Poster Abstracts

1. Title: Integrated Care -The Key to High Quality Care at Enaya Specialised Care Centre

Authors: Dr Irfan Muneeb, Dr Irshad Badarudeen, Dr Haroon Ahmed Saleh

Introduction: Activities are an integral part of individualised care plan. Patients in long term care should be offered opportunities during their stay to participate in meaningful activities that promotes physical and mental wellbeing. People in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and wellbeing; and people in care homes are enabled to maintain and develop their personal identity. (NICE 2013)

Methods: Out of the 40 admissions over the last one year in Enaya - 22 were categorized as active rehabilitation participants. The following standardized tools were used for assessment, intervention and follow up.

By the physical therapy: Mobility scale grading; RLA-Rancho los amigos levels of cognitive functioning and ASIA scale.

By Occupational therapy: Functional Independence Measure score

Results: The occupational and physical therapist identified 22 active patients, over this period 45% of them showed marked improvement with various stimulations given to them during the therapy.

Conclusions: Patients were given active/ passive rehabilitation combined with cognitive, multisensory stimulation and spiritual religious activities. These resulted in significant improvement in patient’s functional capacity and cognitive status.

2. Title: - Dementia: “Breaking Barriers -Building Bridges“ a nationwide awareness campaign

Authors: Dr Asma Abbas, Dr Sameer Acharath Valappil, Dr Amir Abdalla, Dr Mahamoud Refaee, Dr Wasim Akram, Dr Osama Idris, Dr Hanadi Al Hamad

Introduction: Dementia is a term used for several progressive diseases that affect memory, cognitive abilities and behaviour. Alzheimer's disease, common form of dementia, contributes to 60–70% cases. Currently there are approximately 50 million people living with this condition worldwide, this is expected to grow to 130 million by 2050.

Problem: National dementia awareness project was planned to help state of Qatar develop an enabling environment for patients with dementia and make a significant difference to the quality of care being given to them and their wellbeing. Evidence suggest stigma associated with dementia is a pivotal factor in delaying diagnosis. Raising awareness and education helps in minimizing stigma enables better acceptance of care and enhances the quality of life.

Aim - Raise awareness of dementia across healthcare settings and community in the state of Qatar

Results:

1. Dementia as a Public Health Priority: Our national awareness and education project on Dementia across the State of Qatar included;
2. Dementia awareness & friendliness programmes across HMC
3. Dementia risk reduction
4. Formed national dementia carer’s group
5. National dementia plan launched in 27^th November 2018

3. Title: - Challenges in dementia caregiving in Qatar: Insights from informal and formal providers

Author: Suzanne Hammad

Introduction: Formal healthcare providers rarely see older persons with Dementia and Alzheimer until they are in medium to advanced stages of the disease, and on the other hand, caregiving family members’ struggles are not well documented. This constitutes a gap in knowledge and communication issue, which if better understood could lead to earlier help-seeking and ultimately more effective and wider-reaching utilization of services.

Methods: Both formal and informal stakeholders were interviewed in order to generate a comprehensive understanding of caregivers’ experiences.

Results: Six main challenges were identified as consensus. These challenges are illuminated through anecdotes, experiences, and voices from family members and health and social care professionals who encounter patients with dementia.

Conclusions: The qualitative evidence produced through this study provides useful insight from the primary caregivers for older persons with dementia. The challenges identified pave the way for clear pathways for intervention to improve and streamline effective services. Intervention is needed at three levels – national level, family/community level, and formal providers- with underpinning calls for awareness and training and culturally sensitive practice.

4. Title: - Gender aspects of caring for parents with dementia in Qatar: Women’s voices from the field

Authors: Suhad Daher-Nashif, Tanya Kane, Suzanne Hammad, Nour al-Wattary

Background: While most researchers and stakeholders focus on the people with dementia and on enhancing their quality of life, few studies address the experience of caregivers of the elderly with dementia. This presentation will focus on women’s experiences as caregivers for parents with dementia. The research constitutes part of a study conducted by Qatar University in 2017/18, and funded by Ehsan - Centre for Empowerment and Elderly Care in Qatar.

Methodology: Caregiving for the elderly with dementia is a process that structured through meanings of health and illness, social attitudes towards mental illness, status and conceptions of old age. In order to understand these meanings, attitudes and processes, we employed a qualitative research methodology, through which we interviewed 37 Arab-Muslim caregivers in Qatar. 

Findings: Women are the predominant caregivers in Qatar and carry the major burden of caring for the elderly with dementia. They care for their parents, in-laws and grandparents with love and compassion. They regard caregiving as a religious obligation and refer to the holy Quranic verses in framing their commitment. The study found that in 94% of the cases, the main caregiver is female. Women’s caregiving and coping styles are influenced by socio-cultural and socio-economic factors.

Discussion: Caring for the elderly is one of the most important religious rules and obligations in Muslim communities. Women’s unique abilities enable them to care for the elderly with dementia with great satisfaction and honour.

5. Title: Improving access to Comprehensive Geriatric Assessment amongst in-patients living with frailty

Authors: I.Merrony, S.Chaudry, S.Perera, H.Harvey, H.Khoshnaw

Introduction: CGA is an evidence-based intervention, and is thought to be the gold standard for assessing older people with frailty. There is lower mortality associated with those patients who received CGA, and lower rates of deterioration/institutionalisation. At 6 months, the number needed to treat is 17 to avoid one unnecessary death or deterioration.

The Inpatient Older People’s Assessment and Liaison (iOPAL) service is striving to ensure that CGA is accessible to all patients, regardless of the specialty or ward that they belong to.

Methods: An initial pre-intervention 4-week data collection period was planned, 14th March – 10th April 2018. Patients meeting criteria for frailty3 were identified via the Emergency Assessment Unit admissions list. Their patient journey was tracked and patients who were referred to iOPAL for CGA were recorded. A 4-week data collection period ensued from May to June 2018, during which time a Frailty Sticker was implemented. This prompted referral to the iOPAL team for CGA and frailty advice. Patients with frailty were tracked from EAU to in-patient wards as before, and the sticker was placed in their case notes.

Results: In the 4-week pre-intervention period, only 21.5% (23 of 107) of patients with frailty were referred to iOPAL for CGA. Following implementation of the sticker, referrals increased to 40.9% (45 of 110).

