Because of the discretionary nature of voluntary food fortification in the European Union, there is a need to monitor fortification practices and consumption of fortified foods in order to assess the ...efficacy and safety of such additions on an ongoing basis. The present study aimed to investigate the nutritional impact of changes in voluntary fortification practices in adults aged 18-64 years using dietary intake data from two nationally representative cross-sectional food consumption surveys, the North/South Ireland Food Consumption Survey (NSIFCS) (1997-9) and the National Adult Nutrition Survey (NANS) (2008-10). The supply of fortified foods increased between 1997-9 and 2008-10, resulting in a higher proportion of adults consuming fortified foods (from 67 to 82 ) and a greater contribution to mean daily energy intake (from 4.6 to 8.4%). The overall nutrient profile of fortified foods consumed remained favourable, i.e. higher in starch and dietary fibre and lower in fat and saturated fat, with polyunsaturated fat, sugars and Na in proportion to energy. Women, particularly those of childbearing age, remained the key beneficiaries of voluntary fortification practices in Ireland. Continued voluntary fortification of foods has increased protection against neural tube defect-affected pregnancy by folic acid and maintained the beneficial impact on the adequacy of Fe intake. Increased consumption of fortified foods did not contribute to an increased risk of intakes exceeding the tolerable upper intake level for any micronutrient. Recent increases in voluntary fortification of foods in Ireland have made a favourable nutritional impact on the diets of adults and have not contributed to an increased risk of adverse effects.
IntroductionDelirium is a serious medical condition that is common in older adults in acute settings. Clinical practice guidelines recommend that all older patients in acute care settings should be ...screened for delirium using standardised outcome measures.ProblemIn our institution, an audit showed that only 16% of older adults presenting to the emergency department were screened for delirium. The goal of this project was to increase the number of patients being screened for delirium using Lean Six Sigma (LSS) methodology and tools and a multidisciplinary approach.MethodA multidisciplinary team in the emergency department used LSS tools and methodology over a 12-week period to first identify why patients were not being screened for delirium using root cause analysis and second to implement a multifaceted intervention including education, audits and feedback, documentation changes and team huddles. An audit was performed at the 11th week of the project to measure how many patients were being screened for delirium post project intervention.ResultsResults at 5 weeks post intervention (11th week of project) showed that the percentage of patients being screened for delirium had increased from 16% to 82%. A follow-up audit at 17 weeks post intervention showed a further improvement in delirium screening to 92%.ConclusionApplying LSS tools and methodology resulted in a healthcare quality improvement. Delirium screening in an emergency department can be improved through multifaceted interventions including education, documentation changes and team huddle changes.
The objective of this work was to quantify the impact of the voluntary fortification of foods on dietary intakes of vitamins and minerals of Irish adults. Foods that were voluntarily fortified were ...identified and pre- and post-fortification levels of micronutrients were determined from data supplied by manufacturers and food composition tables. Using food consumption data in 1379 adults aged 18-64 years, estimated using a 7-d food diary during the North/South Ireland Food Consumption Survey, intakes of micronutrients were determined, both including and excluding the fortification component in foods. Of approximately 3000 foods recorded as consumed, 1.9 % were fortified, mainly breakfast cereals and beverages. Median micronutrient content of fortified foods (FF) ranged from 18-33 % EC RDA per typical serving. Among consumers (65 % of men, 68 % of women), FF contributed, on average, 3.9 % (men) and 5.0 % (women) to mean daily intake (MDI) of energy. Relative to their contribution to MDI of energy, FF contribute a greater % MDI for Fe (men 16, women 19), folate (men 18, women 21), vitamins B1 (men 14, women 16), B2 (men 16, women 18), B6 (men 12, women 15), D (men 5, women 11), B12 (men 5, women 7) and niacin (men 10, women 12). Fortification significantly improved the adequacy of intake of some micronutrients, particularly of riboflavin, folate, vitamin D and Fe in women and did not contribute to an increased risk of adverse effects from excessive intake of any micronutrient.
The aim of the present study was to assess the impact of fortified food (FF) consumption on overall dietary quality in Irish adults. Data for this analysis was based on the North/South Ireland Food ...Consumption Survey w7/15/2008hich used a 7 d food diary to collect food and beverage intake data in a representative sample of 1379 Irish adults (662 men and 717 women) aged 18-64 years. Foods contained in the database that are fortified were identified from the presence of vitamins and/or minerals in the ingredient list on the label. The results showed that an increased level of FF consumption was associated with lower intakes (percentage food energy) of total fat and saturated fat (women only) and higher intakes of total carbohydrate, total sugars (but not added sugars) and starch. Increased consumption was associated with a more micronutrient-dense diet and a reduced prevalence of dietary inadequacies of Ca, Fe, riboflavin and folate, particularly in women. Higher FF consumption was associated with higher intakes of fruit, lower intakes of alcohol and a lower likelihood of smoking in men and women. Thus it appears that FF consumption is a marker of both better dietary quality and healthy lifestyle behaviours.
