Ableism differs by disability, gender and social context: Evidence from vignette experiments

Existing research on prejudice and discrimination towards disabled people (i.e. 'ableism') has conceptualized it as a general attitude, obscuring the role of social context in its manifestation. We aimed to investigate whether and how ableism manifests differently depending on the nature of the disability, the disabled person's gender and the social context of the interaction. A nationally representative sample of 2000 adults read a series of vignettes about issues faced by disabled people (e.g. employment, relationships). Vignettes varied by presence and type of disability and the disabled person's gender. Judgements about how a disabled person was treated showed clear evidence of ableism towards some conditions (e.g. autism) but not others (e.g. a spine disorder). Judgements about the actions of a disabled person were more nuanced. A disability-gender intersectionality effect was observed for judgements about romantic relationships, with physically disabled women penalized compared to men but no gender difference was observed for intellectual disability. No intersectionality or ableism was observed on a vignette about refusing poorly paid work. We find clear evidence that ableism manifests differently depending on the nature of the individual's disability, their gender and the social context, questioning previous conceptualizations of ableism as a general attitude.

Behavioural evidence on COVID-19 vaccine uptake

OBJECTIVES

The World Health Organization has declared that COVID-19 is no longer a public health emergency of international concern. Nevertheless, it remains a public health issue, and seasonal vaccinations, at the same time of year as influenza vaccinations, will be necessary. When the first vaccines were administered in 2020, decision-makers had to make assumptions about the best methods to communicate and administer vaccines to increase uptake. Now, a body of evidence can inform these decisions.

STUDY DESIGN

A narrative review written by three behavioural scientists who design research for policy.

METHODS

We searched the PubMed database for: (i) reviews of interventions to increase uptake of COVID-19 or influenza vaccines and (ii) empirical studies on uptake of COVID-19 and influenza vaccines. In addition, registered trials gathered by a Cochrane scoping review of interventions to increase uptake of COVID-19 vaccines were searched for updated results.

RESULTS

Results centre around two aspects of a vaccination campaign of interest to policymakers: communication and administration. Results suggest that communications highlighting the personal benefits of vaccination are likely to be more effective than those highlighting collective benefits. The efficacy of vaccination may be underestimated and stressing efficacy as a strong personal benefit may increase uptake. Keeping vaccines free, sending personalised messages, reminders and prebooked appointment times may also increase uptake.

CONCLUSIONS

There is now a body of evidence from behavioural science that suggests how vaccination campaigns for COVID-19 can be structured to increase uptake. These recommendations may be useful to policymakers considering seasonal vaccination campaigns and to researchers generating hypotheses for country-specific trials.

Behaviourally-informed household communications increase uptake of radon tests in a randomised controlled trial

Exposure to radon gas is a leading cause of lung cancer. Testing homes for the gas is straightforward, yet most people do not undertake tests even when offered freely. We report a pre-registered randomised controlled trial of communications to encourage test uptake. Households (N = 3500) in areas at high risk of radon exposure were randomly assigned to receive (i) a the control letter from the national Environmental Protection Agency; (ii) a behaviourally-informed version of the control letter that incorporated multiple nudges, including reciprocity messages and numeric frequencies of risk; (iii) this same behaviourally-informed letter in a re-designed envelope; (iv) the behaviourally-informed letter in the re-designed enveloped with a radon risk map of the household's county. The behaviourally-informed letter led to a large increase in test uptake, from 22% in the control condition to 33% (a 50% increase). There was no additional benefit of the re-designed envelope, which generated uptake of 30%. Including the map led some households to respond faster, but the overall uptake (26%) was weaker. The results have implications for public health communications with households and show the potential for techniques from behavioural science to help mitigate environmental risks.

Specialist Palliative Care and Dementia: Staff Challenges and Learning Needs

Objective: This study explored the perspectives of specialist palliative care (SPC) teams in Ireland, in relation to personal learning needs and education regarding dementia care. Methods: This mixed-methods study involved a survey and focus group. SPC staff were recruited through a professional palliative care society and via hospices in 4 regions. Survey items included challenges in clinical care, personal learning needs, and preferred modes of educational delivery. Quantitative data analysis was descriptive; open-answer survey questions and the focus group transcript underwent thematic analysis. Results: In total, 76 staff completed surveys and rated the following as most challenging: timely access to community agency and specialist support; and managing the needs of people with dementia (PwD). Respondents volunteered additional challenges around the timing/duration of SPC involvement, prognostication, and inadequate knowledge of local services. Staff ranked learning needs as highest in: nonpharmacological management of noncognitive and cognitive symptoms; differentiation of dementia subtypes; and pharmacological management of cognitive symptoms. The focus group (n = 4) gave deeper perspectives on these topics. Overall, 79.2% of staff preferred formal presentations by dementia-care specialists and 76.6% preferred e-learning. Conclusion: Several dementia-care challenges and learning needs are identified by SPC staff, as above. These can inform the design and delivery of tailored education programs for SPC staff. There is also a need for closer working between dementia services and SPC services to provide integrated, holistic care for PwD. One aspect of achieving this is greater awareness of local dementia-care services among SPC staff, and vice versa.

Is it riskier to meet 100 people outdoors or 14 people indoors? Comparing public and expert perceptions of COVID-19 risk

People have limited capacity to process and integrate multiple sources of information, so how do they integrate multiple contextual risk factors for Coronavirus disease (COVID-19) infection? In June 2020, we elicited risk perceptions from a nationally representative sample of the public (N = 800) using three psychologically-distinct tasks. Responses were compared to a sample of medical experts who completed the same tasks. Relative to experts, the public perceived lower risk associated with environmental factors (such as whether a gathering takes place indoors or outdoors) and were less inclined to treat risk factors as multiplicative. Our results are consistent with a heuristic simply to "avoid people" and with a coarse (e.g., "safe or unsafe") classification of social settings. A further task, completed only by the general public sample, generated novel evidence that when infection risk competes with risk in another domain (e.g., a different medical risk), people perceive a lower likelihood of contracting the virus. These results inform the policy response to the pandemic and have implications for understanding differences between expert and lay perception of risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Approaches to co-production of research in care homes: a scoping review

BACKGROUND

Using the technique of co-production to develop research is considered good practice. Co-production involves the public, practitioners and academics working together as equals throughout a research project. Co-production may help develop alternative ways of delivering care for older adults that are acceptable to those who live and work in care homes. However, guidance about applying co-production approaches in this context is lacking. This scoping review aims to map co-production approaches used in care homes for older adults in previous research to support the inclusion of residents and care staff as equal collaborators in future studies.