Conclusions: The implementation of a Frailty Sticker doubled referrals to iOPAL, meaning that more inpatients with frailty had access to CGA. The sticker is now used routinely by the iOPAL team with good effect.

6. Title: The Effect on the Motivation of Older Adults in a Group-Based Exercise Program towards Improved Physical Fitness

Author: Frances C. Muhi

Introduction: Center for Elderly Empowerment and Care is a nongovernmental organization that strive to empower elderly and provide them with proper services and care. The multidisciplinary team uses group-based exercise programs to improve the different aspects of health in older people group. A physically active life and physical exercise can minimize the decline of daily functioning and improve psychological and social functioning.

Methods: A group of 4 female and 12 male older people aging 60 years old above residing in the institution did group-based exercise program for 5 days in a week for 1 hour for a duration of 2 years. Different physiotherapy activities focused on cognitive training and general conditioning exercises were part of the daily routine therapy.

Result: The older people group improve their motivation to participate on their individualized physiotherapy sessions after taking part in the group-based exercise program for several times.
Conclusion: The motivation of the older people groups to participate on their individualized physiotherapy sessions increased after they have been part of multiple group-based exercise sessions.

7. Title: Awareness and attitude towards dementia in high school students in the State of Qatar

Authors: Haiqa Masoodi, Ms. Elena Harimat, Dr Hanadi Al-Hamad.

Introduction: Dementia is a public health priority for the state of Qatar and a pressing problem for the families and the caregivers. As the high school students are the next generation caregivers, having good awareness and attitude towards dementia will be key elements in providing good care for their loved ones with dementia.

Method: The survey was conducted in high schools within Doha, Qatar in first half of 2019. Thirteen high schools affiliated with Qatar Foundation were selected for this study. The survey data was collected by sending an online questionnaire to all the participants.

Results: A total of 107 viewers visited the page with 54 completing the survey (Response rate 50.4%). 82.4% (42) of the respondents were Qatari vs 17.6% (9) who were non-Qataris. 69.4% (34) were males as compared to 30.6% (15) females. 63% (34) have not heard about dementia and 77.8% (42) do not know anyone with dementia. 80% (43) of the respondents believed that there is no awareness about dementia in the media and in the general public in Qatar. More than 83% were of the opinion that patients diagnosed with dementia should not be avoided or treated differently because of their illness. Most respondents (72.5%) agreed to seek help if their loved one showed any signs of dementia, 52.9% would like to know more about dementia, and 79.6% feel uncomfortable to speak about dementia with others if their loved one was suffering from it.

Conclusion: This is the first survey conducted in high school students in the State of Qatar to evaluate their attitude and awareness about dementia. It is evident from our survey that most high school students are unaware of dementia.

8. Title: Avoidability of drug-induced liver injury (DILI) amongst an elderly Hospital cohort: a comparative evaluation of current adjudication tools

Authors: Mohammed Danjuma, Ibrahim Makki, Yassin, Haajra Elshafei, Jamal Sajid, and Abdel Naser El Zouki

Introduction: There has been a steady increase in the prevalence of drug induced liver injury (DILI) in the general population, but more so within the elderly population cohort. Two recent tools/algorithms (Modified Hellas, and Liverpool adverse drug reactions have proven effective in adjudicating the preventability of ADR’s.

Aim: To investigate the preventability of drug induced liver injury in elderly Qatari population

Methodology: The study cohort was comprised of all patients presenting to ED or inpatient units of HMC with suspected ADR as part of prospective study cohort. For this sub-study, we considered patients >65 years from this cohort whose ADR was adjudicated as DILI. Two rating pair clinicians utilized the modified Hallas and the LAAT tools to assess avoidability of DILI-drug phenotype pairs.

Results: Mean age of the study cohort was 69 (7.63±) years. There was preponderance of male population N = 21 (70%), with the principal implicated drugs been antimicrobial agents. The median R-score was 4, with an IQR (2, 4). Up to 41.6%, and 30% of the DILI-drug pair phenotypes were “avoidable” (possibly or definitely avoidable) by the LAAT and modified Hellas tools respectively. The Fleiss kappa agreement with the LAAT and the modified Hellas tools were 0.57 (SE 0.072, confidence interval {CI} = 0.431, 0.715), and 0.59 (SE 0.063, CI = 0.468, 0.715) respectively. The intraclass correlation coefficients with the modified Hallas and LAAT tools were 0.77 (CI 0.645, 0.87) 0.41 (CI = 0.22, 0.61).

Conclusion: utilising current available ADR preventability tools, up to 40% of DILI in our elderly are potentially preventable with a moderate degree of agreement irrespective of the competence of primary adjudicators. 

9. Title: Geriatrics Input in elderly patients suffering Major Trauma.

Authors: Mohammad Qaffaf, Sangeeta Naraen, Hannah Lorimer, Samantha Montandon, Philip Davie, Charlotte Pollard

Introduction: Major trauma is changing from young and male to older and female. Fall of <2 metres are the most common mechanism causing major trauma. 3.2% either admitted directly to medical ward or sustained injury while inpatient.

Methods: Pilot project, sample of 120 patients age>65. Retrospective study of all the notes.

Results: The patients reviewed by geriatrician were 50% (60 patients). Female 53% (32patients), male 47% (28 patients). Age range mostly 70-90 years old. 36.6% major trauma from falling height of<2 metres, 21.6% were above 86 years old. 82% referred from other hospitals, only 18% had direct admission. 91.6% admitted from own homes. 93% of patients had <5 comorbidities, 7% >5 comorbidities. 55% patients were reviewed once. Only one patient seen 9 times by geriatrician. 22% had one investigation requested by geriatrician. 63% had falls assessment done. 63.3% were found to have developed one or more complications. 48% had good recovery; 13% died mostly due to head injury.

Conclusion: Older people living at own home with relatively less comorbidities suffer a variety of trauma, mainly with low energy mechanism; falls. With geriatric input most patients had good recovery even though patients had developed some medical complications.

10. Title: ANTIPSYCHOTIC MEDICATIONS PRESCRIBTION IN DEMENTIA PATIENTS

Authors: Mohammad Qaffaf, Latheef Kalathil

Introduction: Part of (National Audit of Dementia Audit UK) looking into usage of antipsychotics in Dementia patients. Dealing with challenging behaviour in Dementia/Delirium and reducing use of antipsychotics. Risperidone is the only licensed for agitation in Dementia in UK. 

