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Background Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of adverse outcomes from PIP, compared with their non-frail counterparts of the same age. This study aims to examine the relationship between measured frailty and potentially inappropriate prescribing in older adults presenting acutely to hospital. Methods A prospective observational study was conducted. Participants were acutely hospitalised older adults. Inclusion Criteria: Age ≥ 65 years old, acute admission 24 hrs. Exclusion Criteria: Results The mean (±standard deviation [SD]) age of study participants was 79.25[±7.14], 56.5% were female. The prevalence of frailty measured using the CFS and Frail-VIG were 61.5% and 50.5% respectively. Applying the CFS, the mean number of STOPP criteria in non-frail patients was 1.03 and 1.87 for frail patients (p = 0.001 CI 95%) and 1.14 and 2.10 (p = 0.001 CI 95%) using the Frail-Vig Index. Conclusion Frailty is associated with functional decline, falls, hospitalisation and death. Frail patients had a higher mean number of STOPP criteria. As medication side effects are themselves included as part of the frailty syndrome, in-hospital medication review and patient centred medication optimisation should be guided by patient’s frailty status to reduce adverse outcomes.

The validity of dementia diagnostic criteria depends on their ability to distinguish dementia symptoms from pre-existing cognitive impairments. The study aimed to assess inter-rater reliability and concurrent validity of DSM-5 criteria for neurocognitive disorder in Down syndrome. The utility of mild neurocognitive disorder as a distinct diagnostic category, and the association between clinical symptoms and neurodegenerative changes represented by the plasma biomarker neurofilament light were also examined. 165 adults with Down syndrome were included. Two clinicians independently applied clinical judgement, DSM-IV, ICD-10 and DSM-5 criteria for dementia (or neurocognitive disorder) to each case. Inter-rater reliability and concurrent validity were analysed using the kappa statistic. Plasma neurofilament light concentrations were measured for 55 participants as a marker of neurodegeneration and between group comparisons calculated. All diagnostic criteria showed good inter-rater reliability apart from mild neurocognitive disorder which was moderate (k = 0.494). DSM- 5 criteria had substantial concurrence with clinical judgement (k = 0.855). When compared to the no neurocognitive disorder group, average neurofilament light concentrations were higher in both the mild and major neurocognitive disorder groups. DSM-5 neurocognitive disorder criteria can be used reliably in a Down syndrome population and has higher concurrence with clinical judgement than the older DSM-IV and ICD-10 criteria. Whilst the inter-rater reliability of the mild neurocognitive disorder criteria was modest, it does appear to identify people in an early stage of dementia with underlying neurodegenerative changes, represented by higher average NfL levels.

Olive stones obtained as a by-product from olive oil extraction in combination with the favourable climate in Mediterranean countries are value-added feedstocks for the energy sector due to low moisture content ( 20 wt. %), suitable calorific value ( > 18.7 MJ kg−1 as received) and high bulk density (about 750 kg m−3). The torrefaction process at Arigna Fuels with high energy efficiency of (above 90%) improves biomass properties for conversion to a high-value fuel for use in solid fuel stoves. This study reports the effect of moisture content, organic composition, inorganic matter, particle size, heat treatment temperature and residence time on product yields, O2/CO2 reactivity, calorific value, composition and thermal conductivity value of torrefied olive stones. Results showed that both lignocellulosic content and ash composition equally influenced the reactivity of torrefied material. For the first time, time-of-flight secondary ion mass spectrometry (ToF-SIMS) showed that the structure of torrefied material from small olive stone particles contains more cellulose than lignin when compared to large grains. Importantly from a technological standpoint, the lower heating values of torrefied olive stones (21.8 MJ kg−1) [1] from a small scale reactor were within the range of values for torrefied woodchip briquettes containing high starch binder content which was an energy increase of ≈ 15% when compared to the raw feedstock. The results showed that olive stones of particle size ≤ 2 mm produced during torrefaction at 270 °C for 30 min are the most suitable material and conditions for briquetting due to high solid yield, low reactivity and low thermal conductivity values. These conditions are recommended for the pilot plant operation using olive stones from the Mediterranean region.

The purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland.A recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term.An electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland.Sixty-six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty-two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants.This research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized.Failure to successfully integrate the nurse practitioner role risks the long-term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.

Clinical trial populations do not fully reflect routine practice. The power of routinely collected data to inform clinical practice is increasingly recognised.The OPTIMISE:MS pharmacovigilance study is a prospective, pragmatic observational study, conducted across 13 UK MS centres. Data were collected at the time of routine clinical visits. The first participant was recruited on 24th May 2019; data were extracted on 11th November 2021.2112 participants were included (median age 44.0 years; 1570 (72%) female; 1981 (94%) relapsing-remitting MS). 639 (30%) were untreated at study entry, 205 (10%) taking interferon beta/copaxone, 1004 (47%) second/third generation DMT first line and 264 (13%) had escalated from a platform DMT. 342 clinical events were reported, of which 108 infections. There was an increased risk of adverse events in people taking second/third generation DMT (RR 3.45, 95%CI 1.57-7.60, p0.01 vs no DMT). Unadjusted Poisson regression demonstrated increased incident adverse events in people taking natalizumab (IRR 5.28, 95%CI 1.41-19.74, p0.05), ocrelizumab (IRR 3.24, 95%CI 1.22-8.62, p0.05), and GA biosimilar (Brabio) (IRR 4.89, 95%CI 1.31-18.21, p0.05) vs no DMT.Routinely collected healthcare data can be used to evaluate DMT safety in people with MS. These data highlight the potential of pragmatic studies to guide understanding of risks and benefits associated with DMT.

Background the prevalence of adverse drug reactions (ADRs) in hospitalised older patients, their clinical presentations, causative drugs, severity, preventability and measurable outcomes are unclear, ADRs being an increasing challenge to older patient safety. Methods we systematically searched PubMed, Embase, EBSCO-CINAHL, the Cochrane Library, ‘rey’ literature and relevant systematic review bibliographies, published from database inception to March 2020. We included any study reporting occurrence of in-hospital ADRs as primary or secondary outcomes in hospitalised older adults (mean age ≥ 65 years). Two authors independently extracted relevant information and appraised studies for bias. Study characteristics, ADR clinical presentations, causative drugs, severity, preventability and clinical outcomes were analysed. Study estimates were pooled using random-effects meta-analytic models. Results from 2,399 abstracts, we undertook full-text screening in 286, identifying 27 studies (29 papers). Final analysis yielded a pooled ADR prevalence of 16% (95%CI 12–22%, I2 98%,τ2 0.8585), in a population of 20,153 hospitalised patients aged ≥65 years of whom 2,479 patients experienced ≥ one ADR. ADR ascertainment was highly heterogeneous. Almost 48.3% of all ADRs involved five presentations: fluid/electrolyte disturbances (17.3%), gastrointestinal motility/defaecation disorders (13.3%), renal disorders (8.2%), hypotension/blood pressure dysregulation disorders/shock (5.5%) and delirium (4.1%). Four drug classes accounted for 57.8% of causative medications i.e. diuretics (19.8%), anti-bacterials (14.8%), antithrombotic agents (12.2%) and analgesics (10.9%). Pooled analysis of severity was not feasible. Four studies reported the majority of ADRs as preventable (55–95%). Conclusions on average, 16% of hospitalised older patients experience significant ADRs, varying in severity and mostly preventable, with commonly prescribed drug classes accounting for most ADRs.

