 2007 and May 2009.Methods: for supplemented and non-supplemented: ‘cosinor’ analysis (Pulse_XP®) of monthly 25(OH)D. Period global solar radiation (GSR) and solar elevation angle (SEA) data were collected as proxy markers of ultraviolet-B radiation exposure. Multivariate linear regression was conducted to investigate the independent effect of GSR and SEA on 25(OH)D, controlling for confounders.Results: supplemented group (N = 183): 89.1% were on cholecalciferol 800 IU/day. Mean 25(OH)D = 64.1 (95% confidence interval: 52.2–75.8) nmol/l, with no significant seasonality; regression: neither GSR nor SEA predicted 25(OH)D. Non-supplemented group (N = 363): mean 25(OH)D = 40.3 (35.5–45.0) nmol/l, with significant seasonality (55.5% variance remaining), peak in August, amplitude = 6.0 (3.1–8.8) nmol/l; regression: both GSR (P = 0.002) and the interaction GSR * SEA (P = 0.018) predicted 25(OH)D.Conclusions: vitamin D supplementation was associated with a mean serum 25(OH)D increase of 23.8 nmol/l. Interestingly, supplementation seemed to blunt seasonality. In the supplemented group, 72.1% had individual 25(OH)D levels below the recommended 75 nmol/l. There is a case for universal supplementation in Irish older people, probably at a higher dose. Further research is needed to establish the optimum dose. [ABSTRACT FROM PUBLISHER]

Background: the safety of older pedestrians at urban intersections is a matter of gerontological concern. Many older pedestrians report inability to complete crossings in the time given by pedestrian lights. Standard times for pedestrian lights in Dublin pelican crossings are specified in the Traffic Management Guidelines (TMG). The Technology Research for Independent Living Centre is building a database of gait assessments of Irish community-dwelling older people using GAITRite™. [ABSTRACT FROM PUBLISHER]

Background: Anxiety and depression are common in older people but are often missed; to improve detection we must focus on those elderly people at risk. Frailty is a geriatric syndrome inferring increased risk of poor outcomes. Our objective was to explore the relationship between frailty and clinically significant anxiety and depression in later life., Methods: This study had a cross-sectional design and involved the assessment of 567 community-dwelling people aged ≥ 60 years recruited from the Technology Research for Independent Living (TRIL) Clinic, Dublin. Frailty was measured using the Fried biological syndrome model; depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale; and anxiety symptoms measured using the Hospital Anxiety and Depression Scale., Results: Higher depression and anxiety scores were identified in both pre-frail and frail groups compared to robust elders (three-way factorial ANOVA, p ≤ 0.0001). In a logistic regression model the odds ratio for frailty showed a significantly higher likelihood of clinically meaningful depressive and anxiety symptoms even controlling for age, gender and a history of depression or anxiety requiring pharmacotherapy (OR = 4.3; 95% CI 1.5, 11.9; p = 0.005; OR = 4.36; 95% CI 1.4, 13.8; p = 0.013 respectively)., Conclusions: Our findings suggest that even at the earliest stage of pre-frailty, there is an association with increased symptoms of emotional distress; once frailty develops there is a higher likelihood of clinically significant depression and anxiety. Frailty may be relevant in identifying older people at risk of deteriorating mental health.