Method: Retrospective study 56 notes, Diagnosis of Dementia, Discharged April 2017, and Stayed for at least 3 days.

Results: 16 patients have been on antipsychotics while in hospital. 10 were on antipsychotics prior to admission, 6 were started in hospital.

1: Antipsychotic prescribed by Psychiatry Liaison service. Indication; aggressive threatening behaviour. Risperidone 0.5 mg twice daily. Patient was improved and discharged. 

2: Prescribed by Medical consultant, Quetiapine, pain considered as possible cause of agitation, Review of medications recommended on time of prescription in two weeks.

3, 4, 5: Medical consultant prescribed medications. Community Acquired Pneumonia, delirium.

6, 7,8, 9: Haloperidol PRN as part of palliative care and symptoms management.

10: On antipsychotics prior to admission

Conclusions: Antipsychotic should not be prescribed for elderly frail patients with unstable medical conditions; e.g.: cardiac problems, risk of stroke. There should be adequate monitoring in place of patients prescribed and having antipsychotic medicines administrated.

11. Title: Fall in frail elderly and implementing local post-fall proforma

Authors: Dr.Hnin Zaw, Dr.Hlaing Su, Dr Kurien Thyparambil

Introduction: Frailty, Falls and fall-related injuries are a common and serious problem for frail people. Aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. We have had a few patients who have had falls and obtained serious injuries and some missed injuries that were investigated in detail. Hence, we have decided to introduce a post-fall proforma and piloted it.

Methods: Root-cause analysis of the in-patient falls with serious injuries. Conducting a survey upon the confidence of the junior doctors regarding post-fall assessment. Planning, designing a local post-fall proforma and launching a pilot study. Auditing the post-fall assessments during pilot study and
On-going monitoring of the new post-fall proforma.

Results: Survey on 20 junior doctors about their knowledge and confidence on post-fall assessment. 5% not fully confidence in post-fall assessment. 10% not aware the importance of documentation for injuries by using body map, analgesia prescribed and medication reviews. 6% not sure about the post-fall management. All want to have standardized pro-forma for post-fall assessment.

Conclusions: Falls should be assessed comprehensively and risk stratified based on severity. Consider possibility of multiple injuries, and multiple fractures due to frailty and osteoporosis even if relatively minor falls. Standardized documentation in-patient falls frail patients.

12. Title: Early Rehabilitation for Long term Care residents in ENAYA to improve functional status and to prevent secondary complications.

Authors: Mr.Ayman Rafat, Mr.Rashid Buhari, Ms.Sweety David

Background: The model of care for older patients depends on a series of circumstances beyond the disease process that caused the hospital admission. Hospitalized older patients are often bedridden resulting in reduced functional loss, cognitive impairment, high fall risk, pressure ulcer, contracture, increased frailty, and mortality rate. Physical exercise can play an essential role in preventing functional and cognitive decline during hospitalization in the elderly.

Method: Upon admission initial assessment will be done within 5 days for all the residents in Enaya, early rehabilitation will be started by categorizing based on functional strength and cognitive variables as Active (able to follow verbal commands and participate in physical exercises with or without minimal assistance), Low function (able to follow strong/repeated verbal commands and participate in physical exercises with moderate to maximal assistance) and Totally dependent (unable to follow verbal commands and participate in passive exercises).

Results: It was observed that categorizing the resident’s makes goal-setting attainable and marks the personalized physical therapy intervention either improve their functional status or maintain/prevent the severity of morbidity. Overall 65-80% of the active residents exhibited improvement in their functional status, 30-60% in low function residents showed improvement in tolerance to exercises and 75-90% in totally dependent residents were prevented from further deterioration.

Conclusion: Early physical therapy exercise training program in Long term care facility improves physical function, quality of life, prevents functional/cognitive decline and maintains skin/joint integrity among elderly patients.

13. Title: Effect of progressive muscle relaxation on anxiety in geriatric population

Authors: Reshma Gurav, Pothiraj P, Dr.Vrushali Panhale

Background: Aging population and their increased prevalence of chronic diseases are the major challenges faced by health care professionals. Prevalence of anxiety disorders such as panic disorders, obsessive and compulsive disorders and somatoform disorders estimated more than 4% among the geriatric population, posing a threat as socioeconomic burden. Progressive Muscle Relaxation (PMR) has continued to play an important role in the modern treatment of anxiety disorders however lacked in evidence on geriatric population.

Method: Thirty age of 60–80 of both genders were selected through convenient sampling technique after obtaining voluntary informed consent. The Beck Anxiety Inventory (BAI) was used to assess the anxiety levels among the participants. Jacobson’s progressive muscle relaxation with deep breathing exercises consisted of 20 minutes duration of 3 sessions/ week for 3 weeks. BAI was applied pre and post training, obtained score was calculated and statistically analysed using SPSS software.

Results: Findings of study revealed that prior to progressive muscle relaxation, 60% participants had demonstrated moderate, 27% had mild and 13% had severe anxiety level. The mean score of BAI of pre training was 25.5 and of post training was 14.2. The pre and post mean scores of BAI were compared with paired ‘t’ test. There was a significant difference in pre and post-test level of anxiety in the experimental group indicating effectiveness in reducing anxiety.

Conclusion: A non-pharmacological, non-invasive, cost-effective method to relieve anxiety problem among the elderly.

14. Title: Nutrition and Dementia Care: Developing an Evidence-Based Model for Nutritional Care in ESCC

Author: AL-Anoud Fehaidi

Introduction: Enaya Specialized Care Centre provides care for residents who are Diagnosis with Dementia with some disrupt eating behaviour and physiological feeding capacity, Weight loss is one of its clinical features.

Methodology: July2018 to February2019. 13 Residents Files selected retrospective, age75and above, all of which are eating orally who have been a resident of our facility from 6 months. Among the sample 2 patients who are taking antipsychotic medications were excluded. This is in view of the medication’s side effect, which may influence the outcome of study.

Results: All patients were seen by Dietician; food was modified based on their safe food and fluid consistency. Oral nutritional supplements were provided to promote adequacy of intake to achieve a healthy weight and BMI.