Background Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria were developed in 2017 to assist physicians with deprescribing decisions in older people approaching end-of-life. Updating was required to make the tool more practical, patient-centred and complete. Methods a thorough literature review was conducted to, first, devise a practical method for identifying older people who are likely to be approaching end-of-life, and second, reassess and update the existing deprescribing criteria. An eight-member panel with a wide-ranging experience in geriatric pharmacotherapy reviewed a new draft of STOPPFrail and were invited to propose new deprescribing criteria. STOPPFrail version 2 was then validated using Delphi consensus methodology. Results STOPPFrail version 2 emphasises the importance of shared decision-making in the deprescribing process. A new method for identifying older people who are likely to be approaching end-of-life is included along with 25 deprescribing criteria. Guidance relating to the deprescribing of antihypertensive therapies, anti-anginal medications and vitamin D preparations comprises the new criteria. Conclusions STOPPFrail criteria have been updated to assist physicians in efforts to reduce drug-related morbidity and burden for their frailest older patients. Version 2 is based on an up-to-date literature review and consensus validation by a panel of experts.

Key summary points Aim A comprehensive collateral history is a standard of care recommended both in Ireland, by the Irish National Audit of Dementia Care in Acute Hospitals (INAD) and internationally, by the EuGMS. We sought to establish if this standard was being met. Findings Only 44% of patients with cognitive impairment had a collateral history. The level of detail attained was often inadequate and assessment of patients’ current and premorbid cognition was poor. Message Obtaining a comprehensive collateral history is imperative to the diagnosis of delirium and dementia. It is not possible to make a competent clinical assessment or a management plan without exercising this core clinical skill., Purpose Patients with cognitive impairment are often unable to provide information relating to their pre-morbid cognition and function. Such information is essential to correctly identifying delirium and dementia, as well as making an accurate diagnosis and planning appropriate treatment. It is the standard of care recommended by the EuGMS. Methods We reviewed medical notes and administered a short questionnaire to nursing staff of a convenience sample of 100 patients aged ≥ 75 years admitted to medical wards in a tertiary teaching hospital. Results There were 100 patients with a mean age of 82.3 years, 49% of whom were female. Of 43 patients with cognitive impairment, 19 (44%) had a collateral history. Half of the patients described as having dementia did not have any further detail on the severity of dementia documented. Among those for whom a collateral history was obtained, the level of detail regarding pre-morbid cognition, function, mobility, and continence was sparse. Of the total sample, 13% had formal cognitive testing. Conclusion Acute illness characteristically causes significant impairments in cognition and function in frail older patients. Identifying and reversing these impairments is impossible without a comprehensive collateral history. It is alarming that such an essential component of clinical assessment is so often disregarded and highlights the lack of awareness from clinicians of the importance of collateral history in the management of patients with dementia and delirium. This must be emphasised in both undergraduate and postgraduate teaching.

OBJECTIVES Older people approaching end of life are commonly prescribed multiple medications, many of which may be inappropriate or futile. Our objective was to examine the effect of applying the STOPPFrail, a recently developed deprescribing tool, to the medication regimens of older patients with advanced frailty. DESIGN Randomized controlled trial. SETTING Two acute hospitals in Ireland. PARTICIPANTS Adults 75 years or older (n = 130) with advanced frailty and polypharmacy (five or more drugs), transferring to long-term nursing home care. INTERVENTION A STOPPFrail-guided deprescribing plan was presented to attending physicians who judged whether or not to implement recommended medication changes. MEASUREMENTS The primary outcome was the change in the number of regular medications at 3 months. Secondary outcomes included unscheduled hospital presentations, falls, quality of life, monthly medication costs, and mortality. RESULTS Intervention (n = 65) and control group (n = 65) participants were prescribed a mean (plus or minus standard deviation [SD]) of 11.5 (±3.0) and 10.9 (±3.5) medications, respectively, at baseline. The mean (SD) change in the number of medications at 3 months was -2.6 (±2.73) in the intervention group and -.36 (±2.60) in the control group (mean difference = 2.25 ± .54; 95% confidence interval [CI] = 1.18-3.32; P

