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535 - Loneliness and social isolation in attendees of a Psychiatry of Old Age Service in the North West of Ireland: preliminary findings of a cross-sectional study during the COVID- 19 pandemic.
- Clodagh Rushe, Kevin Bernadette, Ericka Maye, Sweeney Gavin, McLaughlin Kevin, Cryan Marguerite, Gannon Aislinn, Vincent Melvin, Valerie Cogan, Wilkie Donna, Elaine McDonagh, McCarthy Geraldine, Dolan Catherine
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- Journal:
- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, pp. 79-80
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Aims and Hypothesis
The primary aim is to establish the prevalence of loneliness and social isolation in older adults referred to a Psychiatry of Old-Age Service in the North-West of Ireland. Secondary aims include exploring associations between loneliness, social isolation and, well-being, depression, cognition and health- status. The overarching aim was to improve patient outcomes by tailoring mental health and social interventions appropriate to patient need.
BackgroundLoneliness is a discrepancy between the social-relations one has and their desired level. It is estimated that one third of older adults will experience loneliness, which along with social isolation has links to poorer health-outcomes, reduced quality of life and cognitive decline. Government advice in Ireland to reduce social activity due to COVID-19 pandemic may compound social disconnection. We present preliminary findings of an ongoing study investigating loneliness, social isolation and related factors in older adults referred to a Mental-Health Service in the North-West of Ireland in 2020 - 2021.
MethodsUsing a cross-sectional study design, participants completed University of California, Los-Angeles(UCLA) Loneliness Scale (UCLA maximum score =10); and Berkman-Syme Social Network Index. Quality of life is measured using WHO-Well-being Index(WHO-5) with a number of relevant personal, clinical and social factors also captured.
ResultsData from 98 questionnaires (January 2020- May 2021), 52% female, showed average participant age was 74.4 years. Average perceived loneliness score was 3.67 and 85.7%, (n=84) reported some loneliness (UCLA >0) with 2% (n=2) reporting high loneliness levels (UCLA =10). The majority, 77.5% (n=76) were socially isolated; 35.7% (n=35) ‘mostly isolated’, 41.8% (n=41) ‘moderately isolated’. Females were noted to be more isolated.
ConclusionsPreliminary results illustrate majority of older adults referred to a mental-health service over a time- period spanning COVID-19 pandemic are lonely and socially isolated. This is likely compounded by changes to daily routines during COVID-19 pandemic. This is concerning given the adverse health implications. We hope final results will guide enhancement of clinical-care through linkage of mental- health services with community agencies, social-care supports and e-health technologies.
Antipsychotic prescribing in dementia
- James McLoughlin, Emma Roemmele, Marguerite Cryan, Catherine Dolan, Geraldine McCarthy
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S91-S92
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Aims
The majority of people with dementia will develop one or more behavioural or psychological symptoms of dementia (BPSD) as the illness progresses. Treating these symptoms in diverse residential environments is a challenge, with frequent prescribing of antipsychotic medications. The risks and limited benefits of antipsychotic use in this context are well recognised, prompting national guidelines in Ireland to improve prescribing patterns.
1) Assess the frequency and appropriateness of prescribing of antipsychotic medication in older adults with BPSD referred to Psychiatry of Old Age service in the West of Ireland (Sligo) by comparing with best practice guidelines.
2) Address identified deficits via quality improvement initiatives within department.
MethodAudit standards were set using draft National Clinical Guidelines and NICE guidelines for prescribing in dementia to develop a study specific audit tool.
Items assessed included: the frequency of review of antipsychotic use, whether or not non-pharmacological methods were trialled, if there was an assessment of benefit of the antipsychotic and discussion or risks, if a reduction/discontinuation of antipsychotic was considered, if metabolic monitoring was achieved.
Clinical records for all patients actively under the care of the clinical team with a diagnosis of BPSD were assessed using this tool at the time of the study.
Result49 patients with BPSD were attending the service in this time period. 58% (n = 29) of the entire cohort were prescribed an antipsychotic, most commonly quetiapine. Patients cared for at home showed the lowest levels of antipsychotic use at 50% (n = 18), while those who were in nursing home (80%, n = 8) and hospital care (100%, n = 3) showed higher rates, though this sample size was too small to demonstrate statistical significance, χ2 = 5.12 p = 0.077.
Exploration of non pharmacological management of BPSD, documentation of discussion of risks of AP medication (metabolic, cardiovascular, falls, sedation, extrapyramidal), attempt at dose reduction or antipsychotic withdrawal were all achieved in less than 45% of cases (range 33–45%).
ConclusionThis audit revealed higher than expected rates of antipsychotic prescribing in our BPSD cohort. It also revealed suboptimal documentation around the use of antipsychotics in this population during clinical interactions.
A subsequent intervention to the proforma assessment tool to prompt these discussions improved these behaviours, there was no impact on the rates of antipsychotic prescribing.
Despite increased attention regarding the limited benefits of antipsychotic medication in BPSD their use remains widespread. Due attention must be given to changing this practice in order to protect this vulnerable patient group.
An audit of lithium prescribing practices in an old age psychiatry service highlighting renal impairment in this cohort
- Leia Valentine, John Cannon, Siobhan Marmion, Michelle Corcoran, Marguerite Cryan, Geraldine McCarthy, Catherine Dolan
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S109-S110
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Aims
To compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-West of Ireland among adults aged 65 years and over with best practice guidelines.
MethodReview of the literature informed development of audit standards for Lithium prescribing. These included National Institute for Clinical Excellent (NICE) 2014 guidelines, The British National Formulary (2019) and Maudsley Prescribing Guidelines (2018). Data were collected retrospectively, using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years or more and prescribed Lithium over the past one year.
ResultAt the time of the audit in February 2020, 18 patients were prescribed lithium, 67% female, average age 74.6 years. Of those prescribed Lithium; 50% (n = 9) had a depression diagnosis, 44% (n = 8) had bipolar affective disorder (BPAD) and 6% (n = 1) had schizoaffective disorder.
78% (n = 14) of patients were on track to meet, or had already met, the NICE standard of 3-monthly serum lithium level. Lithium levels were checked on average 4.5 times in past one year, average lithium level was 0.61mmol/L across the group and 39% (n = 7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).
83% (n = 15) of patients met the NICE standards of 3 monthly renal tests, thyroid function test was performed in 89% (n = 16) and at least one serum calcium level was documented in 63% (n = 15). Taking into consideration most recent blood test results, 100% (n = 18) had abnormal renal function, 78% (n = 7) had abnormal thyroid function and 60% (n = 9) had abnormal serum calcium.
Half (n = 9) were initiated on lithium by POA service and of these, 56% (n = 5) had documented renal impairment prior to initiation. Of patients on long term lithium therapy at time of referral (n = 9), almost half (n = 4) had a documented history of lithium toxicity.
ConclusionThe results of this audit highlight room for improvement in lithium monitoring of older adults attending POA service. Furthermore, all patients prescribed lithium had impaired renal function, half had abnormal calcium and two fifths had abnormal thyroid function. This is an important finding given the associations between those admitted to hospital with COVID-19 and comorbid kidney disease and increased risk of inpatient death.
Our findings highlight the need for three monthly renal function monitoring in older adults prescribed lithium given the additive adverse effects of increasing age and lithium on the kidney. Close working with specialised renal services to provide timely advice on renal management for those with renal impairment prescribed lithium is important to minimise adverse patient outcomes.