Conclusion: Screening resident with dementia for mal-nutrition. Close monitoring of weight. Provision of adequate food according to individual needs with respect to personal preferences.

15. Title: ROLE OF THE OCCUPATIONAL THERAPY IN GERIATRICS AND LONG TERM CARE

Authors: Priya Gawhale, Alaa Festok, Dr Mansoorali Kappachali

Introduction: Role of occupational therapy in rehabilitation is to prevent deconditioning, enhance independency, improving quality of life.

Method: Role of OT varies from acute and chronic conditions. As per the clinical condition the early rehabilitation progress from bed to support sitting RESULTS: OT role in context of using the shoulder, hands in purposeful activities of daily living function to enhance a self-care.

Conclusion: QoL in Geriatrics is crucial role of OT. Along with all interventions early mobilization to wheelchair sitting helps to prevent deconditioning of clients by promoting independence of geriatrics clients.

16. Title: Exercise: Improving Outcomes on People with Frailty and Preventing Risk Factors that Lead to Frailty

Authors: Bea Rillera, Nahed Ali, Laith Ismael, Abdul Rasheed Valappil

Introduction: Frailty is a complex clinical syndrome resulting from multisystem impairments of older adults. Most people consider it part of normal aging however, successful aging is freedom from disease and disability.

Method: The presentation will be regarding the definition of frailty including classification, risk factors, and special considerations; difference of successful aging from frailty; holistic evaluation of people with frailty syndrome; effects of physical therapy interventions on frailty; and effects of exercise in preventing non-communicable diseases and comorbidities that lead to frailty.
Result: Regular exercise is beneficial in reducing risk of falls, muscle weakness, improving endurance and functional performance.
Conclusion: Participants will have a clearer definition of frailty syndrome and learn the importance of exercise on frail older adults.

17. Title: Enaya Physiotherapy team promoting well-being among the residents/families and staff

Authors: Sweety David, Ayman Rafaat, Feda Alshar, Nahed Ali

Introduction: Physiotherapists are uniquely well qualified to promote health and wellbeing of general public and patients through physical activity and exercises. PT in Enaya encourage and empower physical activity to different population whether the resident, their families or even the health care team.

Methods: The plan included three approaches, aiming the residents, the families, and the staff. For the residents, individualized care plans are developed with their preferences that encourage participation in exercises. All residents medically stable are moved out on chairs and provided exercises in the gym. For the Families, emphasising importance of exercise

Results: The awareness of the importance of exercise and how it is related to the wellbeing was significantly delivered to the residents and the families. The resident family satisfaction has improved with a person-centred care approach and the quality of care improved leading to an increase in discharge rates. For the Staff their knowledge about the importance of exercise for themselves and their residents increased; lead to a stress-free working environment.

Conclusion: The PT team in Enaya has proved that there is a significant contribution to promoting wellbeing among their residents/ families and staff.

18. Title: Physical Therapy Interventions to Improve Mobility in People with Dementia

Author: Evangeline Cordero

Introduction: Dementia is one of the major causes of dependency and disability in older adult worldwide. WHO has described the magnitude of dementia-aging’s problem; elderly of 85-year-old has 50% chance of being afflicted with dementia. But people thought that there is a little that can be done to rehabilitate this underserved population. Enaya physical therapy team aims to improve resident’s functional level at the highest possible level despite the physical impairment.

Method: This presentation will provide evidence-based information that physical therapists can enhance the mobility of people with Dementia; improve quality of life and slow cognitive decline. The study will cover the following topics: skilled physical therapy, strength and functional-based rehab, person-centred care approach, stepping, errorless learning, positive physical therapy approach.

Result: These are proven techniques to achieve the aims of physical therapy and being applied in long term care setting specifically in Enaya.

Conclusion: Health care workers enhance mobility for people with dementia.

19. Title: Together we can conquer elder’s fall in Qatar

Authors: Dr Kawa Amin, Dr Susan, Dr Osama, Dr Navas

Background: A FALL is ‘an event whereby an individual comes to rest on the ground or another lower level with or without loss of consciousness’. Falls are regarded as one of the earliest signs of frailty and are one of the highest complications resulting in hospital admission. A fall clinic can be used to screen older adult well-being and frailty in order to offer appropriate management at an earlier stage.

Methods: Falls clinic is one session a week, consultant-led clinic with assistance from trained nurses. It also has service linked with community and outpatients’ therapists. It uses a standardised falls assessment form which is based on NICE falls guidelines. Standardized assessments have enabled clinicians at the clinic to provide specific causes of falls, minimize the risk, enable appropriate intervention, reduce variation in falls management and promote independence. Data were extracted from Rumailah outpatient clinic from 2015 to 2019.

Results: Since the establishing of the Fall Clinic in Rumailah Hospital, A total of 104 patients have screened after getting referral from HGH, AWH and PHCC to RH. Of these, 55 percent of patients were considered as high risk for fall and 61 percent so far been received MDT referral for fall prevention program.

Conclusions: Fall clinic is first kind of clinic in Qatar that can act as frailty clinic where early frailty signs can be identified, providing patients with early medical, physical, and social intervention.

20. Title: High Cortisol and the Risk of Dementia and Alzheimer's Disease: A Review of the Literature.

Author: Sami Ouanes, Julius Popp

Introduction: Cortisol effects on the brain are exerted through two distinct receptors, inducing complex and even opposite effects on the cerebral structures implicated in the various cognitive functions. The study to examine the interrelationships between cortisol, cognitive impairment and AD.

Methods: Review of the literatures.

Results: Clinical studies found that elevated cortisol was associated with poorer overall cognitive functioning, as well as with poorer episodic memory, executive functioning, language, spatial memory, processing speed, and social cognition; while in animals, glucocorticoid administration resulted in cognitive impairment and abnormal behavior. In cognitively healthy subjects, higher cortisol levels have been associated with an increased risk of cognitive decline and AD. Subjects with dementia and Mild Cognitive Impairment (MCI) due to AD have been found to have higher CSF cortisol levels than cognitively healthy controls. Elevated CSF cortisol may also be associated with a more rapid cognitive decline in MCI due to AD. Elevated cortisol levels have been also found in delirium.

Conclusion: Elevated cortisol levels may exert detrimental effects on cognition and contribute to AD pathology.