Aim To explore the mobilization of nurses/midwives in a designated hospital group in Ireland during a global pandemic. Background The recent global pandemic has resulted in the large-scale worldwide mobilization of registered nurses and midwives working in the acute care sector. There is a dearth of literature reporting the mobilization of this professional workforce. Method Mixed-methods design using an electronic survey and facilitated discussion across one Irish hospital group. Results Eight of 11 hospitals responded to the survey. There was a 2% vacancy rate prior to the pandemic. Mobilization included reconfiguration of clinical areas and redeployment of 9% of the nursing/midwifery workforce within 2 weeks of the pandemic. A total of 11% (n = 343) of nurses/midwives were redeployed in 3 months. Nurses/midwives required re-skilling in infection prevention control, enhancement of critical care skills and documentation. Conclusions Three key areas were identified to enable the nursing workforce readiness. These are referred to as the three 'R's': Reconfiguration of specific resources, Redeployment of nurses to dedicated specialist areas and Re-skilling of nurses to safely care for the patients during the pandemic. Implications for nursing management A centralized approach to reconfiguration of clinical areas. Redeployment is enabled by closing non-essential departments. Hands-on re-skilling and reorientating staff are essential.

Objective To investigate the association between potentially serious alcohol–medication interactions (POSAMINO criteria), hypothesised to increase the risk of falls in older adults, and falls in community-dwelling older adults at two and 4 years follow-up. Design A prospective cohort study. Setting The Irish Longitudinal Study on Ageing. Subjects A total of 1,457 community-dwelling older adults aged ≥65 years, with a complete alcohol and regular medication data to allow for the application of the POSAMINO criteria. Outcomes Self-reported falls at 2 and 4 years follow-up, any falls (yes/no), injurious falls (yes/no) and number of falls (count variable). Results The number of participants who reported falling since their baseline interview at 2 and 4 years were 357 (24%) and 608 (41.8%), respectively; 145 (10%) reported an injurious fall at 2 years and 268 (18%) at 4 years. Median (IQR) number of falls was 1 (1–2) at 2 years and 2 (1–3) at 4 years. Exposure to CNS POSAMINO criteria, hypothesised to increase the risk of falls due primarily to increased sedation, was associated with a significantly increased risk for falling (adjusted relative risk (RR) 1.50, 95% confidence interval (CI) 1.21–1.88) and for injurious falls (adjusted RR 1.62, 95% CI: 1.03–2.55) at 4 years. These equate to an absolute risk of 19% for falling (95% CI: 5–33%) and 8% for injurious falls (95% CI, 4–20%) at 4 years. Conclusions Assessment and management strategies to prevent falls in community-dwelling older adults should consider patients’ alcohol consumption alongside their assessment of patient medications, particularly among those receiving CNS agents.

