Corina Naughton

Elder abuse and neglect in Ireland: results from a national prevalence survey

OBJECTIVE To measure the 12-month prevalence of elder abuse and neglect in community-dwelling older people in Ireland and examine the risk profile of people who experienced mistreatment and that of the perpetrators. DESIGN Cross-sectional general population survey. SETTING Community. PARTICIPANTS People aged 65 years or older living in the community. METHODS Information was collected in face-to-face interviews on abuse types, socioeconomic, health, and social support characteristics of the population. Data were examined using descriptive statistics and logistic regression, odds ratios (OR) and 95% confidence intervals (95% CI) are presented. RESULTS The prevalence of elder abuse and neglect was 2.2% (95% CI: 1.41-2.94) in the previous 12 months. The frequency of mistreatment type was financial 1.3%, psychological 1.2%, physical abuse 0.5%, neglect 0.3%, and sexual abuse 0.05%. In the univariate analysis lower income OR 2.39 (95% CI: 1.01-5.69), impaired physical health OR 3.41 (95% CI: 1.74-6.65), mental health OR 6.33 (95% CI: 3.33-12.0), and poor social support OR 4.91 (95% CI: 2.1-11.5) were associated with a higher risk of mistreatment but only social support and mental health remained independent predictors. Among perpetrators adult children (50%) were most frequently identified. Unemployment (50%) and addiction (20%) were characteristics of this group.

The impact of age on 6-month survival in patients with cardiovascular risk factors undergoing elective non-cardiac surgery

An increasing number of patients aged ≥ 70 years are presenting for elective non‐cardiac surgery. We undertook this study to: (i) compare the nature and distribution of cardiovascular disease (CVD) risk factors in an at risk population of patients aged ≥ 70 years undergoing elective surgery compared with a younger at risk cohort; and (ii) identify the impact of age and other risk factors on 6‐month survival. We conducted a prospective observational study of patients undergoing elective non‐cardiac surgery. A total of 1622 patients aged ≥ 40 years with recognised surgical or patient‐specific risk factors for CVD were identified. The patients were divided into two groups; group 1 (aged: 40–69 years) and group 2 (aged ≥ 70 years). Logistic regression was used to identify the factors associated with 6‐month mortality. Odds ratios (OR) and 95% confidence interval (CI) are presented. In hospital, mortality was similar in both groups. However, 6‐month mortality in those aged ≥ 70 years was significantly higher (p = 0.001). Cardiovascular symptoms were significantly more common in group 2 (p < 0.001) as were cardiovascular‐related deaths (p = 0.04) at 6 months follow‐up. Preoperative cardiovascular preventative therapy was under prescribed in the elderly cohort. Factors independently associated with 6‐month mortality were aged ≥ 70 (OR = 3.57, 95% CI: 2.22–5.73), angina (OR = 2.0, 95% CI: 1.26–3.20), renal impairment (OR = 2.39, 95% CI: 1.17–4.89) also operation type and duration. Despite similar in‐hospital mortality, those aged ≥ 70 years had significantly higher 6‐month mortality than the younger surgical cohort. Cardiovascular deaths were significantly higher in patients aged ≥ 70 years. Effective identification and the management of cardiovascular risk factors may improve 6‐month survival.

Decline in research publications from the United Kingdom in anaesthesia journals from 1997 to 2006

We undertook this survey to identify the trend in the published output of original research in anaesthesia emanating from the United Kingdom (UK) in a 10‐year period from 1997 to 2006, inclusive. We examined seven major anaesthetic journals for each of the 10 years, and four other specialist journals for the years 1997, 2000, 2003 and 2006. We included papers on experimental research, randomised controlled clinical trials, large observational studies and case series, formal equipment and apparatus assessments, but we excluded editorials, comments, reviews including systematic reviews, special articles, small case series and case reports, questionnaire surveys of clinical practice and correspondence. We found a highly significant reduction in published research output from the UK in the period under study (% change per year; −5.7 (95% CI −7.4 to −4.0), a trend which was significantly different (p < 0.001) from the trend of changes in research publications worldwide (−1.0% change per year; 95% CI −1.7 to 0.0). We discuss the implications of these findings for UK anaesthesia research strategy.

