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Moloney K, Byrne T, Mathews S, Foran M, Conroy B, Molamphy A, Murphy N, Dillon A, Doyle K, Cunningham C, Romero-Ortuno R. 82 THE IMPACT OF THE COVID-19 PANDEMIC ON THE ACTIVITY OF A RAPID-ACCESS GERIATRIC DAY HOSPITAL SERVICE. Age Ageing 2022. [PMCID: PMC9620317 DOI: 10.1093/ageing/afac218.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background In the 1970s, Jack Flanagan developed the first Geriatric Day Hospital (GDH) in Ireland. Since, the GDH model of care has evolved to accommodate for the growing demands of our ageing population. Before the COVID-19 pandemic, the operational scope of our GDH was extended to allow for the rapid medical and multidisciplinary assessment and follow-up of older patients. During the pandemic, the GDH did not suspend operations and remained open as a COVID-negative ambulatory pathway. We evaluated the activity of this GDH service. Methods Retrospective Service Evaluation Approval was granted by our Research & Innovation Office (Reference: 7419). Pseudonymised data corresponding to all GDH attendances between January 2017 and December 2021 were retrieved from the hospital electronic records. Yearly trends in proportions were tested with the Chi-square for trend statistic. Trends in monthly attendances were assessed via Statistical Process Control (SPC) charts with three-sigma limits. Statistical significance was set at p<0.05. Results There were 27,278 attendances of patients aged 65 and over to the GDH over the 5-year period (6,362, 5,978, 6,115, 4,306, and 4,517, respectively). Mean age was 82 every year. Of the 7,813 new episodes, yearly proportions referred directly by primary care teams were 10.4%, 29.5%, 38.6%, 24.5%, and 16.3% (p<0.001). SPC charts showed that Apr-May 2020 and Jan-Feb 2021 had significantly lower numbers of review attendances (50-59 and 146-142, respectively, average 324 p/m). However, new appointments did not significantly decline (average 130 p/m). Of the 7,813 new episodes, 2,595 (33.2%) were seen by Physiotherapy, and 1,860 (23.8%) by Occupational Therapy. Conclusion Our GDH saw a sustained number of new attendances and demonstrated increased community availability during the unprecedented COVID-19 crisis, especially during the first wave of the pandemic when hospital access was most affected. A rapid access GDH model can facilitate integrated care at times of crisis to promote ageing in place.
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Affiliation(s)
- K Moloney
- St. James's Hospital , Dublin, Ireland
| | - T Byrne
- St. James's Hospital , Dublin, Ireland
| | - S Mathews
- St. James's Hospital , Dublin, Ireland
| | - M Foran
- St. James's Hospital , Dublin, Ireland
| | - B Conroy
- St. James's Hospital , Dublin, Ireland
| | | | - N Murphy
- St. James's Hospital , Dublin, Ireland
| | - A Dillon
- St. James's Hospital , Dublin, Ireland
| | - K Doyle
- St. James's Hospital , Dublin, Ireland
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O'Flaherty N, Moloney K, Ahmad R, Laird E, Hughes C, McNulty H, Ward M, Strain JJ, Molloy AM, Cunningham C, McCarroll K. 135 VITAMIN D FORTIFIED MILK—EFFECT ON VITAMIN D STATUS IN OLDER ADULTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Vitamin D fortified milk is used by some older adults to boost vitamin D status. Combined vitamin D/calcium supplements often cause gastrointestinal upset which reduces adherence. Consumption of fortified milk may be a more consistent and reliable way of increasing serum 25 hydroxyvitamin D [25(OH)D], though studies of it’s efficacy in older adults are limited.
Methods
We examined the vitamin D status of users of vitamin D fortified milk in participants of a longitudinal study of community dwelling Irish adults aged >60 yrs. Patients taking vitamin D supplements were excluded and independent effects were explored in multinomial regression models. Vitamin D deficiency was defined as a 25(OH)D level < 30 nmol/l.
Results
2496 participants were identified: mean age was 70.5 ± 7.0 years (range 60–96 yrs) and 145 (5.8%) reported using vitamin D fortified milk. In those who consumed fortified milk, there was a lower prevalence of vitamin D deficiency (17.9 vs 34.5%, P < 0.001). Vitamin D fortified milk also predicted less deficiency after adjusting for age, gender, season, BMI and physical frailty (OR 0.30. CI 0.19–0.48, P < 0.001).