Background Adverse drug reactions (ADRs) are common and have serious repercussions for older-adults. This descriptive-analysis elucidates clinical presentations, severity and responsible drugs of incident ADRs in the SENATOR (Software ENgine for the Assessment & optimization of drug and non-drug Therapy in Older peRsons) phase I feasibility study. Methods SENATOR-phase-I was a European multicentre-prospective-observational study. Participants were ≥ 65 years, experiencing acute-hospitalisation and on pharmacological treatment for ≥ 3 conditions. Adverse events (AEs) were identified by trigger list at recruitment, day-14/discharge and classified as ADRs when association with an administered drug was adjudicated as being probable/certain, according to the World Health Organization Uppsala Monitoring Centre ADR causality criteria. Results Of 644 participants recruited, 382 (59.1%) experienced 732 AEs, 363 AEs (49.6%) being incident. 139 participants (21.6%) experienced 177 (48.8%) ADRs. Full drug details were recorded in 156 patients (88%). Cardiovascular-system drugs accounted for one-third of ADRs (55, 35.3%). Five drug classes caused three-quarters of ADRs (135, 76.3%); diuretics 28.2% (furosemide 24.4%), opioid analgesics 16.7%, anti-bacterials for systemic use 14.1%, anti-thrombotic agents 10.3%, and drugs used in diabetes 7%. 68 patients (10.6%) experienced 81 (45.8%) clinically significant moderate-severe ADRs. Significant serum electrolyte disturbance (32, 18.1%), acute kidney injury [AKI] (22, 12.4%), unspecified adverse event (UAE; 21, 11.9%), dyspepsia/nausea/vomiting (20, 11.3%), new-onset major constipation (19, 10.7%) were the most common presentations of ADRs, accounting for 114, (64.4%) of all ADRs. In moderate-severe ADRs; AKI (12, 14.8%), acute bleeding (11, 13.6%), new-onset major constipation (11, 13.6%), UAE (11, 13.6%), significant serum electrolyte disturbance (10, 12.4%) were the most common presentations. Conclusion This analysis highlights that; 1-in-5 older adults will experience an incident ADR during acute hospitalisation. 1-in-10 patients experience moderate-severe incident ADRs. 3-of-4 ADRs were caused by 5 drug classes (diuretics, opioids, anti-bacterials, anti-thrombotics and anti-diabetic agents). This study allows for identification of potentially high risk medications which could be targeted for future ADR prevention.

Background Older people with advanced frailty are commonly prescribed lengthy, burdensome medication regimens. When life expectancy is likely to be limited, many of the prescribed drugs may be inappropriate. STOPPFrail Criteria were developed in 2016 to assist clinicians with deprescribing decisions in frail older people with limited life expectancy. Due to an expanding evidence base, updating of the criteria was required. Methods A focused literature review was performed to reassess the original criteria and propose new criteria. Eight panelists, with expertise in geriatric medicine, general practice, palliative medicine, psychiatry and clinical pharmacology, reviewed and critiqued a new draft of STOPPFrail criteria. The revised list of criteria was then validated using Delphi consensus methodology. Results The expert panel agreed a final list of 27 criteria after two Delphi validation rounds. STOPPFrail version 2 proposes a method for identifying older people approaching end-of-life and emphasizes shared decision making in the deprescribing process. New criteria relating to the discontinuation of anti-hypertensive medications, anti-thrombotic therapies and vitamin D are included. Conclusion STOPPFrail version 2 has been expanded and updated for the purpose of assisting clinicians with deprescribing decisions in frail older adults approaching end-of-life. The criteria are based on an up-to-date literature review and consensus validation among a panel of experts.

Background Age-related syndromes of cognitive impairment, including delirium and dementia, are becoming more prevalent in our hospitals. Patients with cognitive impairment are often unable to provide information relating to their pre-morbid cognition and function as well as their admission diagnosis. Such information is essential to correctly identifying delirium and dementia, as well as making an accurate diagnosis and planning appropriate treatment. It is the standard of care recommended by both the Irish National Audit of Dementia 2014 and the UK National Audit of Dementia Care 2017 that a collateral history is obtained. Methods We reviewed the medical notes and conducted brief structured interviews with nursing staff for 100 medical inpatients aged ≥75. Results Only 44% of patients with cognitive impairment had a collateral history. Half of patients described as having dementia did not have any further detail on the severity of dementia documented. 80% of collateral histories were sourced by the admitting NCHD; if the collateral history was not obtained on admission, it was unlikely to be obtained at all. Among those for whom a collateral history was obtained, the level of detail regarding pre-morbid cognition, function, mobility and continence was sparse. The most common informant was the patient’s son or daughter (66%), followed by spouse (16%). Only 13% of patients had formal cognitive testing. Conclusion Acute illness characteristically causes significant impairments in cognition and function in frail older patients. Identifying and reversing these impairments is impossible without a comprehensive collateral history. It is alarming that such an essential component of clinical assessment is so often disregarded and highlights the lack of awareness from clinicians of the importance of collateral history in the management of patients with dementia and delirium. This must be emphasised in both undergraduate and postgraduate teaching. An appropriate admission proforma would also promote competent collateral history taking.