METHODS

A scoping review was conducted using the Joanna Briggs Institute scoping review methodology. Seven electronic databases were searched for peer-reviewed primary studies using co-production approaches in care home settings for older adults. Studies were independently screened against eligibility criteria by two reviewers. Citation searching was completed. Data relating to study characteristics, co-production approaches used, including any barriers and facilitators, was charted by one reviewer and checked by another. Data was summarised using tables and diagrams with an accompanying narrative description. A collaborator group of care home and health service representatives were involved in the interpretation of the findings from their perspectives.

RESULTS

19 studies were selected for inclusion. A diverse range of approaches to co-production and engaging key stakeholders in care home settings were identified. 11 studies reported barriers and 13 reported facilitators affecting the co-production process. Barriers and facilitators to building relationships and achieving inclusive, equitable and reciprocal co-production were identified in alignment with the five NIHR principles. Practical considerations were also identified as potential barriers and facilitators.

CONCLUSION

The components of co-production approaches, barriers and facilitators identified should inform the design of future research using co-production approaches in care homes. Future studies should be explicit in reporting what is meant by co-production, the methods used to support co-production, and steps taken to enact the principles of co-production. Sharing of key learning is required to support this field to develop. Evaluation of co-production approaches, including participants' experiences of taking part in co-production processes, are areas for future research in care home settings.

76 HOW BLOGS SUPPORT THE TRANSFER OF KNOWLEDGE INTO PRACTICE IN THE FIELD OF DEMENTIA PALLIATIVE CARE: FACILITATORS AND BARRIERS

Background

Blogging can help to maximise the impact of one’s work in academia and beyond by making research findings accessible for multiple knowledge users. As part of the knowledge exchange and dissemination activities of the Model for Dementia Palliative Care Project, this study explored stakeholders’ views of blogs as a means to translate research findings in the field of Dementia Palliative care.

Methods

A web-based survey was developed, piloted, and revised. It was distributed electronically via key dementia and palliative care organisations. Complete responses (N=128) were received from healthcare researchers (n=53), healthcare providers (n=46) and others with an interest in healthcare research (n=29). Data were analysed using descriptive statistics and content analysis

Results

The preferred methods of reviewing research findings were scientific papers, websites and news articles. Respondents read healthcare blogs “sometimes” (39.1%), with <19% reading them “often” or “very often”. Receiving an email notification might increase the likelihood of reading a new blog post for 83% of respondents. Barriers to engaging with blogs included lack of time, preference for other media, lack of awareness regarding available blogs, and concerns about the credibility and source of information. An appropriate length and the author of the blog were key features that encouraged engagement with a blog. Most respondents (37.7 % ‘Yes’ and 23.0% ‘Maybe’) would read Dementia Palliative care blogs by the research team.

Conclusion

Despite respondents choosing a scientific paper as their preferred method to consume research findings, many indicated an openness to reading blogs on their area of interest. Creating concise, relevant, and credible blogs, and suitably promoting them, could increase the impact and reach of healthcare research, such as in the emerging field of dementia palliative care, and thus promote translation of research findings into practice.

75 EVALUATING DEMENTIA PALLIATIVE CARE SERVICES ACROSS IRELAND AND THE UK USING THE RE-AIM FRAMEWORK

Background

Dementia is a life-limiting illness, requiring a Palliative Care (PC) approach from diagnosis. In Ireland, People with Dementia (PwD) and their families rarely receive PC in a timely manner. This study aimed to evaluate five exemplar community-based dementia PC services across Ireland and the UK (as identified by key stakeholders), to inform a new service delivery model.

Methods

Data from semi-structured interviews and focus groups with 29 service providers, and service activity data (n=5), was evaluated using the RE-AIM framework.

Results

‘Reach’ - Caseloads varied significantly between 3-154 active cases. Most services accepted self-referrals; all wanted earlier referrals. Factors influencing reach included co-location, dyadic participation, service flexibility, and others’ awareness of PC appropriateness and the service’s existence.

‘Effectiveness’ - All service users received holistic assessments, person-centred care, advanced care planning, continuity of care, improved service access and ‘care-for-the-carer’. Some services offered complimentary therapies, 24/7 phone support, and bereavement support; these were perceived to improve quality-of-life, comfort, and independence.

‘Adoption’ - Staff were highly invested; some provided their personal numbers to families. Outside staff were more willing to engage (refer/support) if shared governance, training was provided, or already familiar with dementia or the tools. Incentive programmes increased adoption rates.

‘Implementation ’ - All services evolved on an ad-hoc basis, with funding provided by local organisations, and a single ‘driving force’, typically a consultant/nurse. Services heavily relied on volunteers. Perceived “essential” elements included a dyadic approach, MDT involvement, open communication, forming relationships, reflective practices, dedicated staff with problem solving skills, and staff support/training.

‘Maintenance’ - All services continued after initial project funding; three increased their activities/reach over time.

Conclusion

Important features and facilitators of community-based dementia palliative care services have been identified. These results are informing the development of the novel Dementia Palliative Care model for use in Ireland (https://pallcare4dementia.com/).

39 CAN BEHAVIOURAL CHANGE INTERVENTIONS IMPROVE SELF-EFFICACY AND EXERCISE ADHERENCE AMONG PEOPLE WITH PARKINSON’S? A SYSTEMATIC REVIEW

Background

People with Parkinson’s (PwP) lead sedentary lifestyles compared to healthy peers. Personal influences including low self-efficacy and poor outcome expectation appear to predict exercise adherence more accurately than disease severity. The purpose of this review is to identify successful behavioural-change interventions that promote self-efficacy and exercise adherence among PwP.

