Abstract Background The AFHS 4Msframework represents an innovative frontier in gerontological care, introducing a structured, person-centred approach for older adults. This study captures the multidisciplinary team perspectives and insights from three sites on the implementation process of the 4Msframework. Methods Ten one-to-one semi-structured interviews were conducted with healthcare staff from acute hospital and community settings between March and April 2025. Guided by the Normalisation Process Theory framework, the interviews focused on staff experiences and perceptions. Thematic content analysis with open coding was employed to identify key themes from audio-recorded, transcribed data. Results Staff described the 4Msframework as a novel and empowering structure that not only supports high-quality, patient-centred care but also fosters a new way of communication. The framework was seen as intuitive, practical, and inherently adaptable, seamlessly integrating into existing practices. Staff highlighted the framework’s role in creating a shared language and a more meaningful way to phrase assessment questions, thereby strengthening engagement with patients, and multidisciplinary staff collaboration. Key factors for success included leadership support, tailored education, and embedding the framework into routine practice. Despite challenges, such as contextual variations between settings and adapting U.S.-based resources, staff consistently reported that the framework felt both innovative and achievable, enhancing care without increasing workload. Conclusion As the first Irish evaluation of the 4Msframework, this study highlights the potential for pioneering change in gerontological care. The framework’s ability to package existing practices into a cohesive, user-friendly model represents significant innovation. By enabling a structured, common language that aligns with staff routines, the 4Msframework demonstrates scalability and sustainability, positioning it as a valuable tool for transforming age-friendly care in Ireland and beyond.

Abstract Background Mild Cognitive Impairment (MCI) is often considered a prodromal phase of Lewy Body Dementia (LBD). While both conditions involve cognitive difficulties, they differ in the type and severity of non-cognitive symptoms. MCI is generally associated with mild cognitive changes and subtle neuropsychiatric, motor, and sleep disturbances. In contrast, LBD presents with more pronounced neuropsychiatric, motor, and sleep-related symptoms, which can affect cognitive performance. This study explores how these symptoms predict cognitive function in individuals with MCI and LBD, highlighting their distinct contribution to cognitive performance in each condition. Methods Data from N=36 patients with MCI, primarily Parkinson’s Disease-MCI (PD-MCI), and N=48 patients with LBD, including Parkinson’s Disease Dementia (PDD) and Dementia with Lewy Bodies (DLB) were analysed. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory, sleep with the Epworth Sleepiness Scale, motor symptoms with the Hoehn and Yahr scale, and cognitive function with the Addenbrooke’s Cognitive Examination. Correlation and regression analyses explored the relationship between these factors and their role in predicting performance Results In the MCI group, neuropsychiatric symptoms were positively correlated with motor symptoms (p = 0.004). In the LBD group, neuropsychiatric (p < 0.001) and motor symptoms (p = 0.03) were significantly associated with lower cognitive functioning. Additionally, in LBD, neuropsychiatric symptoms were positively correlated with both motor (p = 0.02) and sleep symptoms (p < 0.001). In MCI, sleep symptoms significantly predicted poorer cognitive functioning (p = 0.03), whereas in LBD, neuropsychiatric symptoms were the strongest predictor of reduced cognitive functioning (p = 0.02), even after adjusting for age and gender. Conclusion Different patterns were observed in how neuropsychiatric, motor, and sleep symptoms influence cognitive functioning in the MCI and LBD groups, highlighting the distinct roles of non-cognitive symptoms in each condition. Early identification of these symptoms may offer valuable insights for monitoring cognitive functioning over time in these clinical populations.