Background The adverse effects of inpatient falls are well known. The harms of unwarranted bedrest and prolonged immobilisation present insidiously but, arguably, have a greater impact. Deconditioning, itself, is a major contributor to falls in older adults. There is still a troubling assumption that falls can be prevented through restraint and preventing at-risk patients from mobilising. Methods We reviewed medical and nursing notes and conducted brief-structured interviews with nurses and brief bedside observations for medical inpatients aged ≥75. We constructed a research template based on the UK National Falls audit 20151 and the Hospital Elder Life Program (HELP) - mobility toolkit2. We included all patients on medical wards over the age of 75, admitted for 3 or more days. We excluded patients who were critically unwell or imminently dying. Results We reviewed 100 medical inpatients aged over 75. Patients’ mobility deteriorated significantly from their baseline, with 73% of patients requiring assistance compared to 22% at baseline. PJ paralysis was endemic with only one third of patients wearing day clothes. 75% of patients spent more than half of the day in bed. There were 8 falls during the entire study period. Poorer levels of mobility correlated with delirium and incontinence. Conclusion The deleterious effects on older patient of the traditional model of acute hospital care with gratuitous bedrest are universally acknowledged. Falls should be prevented through supervision rather than restraint. Campaigns such as “End PJ Paralysis” and the HELP mobility toolkit can enable a cultural change within hospitals. Such change is impossible without the staffing and leadership to endorse it.

Background Medication errors during unplanned hospital admissions are common in Parkinson’s Disease, often involving late or missed doses. These errors can result in serious complications and loss of function in these patients. Several Parkinson’s Disease networks and associations have run campaigns aiming to improve medication administration in hospital. Methods We reviewed the medical notes and medication charts of 20 patients with Parkinson’s Disease admitted through the Emergency Department. Medication charts were reviewed to assess for levo-dopa containing medications. We assessed whether medication dosing and timing was accurately recorded, if medications were administered on time, and if self-management of medication was considered if the patient was capable during the first 48 hours of admission. We measured our findings against standards from NICE guidelines and Parkinson’s UK. Results Only 9 of 20 cases had the times and doses accurately documented on admission. An average of 2.7 doses/patient were missed or delayed in the 48 hour period. Of 152 total doses, 54 (35%) were missed or late. Only 3 out of 20 patients received all their medications on time. Only one out of 20 patients had a documented order to be allowed to self-manage their medication. Conclusion Medication errors and omissions during unplanned hospital admissions in patients with Parkinson’s Disease are unsurprisingly common. Many doctors are unaware of the need to provide alternative routes of delivering levo-dopa for patients with Parkinson’s Disease who are fasting or unable to swallow. Patients with Parkinson’s Disease are not being empowered to manage their own medication during hospital admission. Educating doctors on the importance of reducing these medication errors, and the existence of the OPTIMAL Calculator to convert the patients’ usual medications to alternative preparations, is imperative to improve inpatient management of patients with Parkinson’s Disease.

Background It is well researched that individuals in long-term care (LTC) are prescribed a greater number of medications, the leading risk factor for inappropriate prescribing, and are thus at greater risk of adverse drug reactions as a result. Many tools with explicit criteria are described in the literature for assessing potentially inappropriate prescribing (PIP) in the general geriatric population, but few have been developed to examine prescribing in LTC. Methods This was a point prevalence observational study of patients aged >65 years residing in three HSE-run LTC facilities in Cork. Demographic characteristics, medical diagnoses and medication regimes at time of admission (TOA) to LTC, and time of data collection were recorded and reviewed using STOPPFrail and NORGEP-NH criteria. Results 98 patients met the inclusion criteria, with 66% being female. The median age was 83 years (IQR 77-88 years), and median length of stay was 31 months (IQR 14-53 months). The median number of medications per person on admission was 8 (IQR 6-11), which increased to 9 (IQR 7-11) at time of review (TOR)(p Conclusion Potentially inappropriate prescribing is highly prevalent in older residents of community hospitals using validated prescribing indicators. Criteria such as those used in this study could be used to highlight potentially inappropriate or futile medications in older, vulnerable patients. Regular medication review is recommended to facilitate deprescribing of such medications.