21. Title: ACHIEVING EGO INTEGRITY: THE PINNACLE OF A HEALTHY AND WELL LIVED LIFE

Author: Karenina Talamayan

Introduction: Geriatric care is a sensitive and daunting task that healthcare needs to address to promote quality care. According to Erickson’s developmental theory, late adulthood entails achieving Ego Integrity, a sense of fulfilment in life in contrast to its polar opposite condition…despair. Many countries, including Qatar, are experiencing growth in the elderly population, posing a demand to help our elderly reach a sense of healthy and productive living. Examples are Brain stimulation through reminiscence therapy, memory-boosting games and learning new skills based of life. Engaging in physical activities improves the overall immune system. Socialization with their friends and acquaintances is an integral part of reducing the likelihood of developing depression caused by isolation and loneliness. Active participation and implementation of health promotion activities such as smoking cessation, safety, adequate nutrition for elderly and immunization program. Finally, managing properly their pension and financial attributes are essential to avoid stress and anxiety, as well as giving them a sense of fulfilment for their accomplishments in life.

Conclusion: Elderly people need enough support system and attention to achieve an age-appropriate goal at this point in their lives.

22. Title: Change in Mindset can do wonders- "Simple things matters

Authors: Dr Hanadi Al-Hamad, Ms. Mariam Al-Mutawa, Ms. Ghaya Al Tamimi, Ms. Anu Santhosh, Mr. Prince Rajan, Ms.Minchu Uthup, Ms.Jasmin Josey, Ms.Ira Anna Abraham

Introduction: Dementia changes a person's life, but there are many ways to support them. The words used to talk about Dementia can have a significant impact on how people with Dementia are viewed and treated in our community. The words used in speech influences others mood, self- esteem and feelings of happiness and depression. A casual misuse of words or the use of words with negative connation when talking about Dementia in everyday conversations can have a profound impact on the person with Dementia, as well as on their family and friends.

Methods: Rumailah, Long Term Care Unit-1 caters long term, geriatric and rehabilitative clients, started to make our unit “Dementia Friendly". We identified that changes should be from the basic level of understanding especially when addressing client with Dementia or to communicate with them. Thus, our team implemented questionnaire to evaluate staff's current knowledge.

Result: Pre- test and post- test. Out of 30 staffs, 2375%) responded as Demented client and the rest 7 (25%) responded as client with Dementia. Based on those result, we arranged a training session for all frontline staff to gain better understanding, be more competent and confident in providing care. Then a post- test was conducted and all the staffs responded correctly.

Conclusion: As a health care professional we have to respect others preferences about words used about them, regardless of whether the person being talked about is present or not.

23. Title: Assisted Home Haemodialysis in Geriatric Patients: A Unique Experience from Qatar

Authors: F. Al-Ali, A. Jadhav, E. Abaricia, M. Afsar, H. Tolba, M. Mohamed, H. Ezzat, S. Joseph, A. Hamad

Background: Home haemodialysis is traditionally offered to independent patients to improve their quality of life (QoL). Geriatric dialysis patients have very poor QOL. We created an assisted home haemodialysis (AHHD) program in the State of Qatar for specially needed patients (geriatrics, sick and ambulance dependent).

Methods: All HD patients in Qatar were evaluated. Inclusion criteria are elderly, bedridden with multiple comorbid conditions that require complex ambulance transfer service. Specially trained AHHD nurses provided HD at home with NxStage portable machine 4 times weekly with laboratory tests and doctor visit done monthly. Data were reviewed from electronic medical record and we did satisfaction surveys for patients (or care givers).

Results: 20 patients in the AHHD over 4 years. Age was 77.5 +/- 9.4 years, Females were 75%. Duration on HD was 19.6+/-12.7 months. Nine patients expired during follow up period. Most patients had multiple comorbidities. Our random survey of 8 aware patients or care givers showed great satisfaction (100% with service, time, schedule, QOL, medical care, psychological support). They reported no fatigue post HD, better appetite, more time with family and no transportations hassles.

Conclusion: We are presenting the first international report of AHHD program.

24. Title: Digital Biomarkers based on Daily Physical Activity to Predict Cognitive Impairment in People Undergoing Haemodialysis

Authors: Fadwa Al-Ali, Abdullah Hamad, He Zhou, Changhong Wang, Rania Ibrahim, Talal, Bijan Najafi

Background: Conventional cognitive screening tools are impractical in some population with chronic disease, such as haemodialysis patients. This study examined whether daily physical activity (PA) shows different patterns between HD patients with and without cognitive impairment. It also evaluated whether sensor-derived PA parameters are able to determine cognitive impairment in HD patients.

Methods: 56 HD were recruited. According to the Mini-Mental State Exam, 31 subjects (55%) were determined as cognitive-intact and 25 (45%) as cognitive-impaired. Daily PA was recorded for a continuous period of 24 hours using a wearable sensor under unsupervised condition during a non-dialysis day.

Results: The cognitive-impaired group spent significantly higher percentage of time in sitting and lying but spent significantly lower percentage of time in walking. They also took significantly less steps than the cognitive-intact group. Significant reductions of number of postural transitions were also observed in the cognitive-impaired group, with the largest effect size observed in number of walk-to-sit transition. Daily PA parameters and demographics together could distinguish cognitive-impaired cases with area-under-curve of 0.898, sensitivity of 76.0%, specificity of 80.6%, and accuracy of 78.6%.

Conclusion: This study suggested that daily PA could be used as novel digital biomarkers to identify cognitive impairment in HD patients under an unsupervised condition. Compared with conventional cognitive screening tools, daily PA measured by a wearable device does not require a professional test in a busy clinical environment, and thus it is more practical as a tool to detect cognitive impairment in early stage and track cognition change for HD patients over a long term, thereby promoting early intervention.

25. Title: A UNIQUE ORTHO-GERIATRIC MODEL: A STEP FORWARD IN IMPROVING THE QUALITY OF CARE FOR HIP FRACTURE OLDER PATIENTS IN QATAR

Authors: Dr.Irfan Muneeb, Dr.Francisco Terazona, Dr Navas Nadukkandiyil, Dr Shirmila Syamala, Dr Mark Hitchcock, Dr.Yousef Asad

Background: Hip fractures have significant impact on the QoL of a patient. 20–35% mortality in the first year following a hip fracture has been reported. Peri-operative optimization of their medical condition improves outcome. Orthogeriatric units have demonstrated improving functional recovery and survival rate, decreasing the length of stay.
Objective: To compare the median length of stay before and after an ortho-geriatric intervention among hip fracture inpatients.