Abstract Background Early Comprehensive Geriatric Assessment (CGA) and Multidisciplinary Team (MDT) intervention is one of 12 core principles of the Management of Major Trauma in Older Adults. At our Model 4 University Teaching Hospital, a designated Trauma Unit, all low-impact hip fracture patients aged 60 and above are seen by the Orthogeriatric Service, however due to staffing constraints, other older orthopaedic trauma patients are not routinely seen. In early 2025 we piloted an Older Persons Trauma Service, as part of an Aspire Fellowship programme, to provide Orthogeriatric care to older adults who had sustained a fracture, other than hip fracture, due to trauma. We emulated the care provided to hip fracture patients, i.e. CGA focusing on preventing future falls and fractures. Here we present some patient demographics of the pilot service. Methods Included patients were aged 75 and above, admitted under Orthopaedics on an Orthopaedic ward, with a fracture(s) (other than hip fracture) due to trauma. Patients were seen and followed by a Clinical Fellow and discussed at weekly MDT. CGA was conducted for all patients. Results Forty-one patients were reviewed during the c. 14-week pilot service. Average age was 82, Clinical Frailty Scale ranged from 1 to 7. Two thirds were female (n = 27) and 68% were from out of county (n= 28). The most common fractures were C-Spine fractures (24%), followed by ankle fractures (20%). Most injuries were from low falls. Feedback to date has been positive from patients, carers, and the MDT, and service evaluation is ongoing. Conclusion In this pilot service, 41 older trauma patients received CGA including falls and bone health assessment. Low falls were the leading cause of trauma, consistent with the results of the NOCA Major Trauma Audit 2021. Formal evaluation of the service is ongoing, however to date feedback has been encouraging.

Abstract Background Frailty is recognised as a predictor of poor outcomes following trauma, including traumatic brain injuries (TBI). Despite this, frailty assessment is not always integrated into acute trauma pathways. This study evaluates the prevalence of frailty and its association with clinical outcomes in older patients admitted with TBI during the first year of a Geriatric Trauma Service at a National Trauma Centre without on-site neurosurgical capabilities. Methods A retrospective review was conducted of patients aged ≥65 admitted with TBI over a 14-month period. Frailty was assessed using the Clinical Frailty Scale (CFS) when recorded during initial evaluation as part of assessment by the Frailty Intervention Team (FIT) in the Emergency Department. Outcomes included 30-day mortality and length of stay (LOS). Minitab was used for statistical analysis. Results Of 107 patients over 65 admitted with TBI, 42% (n=45) had a documented CFS. The mean age was 82 years, and 58% (n=26) were male. The mean CFS was 4.8 (median: 5), with 58% (n=26) classified as frail (CFS ≥5). Higher frailty scores were associated with 30-day mortality (OR 2.4; 95% CI 0.94–6.16; p=0.06). No difference in LOS was observed between frail and non-frail groups, with a median LOS of 6.5 in the non-frail group, and 6 days in the frail group. Conclusion Frailty is common among older patients with TBI and may be associated with increased mortality. These findings underscore the importance of early frailty identification and the integration of geriatric expertise in trauma care.

Abstract Background Potentially inappropriate prescribing (PIP) has been associated with various adverse clinical outcomes, particularly in the context of ageing, multimorbidity and polypharmacy. Despite growing interest in front door frailty initiatives in the emergency department (ED) and acute geriatric units, to date there has been no comprehensive overview of interventions to address PIP in older adults in these settings. We set out to map the breadth of evidence on studies assessing PIP-targeted interventions in emergency care settings. Methods This review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We conducted a search from 1991-2025 across five bibliographic databases and grey literature. Results Our search returned 8119 results. Nineteen studies were identified for inclusion, four of which were randomised controlled trials. The 16 interventions described in these studies encompassed pharmacist-led medication reviews, clinical decision support systems (CDSS), quality improvement initiatives or a combination of these. While PIP was frequently a primary outcome measure, few studies reported clinical outcomes or explored prescriber adherence and experiences of older adults and prescribers. Conclusion Pharmacist-led medication reviews, CDSS and quality improvement initiatives were the main categories of prescribing interventions in the literature. Future studies should focus on clinical outcomes, enhancing communication (between pharmacists, prescribers and older adults), impact on prescriber adherence to interventions, and should incorporate longer-term follow-up.