Methods

Databases including EBSCO, Medline, CINAHL, Web of Science, PubMed, Embase, Scopus, Google Scholar and Cochrane Library were searched from inception to 2020. Interventional studies including a behavioural-change intervention were included. Title, abstract and full-text screening was conducted by two independent reviewers. The Cochrane Risk of Bias Tool and Robins-I were used to assess the Risk of Bias. Data was extracted by two independent reviewers. The outcomes of interest were self-efficacy, quality of life, physical function, and exercise adherence. A narrative synthesis was completed and mapped to the Theoretical Domains Framework, to produce practice-orientated outcomes.

Results

Seventeen studies (n=1319) were included. Risk of bias was generally moderate. A multicomponent behavioural-change intervention encompassing education, behavioural strategies and support groups appeared to improve quality of life, physical function, and exercise adherence in PwP. No intervention improved self-efficacy. Self-monitoring, goal setting, social supports, feedback, self-managements skills and action planning improved long-term adherence.

Conclusion

No intervention changed self-efficacy. However, it appears that a multicomponent intervention is essential to improve exercise adherence. Trials directly comparing different intervention types and adequate follow-up periods are limited, preventing a conclusive finding of the most effective behavioural-change intervention to promote exercise adherence among PwP.

18 EDUCATION AND TRAINING TO SUPPORT PHYSIOTHERAPISTS WORKING IN DEMENTIA CARE: A SCOPING REVIEW

Background

Physical impairments associated with dementia include loss of mobility, diminished postural control and reduced muscle strength, which in turn can lead to an increase in falls, hip fractures and frailty. Physiotherapy can play a key role in many aspects of dementia care. Physiotherapists have reported carrying a high caseload of people with dementia. However, there is a paucity of evidence as to what constitutes effective dementia education and training for physiotherapists. The aim of this scoping review was to explore and map the evidence relating to education and training for physiotherapists, with a view to using these findings to inform the design and delivery of an educational program for physiotherapists.

Methods

This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. The protocol for this review was published in March 2021. This review included studies that examined dementia education and training for the wider healthcare team if physiotherapy was an included profession. All studies with a focus on any aspect of physiotherapy dementia education and training were included. Studies conducted in any setting, including acute, community care and residential or any educational setting were included. A chronological narrative synthesis of the data outlined how the results relate to the objectives of this study.

Results

A total of eleven papers were included. The principal learning outcomes evaluated were knowledge, confidence and attitudes. Immediate post intervention scores showed an improvement in all three outcomes. Most educational interventions reached Kirkpatrick level 2, which evaluates learning. A multi-modal approach, with active participation and direct patient involvement seems to enhance learning.

Conclusion

Allowing for the heterogeneity of intervention design and evaluation, some common components of educational interventions were identified that led to positive outcomes. This review highlights the need for more robust studies in this area. Further research is needed to develop bespoke dementia curricula specific to physiotherapy.

245 A PILOT STUDY EVALUATING USE AND ACCEPTABILITY OF A NATIONAL AUDIT TOOL AND MANUAL FOR PSYCHOTROPIC MEDICATIONS IN RESIDENTIAL CARE

Background

Psychotropic medications are frequently prescribed for long-term care residents, even though the risks frequently outweigh the benefits. A draft tool was developed for self-audit of the appropriateness of psychotropic medications prescribed for non-cognitive symptoms for people with dementia in Residential-Care Facilities (RCF). Prior to national use, the audit tool, audit manual and training required piloting.

Methods

The case notes of ten residents with dementia were selected at random within a single RCF. A set of notes were audited by professional staff after online (pre-recorded) audit training, with subsequent feedback by the auditors on the process via focus groups/individual interviews. A second set of notes were then audited, with feedback via a brief survey.

Results

All auditors (7 nurses, 4 doctors, and 4 therapists) gave feedback via a focus group(n=4) or 1:1 interviews; 7 also completed the second-round survey. The pre-audit online training was welcomed but some auditors required additional support during the audit, especially if inexperienced or if there was a gap between training and audit performance. Improvement suggestions for the audit manual included shortening it; adding a glossary of terms, and additional information for decisions on the appropriateness of “as needed” (PRN) medications. Auditors reported difficulties with reading handwriting, locating information in the chart, and determining if a medication was newly or previously prescribed on occasion (due to inconsistencies with prescribing documentation).

Conclusion

Overall, the feedback was positive; all reported that the audit was relevant to their practice, and the manual and online training were useful. Future audits could be facilitated by electronic prescriptions, protected time to complete audits, and site audit leads (senior nursing or medical staff who are familiar with the residents, the audit topic, and with performing the audit). Inexperienced auditors should have, in addition to a training session, a supported auditing session.

36 WHAT DO OLDER ADULTS AND HEALTH CARE PROFESSIONALS LOOK FOR IN A FOOD PRODUCT?

Background

The Mediterranean diet (Medi-diet) has proven benefits for healthy ageing but isn’t the habitual diet of most middle-aged or older adults in Ireland; there can be accessibility and tolerability issues with high amounts of fresh fruit and vegetables. Providing key Medi-diet nutrients in a food product is a novel approach to this challenge. This research aims to explore what ‘younger-old’ adults and healthcare professionals (HCPs) would value in such a novel food product.

Methods

Semi-structured 1:1 interviews and Focus Groups (FGs) were conducted remotely from July 2021 to January 2022. Older adults, defined as over 55’s, were recruited through relevant social, retirement and disease-support groups. Purposive sampling recruited a gender balance and a range of ages and disease profiles. HCPs were recruited through researcher networks and professional associations. Interviews/FGs were recorded, transcribed, and subsequently examined using inductive thematic analysis.

Results

Older adults (n=47; 50% male) were mostly aged 60-69 years (48.9%). Recruited HCPs (n=26) included dieticians (n=8); geriatricians (n=5); therapists (n=4); and nurses, pharmacists, catering managers (community; residential), and meal delivery service coordinators (n=2 each). Participants supported a food product for older adults requiring a nutrient-dense “boost”, or supplementary fibre or protein, but generally preferred a “food-first” approach, as opposed to a “silver bullet” product. Older adults largely associated functional foods with probiotic products “to repair the gut”, something to have “every now and then”. Product texture and portion size should consider changing dentition and appetite, and consider packaging (dexterity) and preparation ease, but should not stigmatize older adults through targeted branding. Participants felt pre-made soups or cake-type bars would be appealing, but not drinks.

Conclusion

A novel food product could supplement a balanced diet for older adults, providing high-protein content, and high-fibre for gut health, complimenting an overall lifestyle approach to health improvement and disease prevention.