A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing

PURPOSE The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated. METHODS Volunteer general practitioner practices (n = 98) were randomized to receive prescribing feedback via postal bulletin (PB) (n = 50) or academic detailing plus postal bulletin (AD) (n = 48). Data analysis was based on the HSE-primary care reimbursement service (HSE-PCRS) prescribing database. Regression (beta) coefficients, indicating proportion change in prescribing per month, and 95% confidence intervals (CIs) are presented. The cost-effectiveness ratio was calculated from the total cost of the intervention divided by percentage change in antibiotic prescribing in AD versus PB group. RESULTS Immediately post intervention PB (beta = -0.02, 95% CI -0.04, -0.001) and AD (beta = -0.02, 95% CI -0.03, -0.001) practices significantly decreased overall antibiotic prescribing. Second-line antibiotic prescribing was also significantly decreased by 2-3% in both groups. However, there were no significant differences in antibiotic prescribing between the randomized groups in the immediate or long-term post-intervention period. In the cost-effectiveness analysis a postal prescribing feedback service would cost euro 88 per percentage change in prescribing practice compared with euro 778 for a prescriber adviser service. CONCLUSION Prescribing feedback significantly reduced overall and second-line antibiotic prescribing, but academic detailing was not significantly more effective than postal bulletin in changing antibiotic prescribing practice.

Early and late predictors of mortality following on-pump coronary artery bypass graft surgery in the elderly as compared to a younger population

OBJECTIVE To identify independent factors associated with early (30-day) mortality and in surviving patients, identify factors for late (1-year) mortality following primary coronary artery bypass graft (CABG) surgery and to test the interaction with age. METHODS An analysis of a single centres data contribution to the Society for Cardiothoracic Surgery in Great Britain and Ireland database was performed. Data on consecutive patients aged > or =75 years (n=659) and aged 60-74 years (n=3024) undergoing primary CABG surgery (1999-2005) were analysed. One-year mortality data were collected using the Office of National Statistics (ONS) tracking system. Factors associated with early and late mortality were identified using Cox regression; hazard ratios (HRs) and 95% confidence intervals (CIs) are presented. RESULTS The proportion of patients aged > or =75 years increased by 10% over 5 years (2000-2005). One-year mortality in the elderly showed a significant linear decrease from 15% to 7% (p=0.01) while mortality in the younger cohort remained static at 2-4%. Early mortality in the elderly group was 5% compared to 1.8% in the younger group (p<0.001), while late mortality was 4.1% vs 1.8%, respectively (p<0.001). Factors independently associated with early mortality were age > or =75 years, HR 2.0 (95% CI 1.28, 3.11); female gender; angina (CSS III-IV); and cardiopulmonary bypass duration >97 minutes. Arrhythmia and renal impairment were risk factors common in both early and late mortality models. Risk factors for late mortality also included ventricular ejection fraction <30%, non-elective surgery and arteriopathy. Age was not an independent risk factor for late mortality. CONCLUSION Mortality in elderly patients showed a substantial improvement, but remained over twice that of younger patients. The difference in factors associated with early and 1-year morality suggests the need for effective short- and long-term strategies, particularly in the management of chronic diseases such as heart and renal failure.

The role of health and non-health-related factors in repeat emergency department visits in an elderly urban population

Introduction Patients aged 65 years or older account for a growing proportion of emergency department (ED) repeat attendances. This study aimed to identify health and non-health factors associated with repeat ED attendance, defined as one or more visits in the previous 6 months in patients aged 65 years or older, and to examine the interaction between social and health factors. Methods 306 patients were interviewed. Demographic, socioeconomic, physical, mental health and post-ED referrals were examined. Logistic regression was used to identify factors independently associated with a repeat ED visit, OR and 95% CI are presented. Log likelihood ratio tests were used to test for interactions. Results ED revisits were reported by 37% of this elderly population. Independent risk factors for a repeat ED visit were previous hospital admission OR 3.78 (95% CI 2.53 to 5.65), anxiety OR 1.13 (95% CI 1.04 to 1.22), being part of a vulnerable social network OR 2.32 (95% CI 1.12 to 4.81), whereas a unit increase in physical inability as measured by the Nottingham Health Profile had a week association OR 1.01 (95% CI 1.00 to 1.02). There were no significant interactions between social networks and the other health-related variables (p>0.05). In patients directly discharged from ED, 48% (71/148) had no documented referrals made to community services, of which 18% (27/148) were repeat ED attendees. Conclusion ED act as an important safety net for older people regardless of economic or demographic backgrounds. Appropriate assessment and referral are an essential part of this safety role.