Methods: A new service was designed in 2018 facilitating shared care between the orthopaedic and the geriatric teams from HGH. In the new model, orthogeriatrician input commences on a liaison basis. Results: During 2018, 75 patients with eligibility criteria were included in the project. From these 36 were female and the mean age was 76.3 years. Main comorbidities were hypertension, DM and chronic kidney disease. At hospital admission 56 patients had anaemia, and 20 patients had low albumin blood levels. The mean time to surgery was 55.8 hours and 39 of patients underwent surgery in the first 48 hours. LoS was 14.6 days and the mortality rate was 8% and 17.3% of patients needed a surgical ICU admission.

Conclusions: The LoS was significantly reduced with ortho-geriatric input.

26. Title: The prevalence of non-communicable disease in elderly Qatari patients attending primary healthcare centres, 2017

Authors: Ayman Al-Dahshan, Noora Al-Kubiasi, Iheb Bougmiza

Background: Non-communicable diseases (NCDs) are becoming a major public health problem and are responsible for about two-thirds of all deaths globally. Although the NCD can affect any age group, elderly population are considered the most vulnerable age-group to its impact.

Objective: This study aims to estimate the prevalence of common NCDs among the Qatari elderly (≥65 years) patients attending the primary healthcare centres in Qatar.

Methods: A cross-sectional study design was conducted utilizing the Electronic Medical Records database of 23 primary healthcare centres across the country during a period of six months (April - September 2017).

Results: A total sample of 5639 elderly (age ≥65 years) Qatari patients were included in the study. The mean ±SD age (years) was 73.34 ±6.8 for males and 72.35 ±6.2 for females. Almost one-third of patients (31.5%) were overweight (BMI≥25) and more than a half (53.3%) were obese (BMI≥30). Regarding the prevalence of NCD, the majority (82.3%) of the study participants have two or more chronic conditions, hypertension was the most prevalent followed by DM and dyslipidaemia, cardiovascular diseases.

Conclusions: This study shows that the prevalence of NCDs among the Qatari elderly population is substantial. Strengthening of primary healthcare and investment in preventive medicine are essential in order to control this epidemic of NCD.

27. Title: THROUGH THE EYES OF SENIOR CITIZEN: LOOKING BEYOND TO IMPROVE QUALITY OF LIFE

Author: ASHOK BHAGAT

Introduction: Dementia not only affects the clients but also has an impact on their caregivers. Dementia’s impacts can be mitigated through the disease’s progression with proper intervention by engaging clients in personally-tailored activities may have positive effects on their challenging behaviours and quality of life.

Methodology: An Observational study was done with five clients of residential care who were 60 years and above with primary diagnosis of dementia associated with Psychiatric illness for more than 10 years. Standardized Bristol ADL scale and DAD scale were used to evaluate their performance and Daily living skills. The intervention consisted of 3 individual and 2 group therapy sessions held weekly. Each session was about a one hour in duration for 1 year.

Results: Pre and post test results revealed that the client who attended OT program were able to maintain their skills and abilities to perform daily living task. They also exhibited less aggressive behaviour and showed interest and motivation to participate in activities which promoted their functional independence.

Conclusion: From the results we can conclude that OT has a significant role in maintaining the QoL and cognitive functions of clients affected by Dementia.

28. Title: Gender difference and therapeutic effectiveness of platelets rich plasma intra-articular injections among elderly with knee osteoarthritis

Authors: Hala Sweed, Maram Monier, Mohamed El –Helow, Khaled Emara, Mohammad Zakaria, Rana Taha

Background: Osteoarthritis (OA) is the most prevalent aetiology for arthritis. Knee OA clinical symptoms and signs have direct impact on social interactions and various aspects of patients’ lives. The applications of biologic managing agents such as PRP in musculoskeletal disorders are growing considerably.

Methodology: The research clinical trial recruited 44 elderly participants aged sixty years and above with mild to moderate knee osteoarthritis according to Kellgren-Lawrence Grading Scale system. The studied sample have been categorized into two equal matched age research groups: Research Group A: 22 male patients 60 years old and above with knee osteoarthritis. Research Group B: 22 female patients 60 years old and above with knee osteoarthritis.

Results: Significant improvement in pain scores among all grades of knee OA, the best improvement achieved at 6 months follow up.

Conclusions: Intra-articular injection of PRP in knee OA may be a valid alternative treatment for knee osteoarthritis.

29. Title: Promoting Dementia Friendly Environment in a Long Term Care Facility

Author: Angelica Lalamunan

Introduction: Enaya Specialized Care Center – Unit Female 1 has a total of 18 residents. Out of these 18 residents, 8 residents are having dementia. The stages of dementia among the residents ranges from mild, moderate, to severe. The role of the members of the MDT is to promote a rewarding and friendly home-like environment.

Discussions: The team aims also to maintain the identity of the residents by respecting individual needs, encouraging independence, communicating appropriately, providing a barrier-free environment, planning stress- free care routines, and respecting the resident’s sexuality and culture. The interior design of the facility used combined interior design features to create a home-like and useful interior space. The facility is also constructed according to the familiar world for living, from the viewpoint of a person with dementia. The support team which are the staff should be supported in dementia friendly care. The person- centred approach towards the staff and the resident is put into high consideration.

30. Title: Study of Medication Utilization Pattern and Clinical Outcome in Young Elders with Type 2 Diabetes Mellitus in Qatar

Authors: Navas Nadukkandiyil, Hanadi Al Hamad, Maryam Al Obaidely, Amin Abdelghany, Marwan Ramadan, Essa Al Sulaiti

Background: Type 2 DM is a costly illness with significant mortality and morbidity among older patients. The main aim of the study is to evaluate the Medication Utilization Pattern and Clinical outcome in Type2 DM for middle age and older Patients.