924 EXPERIENCES OF HEALTH SERVICE USE FOR PEOPLE LIVING WITH PARKINSON’S DISEASE: A NATIONAL SURVEY

Introduction

Despite the growing prevalence of Parkinson’s disease (PD), and the need to plan for future health service provision, very little is known in the Irish context about PD patients’ experiences of health service access and use.

Method

A cross-sectional survey design, with multiple formats, i.e. online, pen-and-paper, and telephone. Data were collected from May 2020–July 2021 using a multipronged recruitment strategy. It could be completed by a person with PD, or a support person on behalf of/with the person. Survey development was informed through literature review, and in consultation with the Parkinson’s Association of Ireland, and a patient advisory group (N = 10).

Results

A total of 1,504 individuals accessed the survey, with 1,402 meeting the eligibility criteria. Over half (53%) were male. Approx. 9% were diagnosed with young-onset PD. A minority (6%) reported attending only their GP to manage their PD, with the rest attending a specialist outpatient clinic. The mean distance travelled each-way to outpatient clinics was 45.6 km (SD = 49.4, min 1 km, max. 300kms). Most were diagnosed by Neurologists (84%), followed by GPs (8%), and Geriatricians (7%); 1% indicated ‘other’. Of those diagnosed by a Neurologist or Geriatrician, most were diagnosed privately (68%); though 37% of these patients subsequently switched to the public system for ongoing management. The majority (97%) reported currently taking PD medications, but just 52% believed these were working effectively. Just over one-fifth (22%) had access to a PD nurse specialist. Access to the range of other health and social care professionals is also reported, and is universally poor for this patient group.

Conclusion

A number of significant gaps in PD care have been identified, which require urgent attention. A reconfigured model of PD care is necessary to accommodate the growing need for specialist, integrated care at the population level.

80 THE EXPERIENCE OF ACCESSING PARKINSON’S DISEASE CARE: A QUALITATIVE INTERVIEW STUDY

Background

Little is known about the experience of health service access amongst people living with PD in Ireland.

Methods

Semi-structured telephone interviews were conducted from April 2020–January 2021. Purposive maximum variation sampling was employed, to ensure diversity. Recruitment was multipronged; through voluntary support groups, social media outlets, local newspaper, magazine and radio advertising, and posters in nursing homes and GP offices. Interviews ranged from 30–90 minutes and were audio-recorded. The data were managed using NVivo12. A thematic analysis was applied.

Results

Twenty-two participants were interviewed. Four themes were identified relating to service access: 1) ‘The Two Waitlists’; 2) ‘Geographic Factors’; 3) ‘The Private-Public Switch’; and 4) ‘Discriminatory Practices’. Regarding theme 1, the lengthy public waiting list was a deterrent, leading many to pay out-of-pocket to obtain their PD diagnosis privately. However, many cannot afford to pay out-of-pocket, creating a distinct inequity in terms of timely access for those with fewer resources. Additionally, post-diagnosis, the wait times between outpatient follow-up visits is significantly greater for public patients. The second theme refers to the distribution of PD services across the country; the concept of the ‘postcode lottery’ was recurring. Substantial variation in service provision is evident, with rural areas being particularly under-served. The ‘Private-Public Switch’ refers to a pattern of transfer from the private to the public system, post-diagnosis, to access to the range of HSCPs necessary for optimal PD management. Finally, ‘Discriminatory Practices’ refers to perceived discrimination by referring healthcare professionals, at two levels, on the basis of 1) age, and/or 2) perceived severity of disability. Such practices can affect timely access to diagnosis, and ongoing integrated PD management.

Conclusion

The two-tier health system structure, along with under-provision of integrated, outpatient PD services in certain areas, and biases/lack of knowledge amongst referring healthcare professionals, have contributed differentially to inequities in access for public and private PD patients across Ireland.

82 INVESTIGATING LEARNING NEEDS, OUTCOMES, AND CURRICULA IN HEALTHY AND ACTIVE AGEING: A SCOPING REVIEW AND MULTINATIONAL SURVEY

Background

Older people are projected to make up almost one third of the European population by 2060. Healthy and active ageing (HAA) and age-friendly society frameworks offer a method to capitalise on this increasingly older demographic. To inform a new online EU-based taught masters programme, a scoping review and subsequent multinational survey were conducted to identify potential students’ learning needs related to these frameworks.

Methods

The scoping review included a systematic search of four databases. Data were extracted from 32 studies, guiding the development of an anonymous online survey targeting senior undergraduates and recent graduates; future employers; relevant academics; and other key stakeholders (e.g. advocacy groups, policy-makers, and ‘expert’ older people). Participants ranked the importance of 14 broad topics and linked subtopics on a Likert scale, and suggested other key topics. Descriptive data from the first survey wave are presented.

Results

The scoping review revealed a literature focus on intergenerational learning, age-related design, health, attitudes towards ageing, and collaborative learning. Few studies (16%) surveyed students to determine their learning needs. While 72% of studies reported programme evaluations, most were informal/unstructured. From the 473 responses across the initial five survey participation countries (Ireland, Portugal, Greece, Austria, Slovenia), over 90% of potential students, academics, and ‘other’ stakeholders scored psychological aspects of ageing, health promotion, and social inclusion as important topics. In descending order, the workplace/retirement, human rights, physiological and social aspects of ageing, physical environment, technology, and older people in education, were next-ranked. Participants’ suggested other topics included sexual health, oral health, blue zones (regions with marked longevity), and the rights of vulnerable older people.

Conclusion

This study highlights the limited prior investigation into learning needs around HAA and age-friendly society, and demonstrates key stakeholder priorities for education content. The resulting European Masters in Active Ageing will commence student intake in 2023.

51 TO EXPLORE EMERGENCY MEDICINE SPRS UNDERSTANDING, IDENTIFICATION AND MANAGEMENT OF FRAILTY WITHIN THE EMERGENCY DEPARTMENT

Background

Our frail cohort of older adults represent a large proportion of those presenting to our Emergency Departments. This has led to the introduction of diverse teams in many Emergency Departments to support their complex care needs. However, it is not known if Emergency Clinicians have a clear understanding of frailty identification and management or feel this is part of their own role.