Conclusion
Vitamin D fortified milk was associated with a 70% reduction in the risk of vitamin D deficiency in older adults not taking vitamin D supplements. Findings support the use of vitamin D fortified milk as an effective means of improving vitamin D status. Fortified milk also contains additional calcium and so can be used to augment daily calcium intake.
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Affiliation(s)
- N O'Flaherty
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - K Moloney
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - R Ahmad
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - E Laird
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - A M Molloy
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Cunningham
- MedEl Directorate, St James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
| | - K McCarroll
- MedEl Directorate, St James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
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Moloney K, O'Flaherty N, Ahmad R, Laird E, Hughes C, McNulty H, Ward M, Strain JJ, Molloy AM, Cunningham C, McCarroll K. 130 PREDICTORS OF DRIVING STATUS IN OLDER IRISH ADULTS ATTENDING A GERIATRIC OUTPATIENT SERVICE. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
The main mode of transportation in Ireland remains travel by car. Transport mobility is important for older adults in accessing shops, healthcare, services, community and in maintaining relationships. Cessation of driving is associated with negative effects on mental health, loneliness and physical health. We aimed to explore factors associated with driving status in older adults living in an urban environment.
Methods
Study included adults aged greater than 65 years attending a geriatric outpatient service in an urban environment and recruited as part of the TUDA (Trinity Ulster, Department of Agriculture) study. We excluded those with a MMSE (Mini-Mental State Exam) less than 24 as we aimed to include only non-dementia patients. Physical frailty was measured with the Timed Up and Go (TUG) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with driving status were explored in multinomial regression models.
Results
1978 adults, mean age 77.7 ± 7.1 years, 76.0% were female. 35.5% were current drivers but this differed by age category 45.9% (65–75 years), 25% (75–85 years) and 12.5% (85+ years). 28.1% were past drivers. Positive independent predictors of current driving were younger age (P < 0.001), male gender (P < 0.001), married status (P = 0.01), higher socioeconomic status (P < 0.0001) while negative predictors included physical frailty (TUG, P < 0.001), visual impairment (P = 0.01), stroke (P < 0.001), depression (P < 0.001) and self reported loneliness (P = 0.01).
Conclusion
One third of patients attending a geriatric outpatients in an urban environment were currently driving which is much lower than in the general older Irish population. However, our study included frail adults living in more deprived socioeconomic areas and had a high proportion of females who had never learned to drive. Furthermore, access to urban public transport may be a factor. Non-drivers were more likely to have depression and report loneliness independent of other factors highlighting its negative impact.
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Affiliation(s)
- K Moloney
- MedEL Directorate, St James's Hospital , Dublin, Ireland
| | - N O'Flaherty
- MedEL Directorate, St James's Hospital , Dublin, Ireland
| | - R Ahmad
- MedEL Directorate, St James's Hospital , Dublin, Ireland
| | - E Laird
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - A M Molloy
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Cunningham
- MedEL Directorate, St James's Hospital , Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - K McCarroll
- MedEL Directorate, St James's Hospital , Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
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Møller LF, Matic S, van den Bergh BJ, Moloney K, Hayton P, Gatherer A. Acute drug-related mortality of people recently released from prisons. Public Health 2011; 124:637-9. [PMID: 20888607 DOI: 10.1016/j.puhe.2010.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The rate of acute drug-related mortality, or overdose deaths, among prisoners in the immediate post-release period is unacceptably high. Such incidents result from many factors, including decreased tolerance after a period of relative abstinence during imprisonment and the concurrent use of multiple drugs which, with every additional illicit drug consumed in combination with opioids, nearly doubles the risk of death from opioids. Other important factors are the lack of pre-release counselling, post-release follow-up and failure to identify those at risk. Substance dependence is a chronic disorder with high relapse rates and often requires long-term continuous treatment. The deaths are preventable and a number of interventions including opioid substitution treatment reduces the risk of overdose among opioid users after release.
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Affiliation(s)
- L F Møller
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.
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