Background The older inpatient population is a particularly frail cohort with high rates of delirium, falls and immobility. These patients require skilled gerontological nursing with high levels of supervision. Despite this, restraints such as bed rails continue to be common. Tethering through intravenous drips and urinary catheters are another form of restraint. Methods We performed a chart review and a bedside observation of patients aged ≥75 on medical wards admitted for ≥72 hours. We excluded patients who were critically unwell or imminently dying. We used the open source software package PSPP to complete the statistical analysis. Results We reviewed 100 patients, of whom 25 were restrained in some way (most commonly by bed rails 80%), 10 were tethered (through intravenous drips, oxygen tubing, urinary catheters and others), 7 were in isolation for infection control reasons. Restraint was associated with greater dependence in mobility and function, reduced time out of bed (Mann Whitney, P< 0.05), delirium and incontinence (chi square, p Conclusion Patients who are restrained are clearly frailer, more dependent, spend more time in bed, have higher rates of delirium and incontinence. These are particularly vulnerable patients who need high levels of attention from both medical and nursing staff. Supervision is always superior to restraint but requires investment in staff and resources. Patients who are isolated are also more physically dependent. Tethering should be minimised. Simple measures such as leg bags are underused.

Background The objectives of this study were to identify the prevalence of severe drug interactions (SDIs) and potentially inappropriate prescriptions (PIPs) in older adults with cancer. Methods A 12-month prospective observational study of patients ≥65 years admitted to an oncology centre was conducted. SDIs were assessed using Stockley’s interaction checker; PIPs were identified using STOPP/START criteria. Logistic regression was applied to determine the influence of age, gender, co-morbidities and medication number on the likelihood of an SDI and a PIP. Results We enrolled 186 participants; mean age 72.5 (SD5.7) years, 46.2% female, mean co-morbidity number 7.5 (SD3.4), median medication number 7 (IQR4-9). Polypharmacy (≥6 medications) and major polypharmacy (≥11 medications) were identified in 60.8% and 17.7% respectively. Systemic anti-cancer therapies (SACTs) were concomitantly prescribed to 60.2%. SDIs were identified in 50.5% participants; 7.5% ≥1 SACT-SACT SDI, 41.4% ≥1 drug-drug SDI and 10.2% ≥1 drug-SACT SDI. The most common SDIs were beta-blocker/alpha-blocker (n=12), Selective serotonin re-uptake inhibitor (SSRI)/proton pump inhibitor (PPI) (n=11) and SSRI/Aspirin (n=8). A strong correlation between medication and SDI number was identified (r2=0.61, p-value PIPs were observed in 73.1%; median 2(IQR1-3). The most common PIPs were drugs prescribed beyond the recommended duration (46.8%), high-dose PPIs >8 weeks (34.9%) and regular opioids without laxatives (20.4%). Patients prescribed ≥1 PIP had more co-morbidities (8.4(SD3.4) vs 5.2(SD2.4), p< 0.001), a higher cumulative illness rating score (18(IQR12-20) vs 11(IQR10-14), p Conclusion SDIs and PIPs are common in older adults with cancer and higher than previously reported. Comprehensive specialist medication evaluation, by a Geriatrician, may benefit patients.