The aim of this study was to engage with Emergency Medicine Senior Trainees on the national training scheme in Ireland to explore their understanding of frailty and what they feel their role is in its identification and management.

Methods

Following a literature review based on defined criteria, a number of focus groups were held with ED PGY4 and above doctors working in various Emergency Departments throughout the country, with thematic analysis of the transcripts of the focus groups.

Results

In total, 13 Emergency Medicine PGY4 and above doctors partook in the focus groups with an overall view that frailty identification was part of their role within the Emergency Department; however there was agreement they have limited insight into the core principles of frailty identification and management. There was also an overall desire for future formal education on frailty to be provided. Three themes in the form of frailty recognition and assessment, education on frailty, and the role of the multidisciplinary team were identified as well as a number of subthemes for further exploration.

Conclusion

The consequences of frailty often lead to presentation to the Emergency Department. There is an increased awareness of its presentation but the core providers of emergency care feel there is a lack of the education required for them to manage the consequences of frailty which they encounter on daily basis and they have a clear desire to increase the knowledge base and skill set.

222 OLDER ADULT INPATIENTS’ PERCEPTIONS OF PROGRESSIVE RESISTANCE TRAINING IN A SPECIALIST GERIATRIC REHABILITATION SETTING

Background

Progressive resistance training (PRT) has the potential to reduce age-related disability and has been proven to benefit the older adult in a variety of ways. PRT is prescribed routinely by physiotherapists for frail older adults in an inpatient setting. To date little is known of their experiences engaging in PRT. This study aimed to explore older adult inpatients’ perceptions and experience of PRT as part of their overall physiotherapy program in a Specialised Geriatric Rehabilitation Unit.

Methods

The study had a qualitative design. Semi-structured interviews explored experiences and perceptions of PRT along with motivators and barriers to participation. Interviews were face to face and conducted in the unit. Data was analysed using thematic analysis. 11 frail older inpatients with orthogeriatric (n = 5), neurological (n = 2), general surgical (n = 2) and general medical (n = 2) diagnoses were interviewed.

Results

The study identified three overarching themes: Acceptability, Facilitators and Barriers. In the category of Acceptability participants identified the subthemes: (1) PRT is challenging, (2) PRT is Rewarding and (3) PRT is Enjoyable. In the category of Facilitators, the following subthemes emerged: (4) Positive outcomes as motivators and (5) Supervision is necessary for engagement. In the category of Barriers, (6) Low self-efficacy beliefs and (7) the Negative effects of PRT, such as pain and fatigue affected participation.

Conclusion

Frail older inpatients find PRT to be an acceptable form of exercise. It is perceived to be challenging, but rewarding and enjoyable for most. Participants were motivated to participate in PRT by the positive outcomes (improved strength, general health, function, independence, confidence) they experienced. They felt supervision from professionals with medical expertise was essential to participation; and had low self-efficacy beliefs surrounding independent practice; fearing falling and causing harm. Pain and fatigue also impacted participation.

75 EXPERIENCES OF HEALTH SERVICE USE FOR PEOPLE LIVING WITH PARKINSON’S DISEASE: A NATIONAL SURVEY

Background

Despite the growing prevalence of Parkinson’s disease (PD), and the need to plan for future health service provision, very little is known in the Irish context about PD patients’ experience of health services.

Methods

A cross-sectional survey design, with multiple formats, i.e. online, pen-and-paper, and telephone. Data were collected from May 2020–July 2021 using a multipronged recruitment strategy. It could be completed by a person with PD, or a support person on behalf of/with the person. Survey development was informed through literature review, and in consultation with the Parkinson’s Association of Ireland, and a patient advisory group (N = 10).

Results

A total of 1,504 individuals accessed the survey, with 1,402 meeting the eligibility criteria. Over half (53%) were male, and the distribution across Ireland’s provinces was: Leinster (46%); Munster (28%); Connaught (19%); and Ulster (7%). Approx. 5% were diagnosed with young-onset PD. A minority (6%) reported attending only their GP to manage their PD, with the rest attending a specialist outpatient clinic. The mean distance travelled each-way to outpatient clinics was 45.6 km (SD = 49.4, min 1 km, max. 300kms). Most were diagnosed by Neurologists (84%), followed by GPs (8%), and Geriatricians (7%); 1% indicated ‘other’. Of those diagnosed by a Neurologist or Geriatrician, most were diagnosed privately (68%); though 37% of these patients subsequently switched to the public system for ongoing management. The majority (97%) reported currently taking PD medications, but just 52% believed these were working effectively. Just over one-fifth (22%) had access to a PD nurse specialist. Access to the range of other health and social care professionals is also very poor for this patient group.

Conclusion

A number of significant gaps in PD care have been identified, which require urgent attention. A reconfigured model of PD care is necessary to accommodate the growing need for specialist, integrated care at the population level.

Dementia palliative care: A multi-site survey of long term care STAFF'S education needs and readiness to change

Many people with dementia reside in long-term care, where limited staff knowledge of dementia palliative care has been identified, along with poor awareness that a palliative approach can assist in identifying unmet care needs. Evidence-based guidance in palliative care for people with dementia is available however, implementing this guidance requires staff engagement and a tailored educational approach. This pre-implementation situational analysis informed a tailored staff education intervention to support the implementation of national guidance on dementia palliative care in long term care. Using a cross-sectional study design, underpinned by the Consolidated Framework for Implementation Research, survey data were collected on site profile, staff demographics, learning needs, and readiness-to change at three residential care sites for older people in Ireland. In total, 69 staff (predominantly nurses and healthcare attendants) completed the surveys. Medication management and management of pain were the most frequently identified learning needs. Staff were confident in their ability to implement change but de-motivation and powerlessness were substantial factors as only one-third of staff were "ready for change". Staffing levels, managing risk during change and perceived reluctance in others were common barriers. These results informed an educational intervention to address the specific care context, staff learning needs and barriers to change prior to implementation.

Using decision aids to support self-isolation during the COVID-19 pandemic

OBJECTIVE

Self-isolation is a vital element of efforts to contain COVID-19. We set out to test whether decision aids can support self-isolation.

