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306 The Changing Face of Stroke in the DOAC Era
ConclusionThe majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

188 The Use of a Group Based Upper Limb Programme in Improving Outcome in Acute Stroke Rehabilitation
ConclusionThe GRASP group was found to be effective in improving upper limb outcome measures in an acute stroke inpatient hospital setting.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

268 Can the Swallow Screening Component of a Frailty Assessment be Used to Reliably Direct Clinical Dysphagia Assessment Referrals?
ConclusionA trained interdisciplinary frailty team can reliably screen for and identify risk of dysphagia. This indicates a potential for use of more standardised swallow screening protocols beyond the post stroke population into a broader cohort of patients.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

24 Stroke Risk Factors, Aetiology, and Outcomes in a Multi-ethnic Irish Stroke Population
ConclusionOur study demonstrates that NI stroke patients have a different risk factor and stroke sub-type profile compared to Irish patients.  NI patients are more likely to be young, hypertensive, male, and have higher rates of ICH. Cultural and linguistic barriers may adversely influence health seeking behaviour in this group. These findings underscore the need to identify the root causes of these ethnic differences so targeted prima ry prevention campaigns can be established.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

263 An Audit of Patient Medication Lists in the Outpatient Setting
ConclusionThis audit shows that roughly one third of patients do not bring up-to-date lists of medications to their outpatient appointments and only a small proportion of patients feel that they themselves have the most up-to-date list of their own medications. Suggested areas for improvement include patient education campaigns, reminder letters/text messages to patients prior to their clinic appointments and the introduction of a Clinical Pharmacist to the outpatient setting.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

225 Assessment of Well-being after Stroke
ConclusionThis study highlights significant concerns from patients following stroke with regard to their memory and mood. This emphasises the importance of formal assessment of mood and memory both during admission and on an ongoing basis post discharge. A significant proportion of patients required additional help at home with family members providing the majority of this support.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

297 Re-audit of Swallow Assessment in Acute Stroke Patients Following Introduction of a Full-time Speech Specialist
ConclusionIntroduction of a full-time speech and language specialist has increased the rates of swallow assessment in line with the national average. The overall rates of SALT interventions in dietary regimens highlights the need to increase overall assessment rates in patients with acute stroke.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

272 Clinical Audit on Transient Ischaemic Attack Investigations in Acute Medical Unit
ConclusionPatients admitted to AMU with suspected TIAs had relevant imaging and tests completed as per guidelines. 89 % had US Carotid Dopplers which were on average done 33h from admission. 58% of patients had inpatient heart monitoring. The average length of stay was 3 days but three patients stayed in AMU for up to 5 days. Protected imaging slots for AMU would expedite investigations and reduce inpatient stay.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

87 Evolution of Atrial Fibrillation
ConclusionThere has been a significant increase in primary prevention practices for AF and this is reflected in the number of stroke patients presenting with known AF on a NOAC, however more needs to be done as there are still patients who have AF that are not being anticoagulated in the community.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

311 Older Adults Awareness and Response to Stroke in Ireland.
ConclusionAwareness of stroke symptoms does not necessarily influence response to stroke in older adults. Future stroke awareness campaigns should consider FAST2 which speaks to treatment (thrombolysis or thrombectomy) as well as time.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

86 Haemorrhagic Stroke: What's in a Bleed?
ConclusionThere were a greater proportion of patients with lobar versus deep bleeds in our cohort which may be due to the older population in our area.Mortality and disability was far greater in the lobar cohort.None of the lobar bleeds with AF who were on OAC died in contrast to the deep ICH patients. This may suggest that more aggressive hypertensive treatment is required in this subpopulation.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

123 Empowering Patients after Stroke: Development of a Stroke Information Booklet
ConclusionPatients/Families are keen to receive information regarding stroke, particularly about future risk of stroke. Empowering patients with information about stroke that is relevant to them and their care providers is a fundamental part of secondary stroke prevention. We also need to focus more on the psychological impact of stroke. Our booklet will incorporate information we have gathered in this study to make it a truly patient centred resource.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

308 Association of Diabetes and Frailty with Mortality in Middle-Aged and Older Europeans
ConclusionFrailty and pre-frailty are independent risk factors for mortality in diabetics. The identification of frailty is important for the risk-stratification and management of middle aged and older patients with diabetes and should be included in the routine assessment of these high-risk individuals.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

122 Are We Effective Prescribers? A Retrospective Audit of DOAC Prescribing Post Embolic Stroke for Non Valvular Atrial Fibrillation
ConclusionA significant number of patients prescribed DOAC in hospital were not appropriately anticoagulated (21%), a majority of which were under-dosed. The patients who were under-dosed were older and more likely to be on 5 or more medications.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

81 A Review of the Referrals to a Daily TIA Service and Subsequent Specialist Diagnosis
ConclusionEvidence shows that patients suffering TIA should be seen urgently within 24hrs. The degree of non TIA symptoms being reviewed risks these services being overrun.  A review of our service has shown that the average time of referral to review is longer than desired, however only a third of patients seen were felt to have a TIA. Unless there is a change in the standard of referral it will continue to be difficult to see all true TIAs within 24hrs. This will require further education for our colleagues and a more robust triaging system.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

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