ABSTRACT
The Coronavirus Disease 2019 (COVID-19) has accounted for more than 25 000 cases in Ireland with approximately 28% of the clusters in nursing homes as of June 2020. The older population is the most vulnerable to serious complications from this illness and over 90% of deaths due to COVID-19 to date have been in patients over the age of 65. Continuing to provide routine care within nursing homes in these challenging times is an essential part of ensuring that presentations to hospitals for non-essential reasons are minimized. In this article, we describe a project being undertaken by a rural Psychiatry of Old Age Service in the northwest of Ireland. We aim to provide ordinary care in extraordinary times by using mobile tablets within the nursing homes and long-stay facilities in our region for remote video consultations during the COVID-19 crisis.
ABSTRACT
Introduction: The COVID-19 pandemic caused significant disruptions in services and necessitated innovation to continue care provision to the vulnerable population of older adults with psychiatric needs. Objective(s): The objective of this study was to examine the experiences of staff and patients using a hands-free electronic smart-hub (eSMART hub) intervention to keep patients connected with psychiatry of old age following COVID-19 restrictions. Method(s): A risk stratification register was created of all patients known to the Psychiatry of Old Age service in the North-West of Ireland to identify those at highest risk of relapse. These patients were offered a smart-hub with remote communication and personal assistant technology to be installed into their homes. Smarthubs were also installed in the team base to facilitate direct device to device communication. Semi-structured qualitative interviews were conducted with 10 staff members and 15 patients at 6-12 months following the installation of the smart-hubs. Result(s): The smart-hubs were utilized by the POA team to offer remote interventions over video including clinician reviews, regular contact with key workers and day-hospital based therapeutic interventions such as anxiety management groups and OT led physical exercises. Patients also used the personal assistant aspect of the hub to attend to personal hobbies such as accessing music and radio. Positive feedback related to companionship during isolation and connectivity to services. Negative feedback was mainly related to technology, particularly internet access and narrow scope of communication abilities. Conclusion(s): Electronic smart-hub devices may offer an acceptable avenue for remote intervention and communication for isolated high-risk older persons.
ABSTRACT
Aims:To compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-WestofIreland among adults aged 65 years and over with best practice guidelines.Methods:Review of the literature informed development of audit standards for Lithium prescribing. Theseincluded National Institute for Clinical Excellent (NICE) 2014 guidelines, The British NationalFormulary(2019) and Maudsley Prescribing Guidelines (2018). Data was collected retrospectively,using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years ormore and prescribed Lithium over the past year.Results:At the time of audit in February 2020, 18 patients were prescribed lithium, 67% female, average age74.6 years. Of those prescribed Lithium;50% (n=9) had depression, 44% (n=8) had bipolar affectivedisorder (BPAD) and 6% (n=1) schizoaffective disorder.78% (n= 14) of patients met the NICE standard of 3-monthly lithium level. Lithium levels werecheckedon average 4.5 times in past year, average lithium level was 0.61mmol/L across the groupand 39% (n=7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).83% of patients (n=15) met the NICE standards of 3 monthly renal tests. Taking into considerationmostrecent blood test results, 100% (n=18) had abnormal renal function.Half (n=9) were initiated on lithium by POA service and of these, 56% (n=5) had documented renalimpairment prior to initiation. Of patients on long term lithium at time of referral (n=9), almost half(n=4) had a documented history of lithium toxicity. Conclusions:The results of this audit highlight room for improvement in lithium monitoring of older adults attendingPOA service. Furthermore, all patients prescribed lithium had impaired renal function. This is animportant 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 elderly prescribedlithiumgiven the additive adverse effects of increasing age and lithium on the kidney. Close workingwith specialised renal services to provide timely advice on renal management for those with renalimpairment prescribed lithium is important to minimise adverse patient outcomes.
ABSTRACT
IntroductionThe COVID-19 pandemic has required services to evolve quickly to continue routine care and telemedicine has been rapidly implemented to facilitate this. Older persons are at high risk of serious complications of COVID-19 and it is essential that their exposure to COVID-19 is minimized.ObjectivesOur aim was to assess staff and patient satisfaction with remote psychiatric assessments using mobile tablets in long-stay facilities.MethodsRemote clinics using Skype video on mobile tablets were conducted with patients in long-stay facilities attending psychiatry in rural North-West Ireland between April and July 2020. At each review, a satisfaction survey was administered to the patient, their keyworker and the clinician. The patient/keyworker survey instrument had four yes/no statements and the clinician survey had four statements with 5-point likert scale responses (1=very low to 5=very high). Open feedback was also obtained for thematic analysis. Descriptive analyses were completed using SPSS software.Results23 patients (mean age 80.9yrs) were assessed in 10 long-stay facilities. All patients were agreeable to participating in video consultation although only 13 patients were able to respond to survey due to cognitive impairment. There was a 92.3% positive patient response (12/13) and 95.7% positive keyworker response (N=22/23) for all statements. The mean score on the assessor response ranged from 3.43 to 4.04 with the lowest rate for quality of transmission. The main themes identified were related to the quality of connection and sensory difficulties.ConclusionsVideo consultations using mobile tablets offer an acceptable form of remote psychiatry assessment for older persons in long-stay facilities.