DESIGN

We conducted a pre-registered online experiment with a nationally representative sample (n = 500). Three stages tested: (i) whether decision trees help people to decide whether they need to self-isolate; (ii) whether an online planning tool increases people's confidence in their ability to self-isolate; and (iii) whether infographics help people to absorb advice on managing a household in which someone must self-isolate.

MAIN OUTCOME MEASURES

(i) Accuracy of matching symptom patterns to a response scale for the need to self-isolate; (ii) self-reported confidence in coping with self-isolation; (iii) objective tests of recall and comprehension.

RESULTS

Decision trees improved decisions about when self-isolation was necessary, although participants systematically underestimated the need to self-isolate with less common COVID-19 symptoms (e.g. sore throat, fatigue). The online planning tool increased confidence about coping with self-isolation only among the adults aged under 40. Infographics improved recall and comprehension of how to manage self-isolation.

CONCLUSION

Decision aids can be used to support self-isolation during COVID-19. The study also demonstrates how even an emergency public health response can benefit from rapid experimental pre-testing of interventions.

Motivating social distancing during the COVID-19 pandemic: An online experiment

RATIONALE

Maintaining social distance during the COVID-19 pandemic can save lives. We therefore set out to test communication strategies to promote social distancing.

OBJECTIVE

We aimed to test two novel public health messages against a control message. The first was designed to exploit the "identifiable victim" effect by highlighting the risk of transmission to identifiable vulnerable persons. The second sought to counteract intuitive underestimation of exponential transmission.

METHOD

In total, 500 Irish adults undertook a pre-registered, online experiment. They were randomly assigned to a control group or one of two treatment groups. The control group viewed a current poster that encouraged a 2-m separation between people. The two treatment groups saw posters of similar design, but with narrative messages describing how an individual had infected a specific vulnerable person or multiple other people. Later questions measured intentions to undertake three specific types of social interaction over the coming days and the stated acceptability of three other types of social interaction. Pilot work had identified these six behaviors as "marginal" - people were unsure whether they were advisable.

RESULTS

Participants in the treatment conditions were more cautious about undertaking the behaviors and less accepting of them. This positive effect occurred despite participants rating the treatment posters as likely to be less effective and memorable than the control poster.

CONCLUSIONS

Messages that invoke thoughts of infecting vulnerable people or large numbers of people can motivate social distancing and, hence, help to limit the spread of COVID-19. Stated public evaluations (obtained via focus groups or surveys) may underestimate the actual effectiveness of such emotional messages.

It depends on how you ask: measuring bias in population surveys of compliance with COVID-19 public health guidance

OBJECTIVE

Accurate measurement of compliance with COVID-19 guidance is important for public health policy and communications. Responses to surveys, however, are susceptible to psychological biases, including framing effects and social desirability. Our aim was to measure the effects of these biases on estimates of compliance with public health guidance (eg, hand-washing, social distancing).

DESIGN

We conducted two online experiments (n=1800) and varied whether questions were framed positively or negatively (eg, 'I always wash my hands…' vs 'I don't always wash my hands…'). We also varied the degree to which anonymity was assured, via a 'list' experiment.

RESULTS

Reported compliance, despite being generally high, was reduced by negatively framing questions and increasing anonymity using a list experiment technique. Effect sizes were large: compliance estimates diminished by up to 17% points and 10% points, respectively.

CONCLUSION

Estimates of compliance with COVID-19 guidance vary substantially with how the question is asked. Standard tracking surveys tend to pose questions in ways that lead to higher estimates than alternative approaches. Experimental tests of these surveys offer public health officials greater insight into the range of likely compliance estimates to better inform policy and communications.

Using Behavioral Science to help fight the Coronavirus

This rapid, narrative review summarizes useful evidence from behavioral science for fighting the COVID-19 outbreak. We undertook an extensive, multi-disciplinary literature search covering five issues: handwashing, face touching, self-isolation, public-spirited behavior, and responses to crisis communication. The search identified more than 100 relevant papers. We find effective behavioral interventions to increase handwashing, but not to reduce face touching. Social supports and behavioral plans can reduce the negative psychological effects of isolation, potentially reducing the disincentive to isolate. Public-spirited behavior is more likely with frequent communication of what is “best for all”, strong group identity, and social disapproval of noncompliance. Effective crisis communication involves speed, honesty, credibility, empathy, and promoting useful individual actions. Risks are probably best communicated through numbers, with ranges to describe uncertainty – simply stating a maximum may bias public perception. The findings aim to be useful not only for government and public health authorities, but for organizations and communities.

'Around the edges': using behaviour change techniques to characterise a multilevel implementation strategy for a fall prevention programme

Background

Implementation strategies are needed to ensure that evidence-based healthcare interventions are adopted successfully. However, strategies are generally poorly described and those used in everyday practice are seldom reported formally or fully understood. Characterising the active ingredients of existing strategies is necessary to test and refine implementation. We examined whether an implementation strategy, delivered across multiple settings targeting different stakeholders to support a fall prevention programme, could be characterised using the Behaviour Change Technique (BCT) Taxonomy.

Methods

Data sources included project plans, promotional material, interviews with a purposive sample of stakeholders involved in the strategy’s design and delivery and observations of staff training and information meetings. Data were analysed using TIDieR to describe the strategy and determine the levels at which it operated (organisational, professional, patient). The BCT Taxonomy identified BCTs which were mapped to intervention functions. Data were coded by three researchers and finalised through consensus.

Results

We analysed 22 documents, 6 interviews and 4 observation sessions. Overall, 21 out a possible 93 BCTs were identified across the three levels. At an organisational level, identifiable techniques tended to be broadly defined; the most common BCT was restructuring the social environment. While some activities were intended to encourage implementation, they did not have an immediate behavioural target and could not be coded using BCTs.

The largest number and variety of BCTs were used at the professional level to target the multidisciplinary teams delivering the programme and professionals referring to the programme. The main BCTs targeting the multidisciplinary team were instruction on how to perform the (assessment) behaviour and demonstration of (assessment) behaviour; the main BCT targeting referrers was adding objects to the environment. At the patient level, few BCTs were used to target attendance.

Conclusion

In this study, several behaviour change techniques were evident at the individual professional level; however, fewer techniques were identifiable at an organisational level. The BCT Taxonomy was useful for describing components of a multilevel implementation strategy that specifically target behaviour change. To fully and completely describe an implementation strategy, including components that involve organisational or systems level change, other frameworks may be needed.