Abstract Background Lewy Body Dementia (LBD) is the second most common form of dementia, yet it remains under-recognised and under-diagnosed, particularly in Ireland, where no national clinical guidelines or care pathways exist. This study represents the first comprehensive exploration of LBD diagnostic and post-diagnostic pathways in Ireland, drawing on the lived experiences of LBD patients, care partners, and healthcare professionals (HCPs) to identify systemic gaps and opportunities for reform. Methods A qualitative interpretive phenomenological approach was employed to conduct semi-structured interviews with 12 LBD patients, 17 care partners, and 23 healthcare professionals, from both urban and rural areas, across various disciplines, including neurology, psychiatry, geriatric medicine, nursing, allied health, and general practice. Thematic analysis was conducted using Colaizzi’s method, with a focus on diagnosis, post-diagnostic support, and service navigation. Results Five key themes emerged: (1) Recognition and Diagnosis – delays, misdiagnoses, and unclear referral routes were prevalent; (2) Systemic Fragmentation and Informal Anchors – families often coordinated care in the absence of structured support; (3) Emotional and Practical Burden of Care – care partners reported significant exhaustion, isolation, and financial strain; (4) Inequitable Access and Training Gaps – rural, young-onset, and under-65 cases faced substantial access barriers, compounded by inconsistent LBD-specific training; and (5) Call for Awareness and Structural Change – participants emphasised the need for standardised care pathways, specialist roles, and integrated, age-inclusive services. Conclusion This study highlights the distinct challenges faced by LBD patients and their care partners in Ireland, underscoring the need for systemic reform to address inequities in diagnosis and care. It highlights the critical importance of LBD-specific training for healthcare professionals, developing coordinated care models, and implementing policy changes to better support patients and frontline professionals. By centering the lived experiences of patients and care partners, these findings provide a foundation for the design of more inclusive, responsive, and person-centered dementia services in Ireland.

Abstract Background Effective communication during transitions of care for older adults is crucial (Goncalves-Bradley et al., 2016; Hickman et al., 2015). A lack of integrated healthcare records between acute and community settings presents a significant barrier leading to inadequate communication with General Practitioners (GPs) upon discharge from the Emergency Department (ED). This can result in negative outcomes, such as hospital readmissions, duplication of clinical tasks, and medication-related harm. Enhancing communication can promote holistic, patient-centred care. The goal of this quality improvement project was to enhance direct communication between the Geriatric Emergency Multidisciplinary Service (GEMS) and GPs, for older adults discharged from the ED. Methods This pilot took place over 6 months in 2024. After a GEMS assessment, a copy of the Comprehensive Geriatric Assessment (CGA) was sent to the patient's GP via Healthlink when the patient was discharged directly home from the Emergency Department. GPs did not receive communication for patients who were acutely admitted or discharged to a destination other than their own home. At the end of the 6 months 20 GPs were selected at random to complete a feedback form. Results: 758 CGAs were completed by GEMsand 378(49.8%) of these were sent to GPs. Feedback was returned from 6 (33.3%) GPs. 3 (50%) GP’s reported the CGA positively influenced onward management of their patient. 4 (66%) GP’s reported the information shared was useful in the care for their patient. Conclusion This pilot demonstrated that a significant proportion of CGAs were successfully shared with GPs. Feedback from GPs indicated that receiving communication regarding patient assessment in ED had a positive impact on patient care and influenced their management decisions. Findings suggest that improving communication between the GEMS and GPs has the potential to enhance care coordination and support better outcomes for older adults following ED discharge.

Abstract Background Romosozumab is a dual acting antiresorptive and anabolic agent used for severe postmenopausal osteoporosis. Eligibility criteria includes T score ≤ -2.5 at hip, spine or distal forearm (if hip and spine not available) and fracture of humerus, distal radius, hip or vertebrae in the last 24 months. Romosozuamb is recommended as a first line therapy in patients at very high fracture risk. However, contraindications include previous MI or stroke and there is caution with use when significant cardiovascular risk factors. We aimed to identify hip fracture patients at our hospital who might be suitable for romosozumab. Methods Retrospective review of female patients admitted with a hip fracture at our hospital over a one year period. Information on demographics and medical history was collated: myocardial infarction (MI), stroke, ischaemic heart disease (IHD), peripheral arterial disease (PAD), heart failure, atrial fibrillation (AF), diabetes and current smokers. Data on DXA derived T scores in a subset was also recorded. Results 133 patients, mean age 82.8 ± 7.7 years. 8.2% had a history of MI or stroke, 16.5% IHD, 13.5% AF, 10.5% HF and 6.0% PAD. Diabetes was found in 9.0% and 6.7% were current smokers. Overall, 45% had an MI or stroke history and/or any of above the risk factors. In a subset with BMD assessment (n=68), 55.8% had T scores < 2.5 and of them 63.1% had none of the above risk factors. Overall, 35.2% of this sample had none of the above risk factors and T scores < -2.5. Conclusion Nearly 10% had absolute contraindications to therapy, though nearly half had significant cardiovascular risk factors. While the sample with DXA results was small, results suggest that up to one third might potentially be suitable for therapy. However, other factors such as physical frailty, and cognitive impairment are also likely to preclude its use.

