Laura Morrison

Changes in Descriptive Terms for Older People in the Medical Literature Over the Last 65 Years

Recent guidelines recommend that the threshold BP should be 5–10 mmHg lower in HBP than CBP. In this study, the same normotension threshold was used with CBP and HBP. Nevertheless, using HBP, risk of death was significantly higher in the elderly group than in the younger group, although death is also common among the elderly using CBP measurement. The highly significant relationship between HBP at baseline and age in all subjects may support this view. All of the findings from this study indicated that incidences of death and microand macrovascular complications were significantly greater in the elderly than the younger subjects. Earlier identification of hypertension in elderly adults using HBP could be added to a list of risk factors in individuals with T2DM.

119Impact of Frailty on Healthcare Outcomes after Ischaemic Stroke in Patients with Atrial Fibrillation

Background: Frailty is associated with increased mortality and institutionalisation among stroke patients, however, little is known about the impact of frailty on other important healthcare outcomes post stroke. One of the most common stroke mechanisms for older adults with frailty is atrial fibrillation (AF). We examined the impact of frailty on hospital length of stay (LOS) and 30-day mortality post stroke with AF. Methods: Data was collected using an existing database of stroke patients presenting consecutively to a large university hospital from August 2014-July 2016. A retrospective chart review was performed to assess pre-admission frailty, using the Clinical Frailty Scale (CFS), cut-off of ≥5 for established frailty. Baseline function was measured with the Modified Rankin Scale (mRS) score. Results: In total, 113 patients were identified with ischaemic stroke and AF; median age 80 years (range 54–101 years) and 60% male. Frail patients were significantly older, p = 0.008. Median pre-admission CFS score was 3 (+/−3) and 26.5% scored ≥5, indicating most were mildly to severely frail. Median pre-admission mRS was 1 (+/−2) increasing to 3 (+/−2) at discharge. Frail patients had significantly worse scores at baseline & discharge, p < 0.001. Frail patients (CFS ≥ 5) had statistically significantly longer acute hospital LOS, median 22 days vs. 15 for non-frail patients, p = 0.04. In all, 10% of non-frail but no frail patients were suitable/agreeable to avail of early supported discharge, p = 0.02. There was no significant difference in 30-day mortality. Baseline CFS scores correlated most closely with age (r = 0.42, p < 0.001) and post-stroke mRS (r = 0.41, p < 0.001). Conclusions: Though numbers were small, likely under-powering the study, these data suggest an association between frailty and increased LOS in older patients with ischaemic stroke and AF indicating that poor baseline functional status has a significant impact on outcome. Frailty measures could be added to thrombolysis criteria to enhance decisionmaking.

115Non-Consultant Hospital Doctors’ Attitudes and Knowledge towards Sedative Prescription in an Acute Hospital

Background: Consumption of sedative medications is an independent risk factor for falls. These medications are known risk factors for the development of delirium and are known to reduce the alertness and concentration of older patients. Older patients are more vulnerable to adverse effects associated with these medications due to changes in pharmacokinetics and pharmacodynamics associated with ageing. Methods: We aimed to explore attitudes and knowledge of sedative prescriptions among doctors in a tertiary Irish hospital. A structured online questionnaire was distributed to 100 non consultant hospital doctors (NCHDs) including medical registrars, senior house officers and interns. Results: The overall response rate was 40% (n = 40). A total of 38 (95%) of respondents reported prescribing sedatives due to same medications recorded on community prescriptions of patients. 30 doctors (75%) selected that they prescribed these agents due to direct patient request with 32 (82%) citing pressure from patients and 9 (23%) pressure from nursing staff as an influencing factor in increased prescription of sedatives. Of those who took part, 5 (12%) admitted that they never assess background history of drug or alcohol dependency prior to prescribing. NCHDs accurately identified the adverse effects associated with benzodiazepines but one third were unsure regarding common adverse effects with Z drugs. The majority of participants (87.5%) were in favour of an educational session on non-pharmacologic approaches towards sleep hygiene. Conclusions: This survey reflects pressure to prescribe sedatives and hypnotics in the acute hospital setting with many not feeling adequately equipped to educate and encourage non pharmacologic approaches towards sleep hygiene. A multidisciplinary educational module is currently in development and will be integrated into the postgraduate education curriculum.