Electronic supplementary material

The online version of this article (10.1186/s13012-018-0798-6) contains supplementary material, which is available to authorized users.

Moral fatigue: The effects of cognitive fatigue on moral reasoning

We report two experiments that show a moral fatigue effect: participants who are fatigued after they have carried out a tiring cognitive task make different moral judgements compared to participants who are not fatigued. Fatigued participants tend to judge that a moral violation is less permissible even though it would have a beneficial effect, such as killing one person to save the lives of five others. The moral fatigue effect occurs when people make a judgement that focuses on the harmful action, killing one person, but not when they make a judgement that focuses on the beneficial outcome, saving the lives of others, as shown in Experiment 1 ( n = 196). It also occurs for judgements about morally good actions, such as jumping onto railway tracks to save a person who has fallen there, as shown in Experiment 2 ( n = 187). The results have implications for alternative explanations of moral reasoning.

Resistance to Computerized Care Planning Systems by Qualified Nurses Working in the UK NHS

Objective: This study investigated whether computerized systems, designed to produce detailed plans for the nursing care of inpatients, were resisted by the nurses who were expected to use them.

Methods: Qualitative study, using semi-structured interviews with nurses working in the UK National Health Service.

Results and Conclusions: Resistance took the form of ‘resistive compliance,’ and this resistance is analyzed and explained. Resistance can best be understood in terms of the culture of nursing. This implies that the design and implementation of computerized systems in health care should take these factors into account.

Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups

BACKGROUND

Delirium is prevalent and serious, yet remains under-recognised. Systematic screening could improve detection; however, consensus is lacking as to the best approach. Our aim was to assess the diagnostic accuracy of five simple cognitive tests in delirium screening: six-item cognitive impairment test (6-CIT), clock-drawing test, spatial span forwards, months of the year backwards (MOTYB) and intersecting pentagons (IPT).

METHODS

A cross-sectional study was conducted. Within 36 h of admission, older medical patients were assessed for delirium using the Revised Delirium Rating Scale. They also underwent testing using the five cognitive tests outlined above. Sensitivity, specificity, positive and negative predictive values (PPV; NPV) were calculated for each method. Where appropriate, area under the receiver operating characteristic curve (AUC) was also calculated.

RESULTS

Four hundred seventy patients were included, and 184 had delirium. Of the tests scored on a scale, the 6-CIT had the highest AUC (0.876), the optimum cut-off for delirium screening being 8/9 (sensitivity 89.9%, specificity 62.7%, NPV 91.2%, PPV 59.2%). The MOTYB, scored in a binary fashion, also performed well (sensitivity 84.6%, specificity 58.4%, NPV 87.4%, PPV 52.8). On discriminant analysis, 6-CIT was the only test to discriminate between patients with delirium and those with dementia (without delirium), Wilks' Lambda = 0.748, p < 0.001.

CONCLUSION

The 6-CIT measures attention, temporal orientation and short-term memory and shows promise as a delirium screening test. This study suggests that it may also have potential in distinguishing the cognitive impairment of delirium from that of dementia in older patients. Copyright © 2016 John Wiley & Sons, Ltd.

Malnutrition in Hospitalised Older Adults: A Multicentre Observational Study of Prevalence, Associations and Outcomes

BACKGROUND

Malnutrition is common in older adults and is associated with high costs and adverse outcomes. The prevalence, predictors and outcomes of malnutrition on admission to hospital are not clear for this population.

DESIGN

Prospective Cohort Study.

SETTING

Six hospital sites (five public, one private).

PARTICIPANTS

In total, 606 older adults aged 70+ were included. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded.

MEASUREMENTS

Socio-demographic and clinical data, including nutritional status (Mini-Nutritional Assessment - short form), was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and new institutionalisation.

RESULTS

The mean age was 79.7; 51% were female; 29% were elective admissions; 67% were admitted to a medical specialty. Nutrition scores were available for 602/606; 37% had a 'normal' status, 45% were 'at-risk', and 18% were 'malnourished'. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/ separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition, compared to normal status (p < .001). Malnutrition was associated with outcomes including an increased length of stay (p < .001), new institutionalisation (p =<0.001) and in-hospital mortality (p < .001).

CONCLUSIONS

These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all patients ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.

Antipsychotic prescription amongst hospitalized patients with dementia

BACKGROUND

Antipsychotic drugs are used to treat behavioural and psychological symptoms of dementia, despite significant safety concerns regarding increased risk of stroke and mortality. The numbers of patients with dementia and related behavioural symptoms being treated in acute hospitals is increasing.

AIM

(i) to determine pre-admission and in-hospital prevalence of antipsychotic use in a national sample of patients with dementia and acute illness; (ii) identify reasons for antipsychotic use; (iii) assess features of the ward environment which impact on patients with dementia; (iv) determine availability of dementia-specific policies, training, appraisal and mentorship programs which influence service delivery.

DESIGN AND METHODS

Four-part standardized audit in 35 public acute hospitals comprising (i) retrospective healthcare record review (n = 660); (ii) prospective assessment of ward environment (n = 77); (iii) ward organization interview with clinical managers (n = 77); (iv) hospital organisation interview with senior managers (n = 35).

RESULTS

Antipsychotic drugs were prescribed to 29% of patients with dementia before hospitalization and to 41% during hospitalization; one quarter received new or additional prescriptions. Assessments for delirium (45%), dementia symptoms (39%), mood (26%), mental state (64%) and distress-provoking factors (3%) were suboptimal. Drug indications were documented in 78%. Non-pharmacological interventions were not documented. Most wards lacked environmental cues to promote orientation. Dementia-specific care pathways existed in 2 of 35 hospitals. Staff support and training programmes were suboptimal. 12% of patients were discharged with new antipsychotic prescriptions.

CONCLUSION

Antipsychotic medications are commonly prescribed for hospitalized patients with dementia in Ireland. Ward environments and dementia-related governance structures are suboptimal.