Abstract Background Burnout syndrome is defined as an emotional response to chronic stress, however research on the extent of this problem among Directors of Nursing in the long-term care (LTC) sector is limited. The intent of this study was to contribute to a better understanding of factors associated with burnout in Directors of Nursing in the LTC sector. Methods This study is part of a broader multi-phase mixed methods research study. This component involved a cross-sectional online survey, data was collected using the Maslach Burnout Inventory (MBI) measuring three dimensions of burnout emotional exhaustion (EE) depersonalization (DP) and personal accomplishment (PA), the Nurse Manager Practice Environment Scale (NMPES) and the Utrecht Work Engagement Scale -9 (UWES-9). The sample population consisted of 195 directors of nursing and assistant directors of nursing from the LTC sector in the Republic of Ireland. Results Among those surveyed the mean EE subscale was 26.9 (SD;12.8), DP subscale was 7.24 (SD;6.10) and the mean PA subscale was 35.4 (SD;7.47). For this cohort the mean EE subscale was significantly higher than the published normative data for the MBI 22.19 (SD;9.53). Factors significantly associated with directors of nursing intention to leave their current position were a lower UWES-9 score (OR 0.18; 95% CI 0.05-0.70), a lower NMPES total score (OR 0.11; 95% CI 0.02-0.68) and higher EE total score (OR 1.21; 95% CI 1.06-1.37) Conclusion Nurse managers presented with increased levels of burnout, manifested by feelings of higher emotional exhaustion. Psychological and work-related factors such as staffing shortages, staff turnover and recruitment, scope of responsibility, general feeling of being unsupported, and lack of protected time off work may play an important role in the development of this syndrome. Addressing factors associated with burnout in nurse managers is essential in order to maintain adequate healthcare delivery in the long-term care sector.

Abstract Background Older adults who are homebound, those who rarely or never leave home without assistance, represent a growing and under-recognised population. They experience high levels of multimorbidity, functional decline, and mortality, yet their needs remain poorly integrated into health systems. This review aimed to summarise the determinants, characteristics, and outcomes of being homebound to identify care gaps and propose directions for future research. Methods We conducted a scoping review in accordance with PRISMA-ScR guidelines. A systematic search of four databases (PubMed, Embase, Web of Science, and CINAHL) was performed. English-language, peer-reviewed studies involving adults who are homebound were included. Data extraction captured study setting, population, design, and key findings. Thematic analysis was performed and categorised by consensus. Results Of 6,406 studies screened, 159 were included. Prevalence of homebound status ranged from 4% to 65%, reflecting differences across populations and settings. Risk factors included advanced age, female sex, cognitive impairment, depression, frailty, social isolation, and substance misuse. Once homebound, individuals faced multiple unmet needs: untreated dental disease, malnutrition, falls, medication-related harm, and limited access to rehabilitation and mental health services. Functional dependence and high symptom burden were common. Caregiver burden was substantial, with some studies reporting depressive symptoms in over half of carers. Homebound status was associated with increased emergency department visits, hospitalization, and early mortality. Studies of home-based primary care showed improved continuity, reduced hospital use, and better end-of-life care. However, service delivery remained inconsistent and often excluded allied health and social care. No studies addressed the prevalence or care needs of homebound individuals in Ireland, highlighting a lack of national data. Conclusion This scoping review maps the fragmented literature on older adults who are homebound. It highlights complex medical, functional, and social vulnerabilities and identifies substantial care gaps. Ireland’s homebound population must be assessed to inform equitable, integrated, person-centred care.