Background With increasing numbers of older multi-morbid people being exposed to polypharmacy, research needs to focus on medication-related outcomes affecting quality-of-life (QoL). This study examines older-patients’ medication-related QoL (MRQoL), its relationship to medication burden/complexity, frailty, health-related QoL (HRQoL) and potentially inappropriate medications (PIMs. Methods A cross-sectional-study was conducted in older-patients attending out-patients and day-hospital services of a tertiary-teaching-hospital. Participants were aged ≥65 years, first-time attendees, taking ≥5 chronic-medications for ≥3 chronic-conditions and mini-mental state examination score ≥26/30. Demographic, medication, comorbidity, frailty status, PIMs(STOPP/STARTv.2 criteria), MRQoL (MRQoL-LS v1.0) HRQoL (Short-form-12; SF-12) and medication burden (Living with Medicines Questionnaire v.2; LMQv2) data were collected. Drg compliance was measured using the Medication Adherence Rating Scale (MARS). Lower MRQoL-LS v1.0 scores indicate better MRQoL (range 0-84). Higher LMQv2 scores indicate higher medication burden (range from 60-300). A negative age-specific mean-difference score in SF-12 physical and mental health composite scale scores (SF12-PCS, SF12-MCS) indicates poorer health. Results Over 12 months, 234 patients (attending 78 clinics) were screened, 59 met inclusion criteria and 30 were recruited; 3 patients were subsequently identified as ineligible. Eighteen patients were female (66%), mean age was 79.4 years (SD±6.2), median number of daily medications was 10 (IQR 8-13), median number of comorbidities was 11 (IQR 9-14). Participants were generally drug-compliant, median MARS score of 9 (IQR 6.5-10). Patients’ median MRQoL score was 14 (IQR 14-22.5); mean LMQ v2 score was 115.64 (SD± 25.18). Mean age specific mean-difference SF12-PCS and SF12-MCS scores were -22.61 (SD±11.7) and -22.1 (SD±17.5) respectively. There was no significant correlation between MRQoL and number of daily medications, number of comorbidities, LMQ, HRQoL, or PIMs(Pearson’s 2-tailed test). Conclusion This study demonstrates that MRQoL-LS v.1 is not applicable to most patients attending geriatric ambulatory services. Furthermore, polypharmacy, multimorbidity, presence of PIMs poorer HRQoL do not correlate significantly with MRQoL.

Background Older people with advanced frailty are among the highest consumers of prescription medications. When life expectancy is limited, the use of multiple medications may be unnecessary or burdensome. STOPPFrail criteria were recently developed to assist clinicians with deprescribing decisions in frail older people approaching end-of-life. The aim of this study was to examine whether long-term medications could be safely discontinued in frail older people using STOPPFrail criteria. Methods We recruited hospitalized adults aged ≥75 years with polypharmacy (≥5 long-term medications) that were transitioning to nursing home care. Participants were eligible if their Clinical Frailty Scale score was ≥7 and if their attending physician indicated that he/she “would not be surprised if the patient died in the next 12 months”. Patients were randomized to single time point pre-discharge STOPPFrail-guided deprescribing or routine pharmaceutical care. The primary outcome was change in the number of regular medications at 3 months. Secondary outcomes included emergency hospital transfers, incident falls, fractures and mortality. Results Results are presented for the first 100 enrolled patients. The mean (±standard deviation [SD]) age of study participants was 85.1 (±5.7) and 61% were female. Intervention (n = 49) and control group (n = 51) participants were prescribed a mean (±SD) of 11.5 (±3.0) and 10.9 (±3.5) regular medications, respectively, at baseline. The mean (±SD) change in the number of regular medications at 3 months was -2.7 (±2.8) in the intervention group and -0.6 (±2.6) in the control group (estimated difference 2.1 ±0.6, 95% confidence interval 0.8 -3.3, p=0.001). Ten intervention participants and 14 control participants died within 3 months of randomization (20.4% vs 27.4%, p=0.49). There was no significant difference between groups for emergency hospital transfers, incident falls or fractures. Conclusion STOPPFrail-guided deprescribing significantly reduced medication burden in frail older people without adversely affecting clinical outcomes in the prospective 3 months.