Methods: A retrospective longitudinal study was conducted from 1st Jan 2016 to 30 June 2016 in an out-patient Geriatric clinic at Rumailah hospital in Doha. The sample size for the study is selected 150 middle-aged and older patients from a total of 800 patients during the study period. Data were compared to find out the associations between DM and socio-demographic and clinical indicators using inferential statistics.

Results: The study found a significant positive correlation between Age and HbA1C in addition to Fasting Blood Sugar (FBS) and Glycated haemoglobin (HbA1c) levels.

Conclusion: Drug utilization pattern was different according to age group. Monotherapy was found to be most effective in attaining the target HbA1c in middle aged and young elderly population. Our data suggest that standard treatment guideline was followed properly among diabetic older population in Qatar.

31. Title: Say What You See: Falls simulation training for nurses

Authors: Debbie Watkins and Kawa Amin

Introduction: This specialised training is aimed at improving falls management and prevention in the acute health care setting. With the growing ageing population the incidents of falls will increase and addressing this requires a structured and practical approach in training front line staff.

Methodology: The Simulation Centre has a bed with an electronic manikin which can simulate basic observation changes including pupil size and can be verbally interacted with via role play from a facilitator. At the end of each scenario all the candidates regroup into the debrief room for discussion and peer feedback. Six practical scenarios [Post-falls assessment of a head injury, Post-falls assessment of a fractured neck of femur, Consolidation session on manual handling, Recognition of cardiac syncope and when to escalate, Duty of Candour and communication with next of kin and Lying and Standing blood pressure practical teaching and assessment.

Results: The course evaluation has been very positive. The nursing teams find this style of learning beneficial to their confidence and how they practice. Organisationally the first two quarters of 2016/2017 show a 20% reduction in total falls reported and a reduction in falls resulting in moderate and above harm by 45% compared to the same period in 2015/2016. It is to be noted other falls prevention activities are also in place.

32. Title: Geriatric patient in radiography

Author: Hissa Mohammed

Introduction: Advanced care planning is the prices of planning for the future decision associated with patient’s health and present discussion with the healthcare providers, family members, and care-provider. These specific decision and discussion can help the geriatric patient to understand the radiography procedure and allow health care profession and family member stop take decision of the behalf of geriatric patient.

Methods: Informing and consent, including the patient in decision making prices, discuss with the patient about values, beliefs and culture, and record their choices and decision related to the procedure. Face to face interviews has been conducted with around 300 patients, and data has been recorded and analysed by using data analysis tools

Results: The results shows that majority 70% of the patient find advancer planning effective before go through radiography in a health care sector, 20 per cent revealed that it is not that effective, and 10 per cent stated they are not sure.

Conclusion: it can be concluded that ACP is quite effective for geriatric patient before radiography.

33. Title: Enaya Physiotherapy Advanced care plan & patient dignity

Author: Suneer Kannu, Laith Ahmed Ismail, Ayman Rafat Mahmoud, Sweety David, Syed Rashid Buhari, Abdul Valappil

Introduction: ACP is the process by which patients make decisions that can guide their future health care, if they become unable to speak for themselves. It is based on the ethical principle of respect for patient autonomy. In Enaya, family conference with MDT is important in guiding decision-making at the time when a patient is too unwell to make their own decisions, or is unable to communicate.

Objective: Ensure that the care of Enaya residents is personalized, reflective of individual needs and preferences, improve communication MDT, clarify their broad goals of care.

Methods: The procedure will include monthly meeting between the residents/family/caregiver with physiotherapist to discuss the suggestions and preference regarding physical therapy services. The physical therapy team will overcome the challenges of sessions by following the ESCC project and proved monthly result to be compared every 3 months.

Result: The initial results are significantly optimizing Residents their families and caregivers who are involved to the project are cooperative and responsive to the meetings.
Conclusion: ACP is important for people who are older, or people who have a chronic illness, multiple diseases, an early cognitive impairment, or are approaching their end of life.

34. Title: Normal Aging or a Mild Neurocognitive Disorder? Challenges and Solutions Inspired From the Omani Cohort Study

Authors: Ammar Alobaidy, Hamed Al-Sinawi, Ahmed Alharrasi

Introduction: The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), emphasizes the challenges of distinguishing the normal aging process from mild neurocognitive disorder. Neurocognitive assessment tools are scarce in the Arabic community that differentiate normal aging from mild neurocognitive disorders, which is a major mental health challenge in the rapidly growing geriatric age group.

Methods: This is a prospective cross sectional study to evaluate the Consortium to Establish a Registry for Alzheimer’s disease Neuropsychological Battery–Arabic Version (CERAD-ArNB) for the differentiation between normal aging and mild neurocognitive disorders. The study enrolled all patients referred for cognitive assessment at the Memory Clinic of Sultan Qaboos University Hospital, a tertiary referral centre in Oman during the period from January 2017 to May 2019.

Results: 171 subjects were enrolled in the study. 106 subjects were males and 65 were females. Based on DSM-5 criteria for definition of neurocognitive disorders and by using CERAD-ArNB normative data, we were able to identify 24 subjects with normal aging, 34 subjects with mild neurocognitive disorder and 74 subjects with dementia. 39 patients were having a known precipitating factor for cognitive decline and they were not included in the study analysis.

Conclusions: CERAD-ArNB is a useful tool for assessment of cognitive function in the Omani geriatric age group, and it helps differentiating normal aging process from mild or major neurocognitive disorders.

35. Title: Visually Pleasing Pureed Diet for Elderly People with Dementia

Authors: Amal Ahmad, Mary Soriano, Freeda Dass

Introduction: Dysphagia is a prevalent difficulty among elderly people with Dementia. It is also associated with nutritional deficits and increased risk of pneumonia. Speech Therapists often recommend pureed diet to aging patients as the texture is easily manipulated in the mouth and the risk of choking and aspiration is reduced. However, pureed food can be boring and unappetizing for seniors.

Methods: The Speech Therapists collaborated with the Hamad General Hospital kitchen staff and dietician in preparing pureed diet that are moulded into different shapes with added colourful designs. The Speech Therapists selected 10 patients with Dementia residing in Enaya. Mini-Mental State Exam (MMSE) was conducted and these patients scored mostly 22 or below. The inclusion criteria are: patient must be on pureed diet, with mild-moderate dementia, with occasional food refusal, no visual impairment, and at least minimally communicative. The Speech Therapists reviewed the profile of each patient and 8 out of 10 patients passed the inclusion criteria. A feeding trial during lunch was done with these 8 patients for 4 consecutive days.