Frequency of delirium and subsyndromal delirium in an adult acute hospital population

Background The frequency of full syndromal and subsyndromal delirium is understudied. Aims We conducted a point prevalence study in a general hospital. Method Possible delirium identified by testing for inattention was evaluated regarding delirium status (full/subsyndromal delirium) using categorical (Confusion Assessment Method (CAM), DSM-IV) and dimensional (Delirium Rating Scale-Revised-98 (DRS-R98) scores) methods. Results In total 162 of 311 patients (52%) screened positive for inattention. Delirium was diagnosed in 55 patients (17.7%) using DSM-IV, 52 (16.7%) using CAM and 58 (18.6%) using DRS-R98⩾12 with concordance for 38 (12.2%) individuals. Subsyndromal delirium was identified in 24 patients (7.7%) using a DRS-R98 score of 7-11 and 41 (13.2%) using 2/4 CAM criteria. Subsyndromal delirium with inattention (v. without) had greater disturbance of multiple delirium symptoms. Conclusions The point prevalence of delirium and subsyndromal delirium was 25%. There was modest concordance between DRS-R98, DSM-IV and CAM delirium diagnoses. Inattention should be central to subsyndromal delirium definitions.

The potential lost hospital income from miscoded emergency department boarders in Ireland

BACKGROUND

Emergency department (ED) boarders, namely patients who have been admitted under an in-patient service but remain on a trolley in the ED, have long been a problem in the Irish healthcare system.

METHODS

We conducted a retrospective analysis of all ED boarders in Cork University Hospital (CUH) for a 6-month period from January to July 2011. Data were obtained from the Hospital In-Patient Enquiry Office (HIPE). The income generated by the hospital for a subset of these patients (January and February attendances) was obtained from the Finance Office in the hospital, based on diagnoses as recorded on the HIPE system. A convenience sample of two-thirds of the 39 acute hospitals nationally was surveyed to ascertain whether ED boarders were coded by individual HIPE offices as hospital in-patients or as ED attendees.

RESULTS

A total of 806 patients were admitted to an in-patient service from January to July 2011 in CUH and subsequently discharged, having completed their entire stay in the ED. The income generated by a sub-sample of 228 patients (January and February ED boarders) was determined. The hospital was remunerated by <euro>685,111 for these patients, i.e. an average income of <euro>3,098 per patient. Only 8 hospitals of the 27 surveyed hospitals coded overnight ED Boarders as in-patients and were thus able to request income for these patients appropriately.

CONCLUSION

Discrepancies in coding of ED boarders may result in significant revenue losses for certain hospitals.

Accuracy of linear measurement in the Galileos cone beam computed tomography under simulated clinical conditions

OBJECTIVES

The aim of this study was to determine the geometric accuracy of cone beam CT (CBCT)-based linear measurements of bone height obtained with the Galileos CBCT (Sirona Dental Systems Inc., Bensheim, Hessen, Germany) in the presence of soft tissues.

METHODS

Six embalmed cadaver heads were imaged with the Galileos CBCT unit subsequent to placement of radiopaque fiduciary markers over the buccal and lingual cortical plates. Electronic linear measurements of bone height were obtained using the Sirona software. Physical measurements were obtained with digital calipers at the same location. This distance was compared on all six specimens bilaterally to determine accuracy of the image measurements.

RESULTS

The findings showed no statistically significant difference between the imaging and physical measurements (P > 0.05) as determined by a paired sample t-test. The intraclass correlation was used to measure the intrarater reliability of repeated measures and there was no statistically significant difference between measurements performed at the same location (P > 0.05).

CONCLUSIONS

The Galileos CBCT image-based linear measurement between anatomical structures within the mandible in the presence of soft tissues is sufficiently accurate for clinical use.

An audit of healthcare workers' knowledge of meticillin resistant Staphylococcus aureus (MRSA) against current infection control standards

The aim of this audit was to establish the knowledge of different healthcare workers regarding meticillin resistant Staphylococcus aureus (MRSA) infection control precautions within the clinical environment. Data was interpreted to identify how education could be appropriately targeted to enhance the knowledge of all staff.

A cross-sectional audit tool was developed from existing policies and national guidelines. Stratified random sampling was undertaken and 961 audits were distributed proportionately to differing groups of healthcare workers from within one UK NHS hospital; 411 audits were returned giving a 43% response rate.

The majority of staff (71%) felt that MRSA is a very serious issue. The amount of staff that had read the trust's MRSA policy or received any formal MRSA education varied considerably, depending on the healthcare worker's occupation, and it was predominantly the nursing staff who had read the MRSA policy. It was unexpected, but encouraging, to find that unregistered nurses (healthcare assistants) and doctors had received the most education regarding MRSA. Of concern was that the majority of hotel services staff (69%) had not read the policy or received any MRSA education (79%). Only medical staff felt they had received adequate amounts of education on MRSA.

Inter-professional working in the RAF Critical Care Air Support Team (CCAST)

OBJECTIVE

To understand working relationships between doctors and nurses in the (UK) Royal Air Force (RAF).

METHODS

Qualitative, semi-structured interviews.

SAMPLE

Six nurses and five anaesthetists from the RAF Critical Care Air Support Team were interviewed.

FINDINGS

A variety of factors had an effect on inter-professional dynamics between anaesthetists and nurses within CCAST.

DISCUSSION

The military setting makes this relationship different from that which has been observed in the National Health Service (NHS) and reported in the literature. An area which had not been analysed before in terms of doctor-nurse relationships debate is the issue of personality. This research shows it to be a significant issue in this relationship, for both groups of professionals.

The financial implications of falls in older people for an acute hospital

BACKGROUND

Falls are a common occurrence in older people and frequently lead to hospital admission. There is a current lack of cohesive fall prevention strategies in the Republic of Ireland.

AIM

To demonstrate the cost of fall-related admissions to an acute hospital.

METHODS

A review of Hospital Inpatient Enquiry (HIPE) data and medical case notes was performed for all fall-related admissions over a one-year period. The cost of fall-related admissions was calculated. In addition a detailed cost analysis was performed to determine the true cost of a hip fracture admission.

RESULTS

There were 810 fall-related admissions, resulting in 8,300 acute bed days, and 6,220 rehabilitation bed days, costing euros 10.3 million. Fall-related readmissions resulted in 650 bed-days, bringing the total cost to euros 10.8 million. A typical hip fracture incident admission episode costs euros 14,300.

CONCLUSION

Fall-related admissions of olderpeople are a significant financial burden to the health service.