Centre for Gerontology and Rehabilitation - Journal Articles
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Item Regeneration in vulnerable communities: resident and stakeholder perspectives(Cogitatio Press, 2024) O'Sullivan, Siobhán; O'Connell, Cathal; Cullinane, Mark; Kenny, Lorna; Folan O’Connor, Elizabeth; Gaston, Sadhbh; Cork City CouncilThis article assesses the implementation of a regeneration programme in a disadvantaged area in the south of Ireland, with particular focus on how residents in vulnerable circumstances have been supported in the face of multiple crises including economic recession and austerity, service reductions and cutbacks, risk of poverty and social exclusion, and neighbourhood change. The article draws on longitudinal qualitative and quantitative data generated over the time frame of a decade through research with residents, community organisations, and the municipal authority. Drawing on the principles of sustainable regeneration, i.e., physical, social, economic, and environmental dimensions, the article explores the effectiveness and outcomes of regeneration strategies on improving estate liveability and the quality of life of residents across multiple themes and indicators. The key themes explored include supports across the life course, community safety and public realm, education and opportunity, and well‐being and resilience. Through this analysis, the article aims to better understand the experiences of residents in vulnerable circumstances and the impacts, both positive and negative, of a major regeneration programme on their lives.Item Prevalence and predictors of continence containment products and catheter use in an acute hospital: A cross-sectional study(Elsevier Inc., 2021-03-05) Condon, Marie; Mannion, Edel; Collins, Gillian; Abd Ghafar, Mohd Zaquan Arif; Ali, Bushra; Small, Majella; Murphy, Robert P.; McCarthy, Christine E.; Sharkey, Anthony; MacGearailt, Conall; Hennebry, Aisling; Robinson, Stephanie; O'Caoimh, RónánAlthough incontinence is common in hospital, the prevalence and predictors of continence aid use (continence wear and catheters) are poorly described. A one-day cross-sectional study was conducted in a large university hospital assessing consecutive inpatients (≥55) for their pre-admission and current use of continence aids. Barthel Index, Clinical Frailty Scale and Charlson Co-morbidity scores were recorded. Appropriateness was defined by local guidelines. 355 inpatients, median age 75±17 years, were included; 53% were male. Continence aid use was high; prevalence was 46% increasing to 58% for those ≥75. All-in-one pads were the most common, an overall prevalence of 31%. Older age, lower Barthel and higher frailty scores were associated with continence aid use in multivariate analysis. Inappropriate use of aids was high at 45% with older age being the only independent predictor. Continence aids are often used inappropriately during hospitalisation by older patients. Concerted efforts are required to address this issue.Item Continuous home monitoring of Parkinson's disease using inertial sensors: A systematic review.(PLoS, 2021-02-04) Sica, Marco; Tedesco, Salvatore; Crowe, Colum; Kenny, Lorna; Moore, Kevin; Timmons, Suzanne; Barton, John; O'Flynn, Brendan; Komaris, Dimitrios-Sokratis; European Regional Development Fund; Interreg; Enterprise Ireland; AbbVie; European CommissionParkinson's disease (PD) is a progressive neurological disorder of the central nervous system that deteriorates motor functions, while it is also accompanied by a large diversity of non-motor symptoms such as cognitive impairment and mood changes, hallucinations, and sleep disturbance. Parkinsonism is evaluated during clinical examinations and appropriate medical treatments are directed towards alleviating symptoms. Tri-axial accelerometers, gyroscopes, and magnetometers could be adopted to support clinicians in the decision-making process by objectively quantifying the patient's condition. In this context, at-home data collections aim to capture motor function during daily living and unobstructedly assess the patients' status and the disease's symptoms for prolonged time periods. This review aims to collate existing literature on PD monitoring using inertial sensors while it focuses on papers with at least one free-living data capture unsupervised either directly or via videotapes. Twenty-four papers were selected at the end of the process: fourteen investigated gait impairments, eight of which focused on walking, three on turning, two on falls, and one on physical activity; ten articles on the other hand examined symptoms, including bradykinesia, tremor, dyskinesia, and motor state fluctuations in the on/off phenomenon. In summary, inertial sensors are capable of gathering data over a long period of time and have the potential to facilitate the monitoring of people with Parkinson's, providing relevant information about their motor status. Concerning gait impairments, kinematic parameters (such as duration of gait cycle, step length, and velocity) were typically used to discern PD from healthy subjects, whereas for symptoms' assessment, researchers were capable of achieving accuracies of over 90% in a free-living environment. Further investigations should be focused on the development of ad-hoc hardware and software capable of providing real-time feedback to clinicians and patients. In addition, features such as the wearability of the system and user comfort, set-up process, and instructions for use, need to be strongly considered in the development of wearable sensors for PD monitoring.Item Antidepressant use and orthostatic hypotension in older adults living with mild-to-moderate Alzheimer disease(John Wiley & Sons, Inc., 2020-07-15) Dyer, Adam H.; Murphy, Claire; Briggs, Robert; Lawlor, Brian; Kennelly, Sean P. for the NILVAD Study Group; Seventh Framework ProgrammeObjectives: Antidepressant use is often reported as a risk factor for Orthostatic Hypotension (OH), however this relationship has never been explored in those with mild/moderate Alzheimer Disease (AD), who may represent a particularly vulnerable cohort. Methods: We performed a cross‐sectional analysis of baseline data from the NILVAD study. Participants with mild‐moderate AD were recruited from 23 centres in nine countries. Systolic and Diastolic Blood Pressure (SBP/DBP) was recorded in the seated position and after both 1 and 5 minutes of standing. OH was defined as a drop of ≥20 mmHg SBP/≥10 mmHg DBP. We examined the relationship between antidepressant use, orthostatic BP drop and the presence of OH, controlling for important covariates. Results: Of 509 participants (72.9 ± 8.3 years, 61.9% female), two‐fifths (39.1%; 199/509) were prescribed a regular antidepressant. Antidepressant use was associated with a significantly greater SBP and DBP drop at 5 minutes (β: 1.83, 0.16‐3.50, P = .03 for SBP; β: 1.13, 0.02‐2.25, P < .05 for DBP). Selective Serotonin Reuptake Inhibitor (SSRI) use was associated with a significantly greater likelihood of OH (OR 2.0, 1.1‐3.6, P = .02). Both findings persisted following robust covariate adjustment. Conclusions: In older adults with AD, antidepressants were associated with a significantly greater SBP/DBP drop at 5 minutes. SSRI use in particular may be a risk factor for OH. This emphasises the need to screen older antidepressant users, and particularly those with AD, for ongoing orthostatic symptoms in order to reduce the risk of falls in this vulnerable cohort.Item General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed-methods systematic review(John Wiley and Sons Ltd, 2018-06-13) Jennings, Aisling A.; Foley, Tony; Walsh, Kieran A.; Coffey, Alice; Browne, John P.; Bradley, Colin P.; Health Service Executive, Ireland; Irish College of General Practitioners; Atlantic PhilanthropiesObjectives: To synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions. Methods: We conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta-ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings. Results: Of the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A “line of argument” was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached. Conclusion: This systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.