Results: During the 4-day feeding trial, it was noted consistently that 7 out of 8 patients expressed their positive feedback on the pureed diet.

Conclusion: A visually pleasing pureed diet is enticing to elderly people with Dementia, thus improving their appetite and quality of life is also optimized

36. Title: Audit on Readmissions in Acute Geriatric Care

Authors: Dr.Noorudeen Kunnummal, Dr Sameer Acharath, Dr Biju Naduvilpurakkal, Dr Haroon, Dr Hanadi Hamad

Introduction: Hospital readmission rates are increasingly used for both quality improvement and quality control. Readmission is defined as any unplanned admission into the hospital that is related to the initial admission within 30 days. A literature review on readmissions showed that the rates in older people are 17 % to 24 %, however, in patients with complex conditions such as congestive cardiac failure, this is as high as 36%.

Methods: Aim: To monitor the emergency readmission rate in acute geriatric care and determine the causes for these readmissions. Retrospective audit conducted on elderly patients aged 65 years and above readmitted January to March 2019.

Results: Readmission rate in acute geriatrics during the study period was 23.63%. Majority of patients were readmitted within the first two weeks of discharge. The principal causative factor for readmission was respiratory infection. Fifty percent of patients were on NG feeding.
Interventions: Identifying high-risk patients for readmission pre-discharge and enhance MDT, Integrate post-discharge care plan with home care services, mobile physicians, and rapid assessment geriatric team and Implementing a Pre-discharge checklist

Conclusions: Most readmissions were due to aspiration respiratory infections. Patients with NG were at higher risk and this group of patients need specific measures to prevent recurrent admissions.

37. Title: The Role of Family Home Caregivers taking Care of their Elderly Family Members in Qatar.

Author: Azza Abdelmoneium,

Introduction: Family home caregivers play an important role in the health and life quality of elderly people. In particular, chronically ill elderly people are dependent upon family caregivers to carry out everyday activities; Qatar is no exception where family members take care of their old persons. Caregivers experienced stress and expressed the need for informal and formal support services for them and the ones they cared for. This paper focuses on the consequences of caregiving, including the stresses and positives of caregiving, coping strategies and resources of caregivers. Methodology Utilizing qualitative, semi-structured interviews with open-ended questions based on the methodological approach of transcendental phenomenology assisted in gaining a better understanding of the themes that arise in peoples’ descriptions of the stressors, benefits, and coping strategies and resources for this sample of caregivers.

Results: The findings in this paper focus on the different stressors and coping strategies that caregivers implemented. Some of the findings related to stresses were: isolation, financial stresses, anger, guilt, frustration, formal support and others.

Conclusion: Despite the demands of caregiving, most caregivers appeared to be coping somehow but they face challenges in the coping process.

38. Title: Should a falls risk assessment be undertaken in elderly patients prior to the prescription of anti-hypertensive?

Authors: Amine Dincer, Naeema Farrah

Background: Studies suggest that the use of antihypertensive medication is associated with an increased risk of falls and subsequent fractures in the elderly. We have conducted a literature review to assess the extent of this link and determine if there is a need of a formal falls risk assessment tool prior to the prescription of anti-hypertensive.

Method: A literature search was conducted on Medline to identify articles investigating fall risk and anti-hypertensive medication use in adults aged 65 and above. Search limitations include meta-analyses studies, human participants and end search data being September 2010. We included seven meta-analyses publications representing 189 randomised controlled trials of relevant primary data.

Discussion: Falls occur in over 25% of elderly people and are reported as the leading cause of mortality and morbidity in above 75s. In geriatric outpatients, poly-pharmacy was associated with a greater falls risk than other of co-morbidities. This factorial effect warrants the inclusion of a falls risk assessment prior to starting a treatment plan for geriatric patients diagnosed with hypertension. A validated falls risk assessment tool, such as the Quick Screen and Falls Risk Assessment Tool (FRAT), can be incorporated into General Practitioner (GP) practice and algorithms to ascertain the benefit/risk ratio of anti-hypertensive. A multi-site survey across GP practices may be required to assess the feasibility of using a falls risk assessment tool in the management of hypertension in the elderly.

39. Title: Geriatrics consultation team in Hamad General Hospital (HGH) Emergency department

Authors: Dr. Hanadi Al Hamad; Dr. Amir Abdalla, Ahmad Musallam, Mr. Yahia Mehaisn, Mrs. Samah Belgacem Bahia

Background: A team was established by the Geriatrics and long term care department to work HGH ED to enhance safe elder’s care. The project has been implemented in collaboration with Home Health Care Service. department.

Method: All patients have been screened, present in ED on weekdays by visiting areas, reviewing data and receiving consultations. A simple 5-question scale that assisted the plan of care. The most vulnerable group which has no clear disposition were assessed using initial iCGA.

Results: 40% of patients in this audit have moderate to severe frailty. 86% have polypharmacy, 21% have 3 or more geriatric syndromes. More than 85% of patients reviewed by the team were discharged home from ED.

Conclusion: Elderly in HGH ED have frailty as part of their medical problems and presentations. Geriatric team in ED has supported the screening for these problems and has also supported the discharge of these patients back to their usual place of residence.

40. Title: “Delirium - Clinical Orphan - Time to Own It”

Authors: Dr Pravija Talapan Manikoth, Dr Biju Bhaskaran, Dr Wasim Akram,Dr Hanadi Al Hamad

Introduction: Delirium is a clinical syndrome involving disturbances in cognitive function, perception, attention and consciousness. Delirium is associated with increased adverse incidents in hospital (eg, falls, pressure sores), increased length of hospital stays, chance of institutional placement on discharge, likelihood of long-term cognitive impairment and higher mortality risk. We initiated the delirium awareness project to raise awareness among healthcare professionals and community over the year 2018.

Methods: International Delirium Expert Didactic Lecture across HMC

Results: Initiated Delirium clinical practice guidelines, HMC delirium awareness and educational campaign Team, Ongoing community awareness programs will help in overall increased early recognition.

Conclusions: This project has improved screening, detection, management of Delirium in Emergency and acute medical units with significant improvement in using a standardized screening tool.