337 Falls Pathway and Assessment, an Audit McCarthy, Kate; Hannon, Evelyn; Carroll, Jennifer
Age and ageing,
09/2019, Letnik:
48, Številka:
Supplement_3
Journal Article
Recenzirano
Odprti dostop
Abstract
Background
Falls remain a common presentation to emergency departments and medical assessment units. They can result in serious injuries requiring surgical intervention and prolonged ...hospital admission. Conversely a fall may have minimal injury yet still result in prolonged hospital admission. The frailty intervention therapy team (FITT) aims to complete a comprehensive assessment physical and social needs in a time efficient manner.
Methods
We reviewed the medical notes of a cross-section of patients, aged over 65 years, on medical wards admitted with a fall. The service, under which, the patient was admitted was noted. We looked at the length of time between admission and physiotherapy review, undertaking bedside tests for postural hypotension and assessment of bone health, with commencement of appropriate therapy pre discharge. We also reviewed medications and if anti hypertensives were stopped or adjusted.
Results
Of the 30 patients included, the average length of time from admission to physiotherapy review was 2.6 days. 7 of the patients were seen on the same day, however 3 were awaiting review.
Postural blood pressures were requested in one third of the group, predominately in those patients admitted under a geriatric service.
A similar pattern was seen in assessment of bone health, although of the patients included, half of them were on at least a single agent for osteoporosis.
Conclusion
Development of FITT is of benefit to the health service as a whole and improves early mobilisation, extension for weekend cover should be considered.
Interventions such as adjustments to anti hypertensives and opportunistic assessment of bone health should be highlighted to all medical teams.
A concise falls pathway encompassing these interventions and FITT assessment does not seem obscure in this age of over-crowding and crisis.
Abstract
Background
Biologics are a key component of the treatment armamentarium for inflammatory arthritis (IA). Questions remain surrounding the prescription, efficacy and safety of biologics in ...the older population. This study aims to describe the use of biologics in older patients with IA and compare it to younger patients.
Methods
This was a retrospective cohort study of patients with a diagnosis of IA who were receiving a biologic. Data was collected from medical charts at rheumatology outpatient clinics. Patients were divided into two groups: younger group (age 45 – 65) and older group (age >70).
Results
Each group had 30 patients (total n=60). 58% were female and the mean age overall was 65 years. Rheumatoid arthritis was the most common diagnosis (57%). 8 patients had active disease, and these were mainly older patients (n=6). 8 different biologics featured; the majority of patients received the standard dose of biologic (87% of younger, 80% of older). The incidence of biologic discontinuation due to drug ineffectiveness was the same for both groups (16%). 1 older patient had a biologic discontinued due to a serious adverse event. Infections requiring hospitalisation were not common (total n=5) but were more frequent amongst older patients (n=4). 47% of younger and 60% of older patients received concomitant therapy; most received a disease-modifying antirheumatic drug (DMARD) (72%), and those who received a steroid (n=6) were more likely to be older (n=5).
Conclusion
Biologic prescribing was similar between both groups with regard to the dosage administered, but there were differences in the types of biologics prescribed to each group. Rates of significant infection were low overall, however they were more prevalent amongst the older population. More older patients had active disease, and more were prescribed concomitant steroid therapy, which may represent under-dosing of biologic therapy in this older cohort.
Abstract
Background
Polypharmacy among older adults is a well-documented problem. The practice has been associated with potentially inappropriate medications (PIMs, adverse drug events (ADEs) and ...hospitalisation. This retrospective cohort study aims to evaluate polypharmacy, ADEs and anticholinergic burden in the ≥65 population with rheumatic disease.
Methods
All patients who were ≥65 and had a diagnosed rheumatic disease were included in this study. Patients' medication lists, specific rheumatic disease, laboratory findings and associated comobidities were obtained from their medical charts at rheumatology outpatient clinics. The data was screened for PIMs using the Screening Tool of Older Persons' Medications (STOPP) criteria and probable ADEs using the WHO-UMC criteria. Anticholinergic burden was determined using the ACB calculator. Polypharmacy in this project was defined as ≥4 regular prescription medications.
Results
70 patients were studied. The prevalence of polypharmacy was 94%. The median (IQR) number of regular prescription medications was 7 (2-16). PIMs were recorded in 43 patients (61%). Increasing numbers of medications was a significant risk factor for PIMS (p=0.0027). ADEs were detected in 18 patients (26%). The ADE detection rate in PIM positive patients was 35% (15/43) and 11% (3/27) in PIM negative patients. A patient who was PIM positive had a statistically significant risk of having an ADE (p=0.047). Of the ADEs detected, 73% were due to a STOPP PIM.
Increasing numbers of medications was a significant risk factor for an increased anticholinergic burden (p=0.017). An anticholinergic burden of ≥3 was a statistically significant risk factor for falls (p=0.025), however it was not a statistically significant risk factor for cognitive decline (p=0.073).
Conclusion
There is a high prevalence of polypharmacy in older adults with rheumatic disease. Increasing numbers of medications is statistically associated with increased number of PIMs, ADEs and increased anticholinergic burden.
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