The relationship between older people's awareness of the term elder abuse and actual experiences of elder abuse

BACKGROUND Awareness and experiences of elder abuse have been researched as separate entities; this study examined the relationship between awareness of elder abuse, disclosure of abuse, and reporting of abuse among people aged 65 years or older. METHODS A national cross-sectional survey of a random sample of 2,012 community-dwelling older people was carried out in Ireland. People described their understanding of the term elder abuse followed by their experiences of mistreatment. Descriptive statistics and logistic regression were used with frequency, percentage, odds ratios (OR), and 95% confidence intervals (CI) presented. RESULTS The prevalence of elder abuse, including stranger abuse, since 65 years of age was 5.9% (95% CI 4.6-7.3). Overall, 80% of the population demonstrated some understanding of the term elder abuse. Older people who experienced physical abuse (OR 5.39; 95% CI 2.31-12.5) and psychological abuse (OR 2.51; 95% CI 1.58-3.97) were significantly more likely than older people who had not experienced mistreatment to relate the term elder abuse to their personal experiences. There was no association between experiences of financial abuse or neglect and awareness of the term elder abuse. CONCLUSIONS There was a relatively high level of awareness of the term elder abuse; however, a substantial proportion of people could not readily associate abusive behaviors within their personal lives with elder abuse. Public information campaigns need to move beyond simple awareness rising to enable people to bridge the gap between a theoretical understanding of elder abuse and recognizing inappropriate behavior in their own circumstances.

Regional variation in prescribing for chronic conditions among an elderly population using a pharmacy claims database

BackgroundAge, gender and geographical regions are recognised factors in inequalities in prescribing for chronic diseases in the elderly.AimTo compare the health board regional distribution of chronic disease among the elderly and to examine variation in quality prescribing across age, gender and regions.MethodsPopulation based study of prescribing for chronic disease using a national pharmacy claims database. All individuals aged 70 years and over (n=271,518) were eligible.ResultsOver 60% of the elderly in all regions received cardiovascular related medication. The South Eastern, North Western and Western Health Boards had below average prescribing for many chronic conditions. Logistic regression identified age, gender and regional variations in prescribing of preventative therapies for CVD and diabetes.ConclusionThere is a high prevalence of prescribing for chronic conditions in the elderly in Ireland, and there is evidence of gender, age and residing health board inequalities in prescribing.

Identifying clinical learning needs using structured group feedback: First year evaluation of pre-registration nursing and midwifery degree programmes

BACKGROUND Facilitating and supporting clinical learning for student nurses and midwives are essential within their practice environments. Clinical placements provide unique opportunities in preparation for future roles. Understanding the experiences of first year student nurses and midwives following clinical exposures and examining the clinical facilitators and barriers can assist in maintaining and developing clinical supports. METHODS The study used a structured group feedback approach with a convenience sample of 223 first year nursing and midwifery students in one Irish university in April 2011 to ascertain feedback on the clinical aspects of their degree programme. RESULTS Approximately 200 students participated in the process. Two key clinical issues were identified by students: facilitating clinical learning and learning experiences and needs. Positive learning environments, supportive staff and increased opportunities for reflection were important issues for first year students. CONCLUSIONS The role of supportive mentoring staff in clinical practice is essential to enhance student learning. Students value reflection in practice and require more opportunities to engage during placements. More collaborative approaches are required to ensure evolving and adapting practice environments can accommodate student learning.

Evaluating midwife-led antenatal care: choice, experience, effectiveness, and preparation for pregnancy.

OBJECTIVE to evaluate midwife-led care (MLC) antenatal care compared with antenatal care provided in traditional obstetric-led hospital antenatal clinics (usual care). DESIGN a mixed methods approach involving a chart audit, postal survey, focus group and in-depth interviews. SETTING data were collected at a large maternity hospital and satellite clinics in Dublin from women attending for antenatal care between June 2011 and May 2012. PARTICIPANTS 300 women with low-risk pregnancy who attended midwife-led antenatal care or usual clinics during the study period were randomly selected to participate. MEASUREMENTS data were collected from 292 women׳s charts and from 186 survey participants (63% response rate). Nine women participated in in-depth interviews and a focus group. FINDINGS MLC was as effective as usual care in relation to number of antenatal visits and ultrasound scans, referral to other clinicians, women׳s health in pregnancy, gestation at childbirth, and birth weight. Women attending MLC booked significantly earlier, fewer women attending MLC were admitted to hospital antenatally and more women breast fed their infant. Women attending MLC reported better choice and that shorter waiting times and having more time for discussion were important reasons for choosing MLC. Women attending MLC reported a better experience overall, and recorded better outcomes in relation to how they were treated, along with easier access to antenatal care and shorter waiting times to see a midwife. Although women attending MLC clinics reported higher satisfaction with the information that they received, they also identified that antenatal education could be improved in relation to labour, breast-feeding, depression and emotional well-being, and caring for the infant. KEY CONCLUSIONS midwife-led antenatal care was as effective as usual care for women with low-risk pregnancy and better in relation to choice, breast feeding and women׳s experience of care.