Cian O'Caheny

Hospital Pharmacist with an interest in medicine for the older person, deprescribing and frailty. Part time PhD examining Fraily, ADRs and PIP.All views my own.

[Cian O'Caheny @CahenyO]

@IrishRail @LauraBe39393359 There needs to be an announcement on reduced services, fair enough reduced capacity can happen but passengers are crowded around the doors, impossible to get on despite space in the aisles

[Lucy Pollock @lucypgeridoc]

This is a detailed and impressive analysis . Not all people w frailty are the same. Some will benefit from SGLT2i, others will not tolerate or will be harmed

[Cian O'Caheny @CahenyO]

#frailty #MDT #frailtyatthefrontdoor #emergencymed

[Cian O'Caheny @CahenyO]

Happy 5th Birthday to MaterFIT. Great to celebrate our achievements with our Emergency Dept, Medical, Nursing and HSCP colleagues! @MaterTrauma @MaterHSCPs @MaterPhysio @MaterOccTherapy @MaterSLT @MaterNursing

[The Medication Safety Minute @medsafetymin]

When one thing leads to another…
@stjamesdublin #FOAMed

[Alasdair MacLullich @A_MacLullich]

New Research: Delirium in Hip Fracture Patients Associated with Doubled Mortality Risk

I'm pleased to share our new study on delirium and hip fracture, led by @rosespenfold.

91% of all hip fracture patients attending Scottish hospitals had a 4AT delirium assessment tool performed at presentation (N=16,476 ). N=3,386 (21%) had delirium.

Key findings:
- Delirium was associated with important adverse outcomes including 2-fold higher mortality risks as an inpatient and at one year, and a lower likelihood of returning home following hospital admission.

Key implications:
- Delirium assessment on initial presentation is feasible at national scale.
- Delirium assessment should be performed on presentation of hip fracture.
- Hip fracture care without delirium assessment is deficient care.

***Background***
Previous studies have focused primarily on postoperative delirium. This is the first large scale study using routine data to examine delirium ascertained directly with a real-time clinical assessment at the time of hospital admission.

***Methods***
We analysed data from the Scottish Hip Fracture Audit, which covers over 99% of people aged 50+ years hospitalized with acute hip fracture in Scotland.

Delirium assessment: 4AT (https://t.co/XMJpy4ZmOx), which is embedded into routine care and performed by clinical staff.

***Results***
Delirium was present 21% of patients.

Patients with delirium were older (mean age 85 vs. 78 years), more likely to be in care homes, and had higher ASA grades.

After adjusting for age, sex, pre-fracture residence, and ASA grade, patients with delirium had a 2-fold increased risk of inpatient mortality (adjusted OR 2.26, 95% CI 1.79 to 2.84).The same pattern was observed for one-year mortality (adjusted OR 2.05, 95% CI 1.83 to 2.29).

Patients with delirium were less likely to return to their original residence within 30 days (adjusted OR 0.27, 95% CI 0.24 to 0.30)

***Conclusions***
Delirium at hip fracture presentation is a powerful prognostic indicator that can inform shared decision-making with patients and families. Identifying delirium early allows clinicians to address potentially reversible causes and implement appropriate management strategies. Recognition of delirium can help in planning post-acute care needs.

Another crucial implication is that we have definitively demonstrated that delirium testing using a validated tool is *feasible in routine practice* in this population.

Hip fracture patients must have delirium assessments, and these must be done pre-operatively as well as post-operatively.

***Call to action***
Let's move forward and make good delirium care the norm in hip fracture patients.

Let's make system-wide groupthink that it is okay to neglect delirium a thing of the past.

Study: https://t.co/itCy5o4zoF

#delirium #hipfracture

[Cian O'Caheny @CahenyO]

Delighted to celebrate Hospital Pharmacy Day 2025 in MMUH. Pop by our stand on Whitty Street to hear all about Pharmacy, our new Guidelines App, win prizes and collect your cupcake prescription!! #hospitalpharmacyday @mmuhpharmacy @MaterHSCPs @MaterTrauma

[Therapeutics Initiative (TI) @Drug_Evidence]

ICYMI - TI Therapeutics Letter 151
Minimizing harms of tight glycemic control in older ppl with type 2 #diabetes
👉🏽https://t.co/FUrfgpQgpF

"For most older adults (65 years or older) with type 2 diabetes who have an A1c below 7%, sulfonylureas or insulin do more harm than good"

[Cian O'Caheny @CahenyO]

@DarrenJ_Walsh No one can ever moan enough about tramadol!!��

[Frank Moriarty @FrankMoriarty]

This study is aiming to understand what deprescribing recommendations should look like, to inform future guideline development.

If you're a healthcare professional, please consider taking part in this short survey!

[Jack Holman @JackAHolman]

New publication!

Key point - Utilising information like hearing ability may increase sensitivity of risk stratification provided by the world guidelines for falls prevention and management

https://t.co/GvGUMz4XbL

@RouKat @siobhanmagner @CahenyO @colmpbyrne

[Cian O'Caheny @CahenyO]

@Inox94 @iCOD2 @MaterFIT @mmuhpharmacy @RCSIPharmBioMol @RCSI_postgrad @shanecull @colmpbyrne Not yet, working on it!

[Cian O'Caheny @CahenyO]

Great to present the findings of our SR looking at frailty and ADRs in older adults @ICOD2  #deprescribing @MaterFIT @mmuhpharmacy @RCSIPharmBioMol @RCSI_postgrad @shanecull @colmpbyrne

[Mala Shah @MalaShah11]

In line with Patient Safety Day theme this year, Skip the Dip is especially relevant to improve diagnosis of UTI in older people and reduce unnecessary antibiotic use. See https://t.co/klv1YTLnUm for more info
@NationalQPS #QIreland #patientsafety @eimeartb

[Therapeutics Initiative (TI) @Drug_Evidence]

🧵#Deprescribing tramadol in a long-term care setting: A case study

1/ Tramadol for pain management:

⚖️does NOT have a better #safetyor #efficacy profile than other pain relievers

⚠️ has more problematic interactions

💰costs more

https://t.co/lz7759pEgS

#tramadol #ptsafety

[The Medication Safety Minute @medsafetymin]

Cascading issues…
#FOAMed @stjamesdublin

[Roisin Riches @riches_roisin]

Excellent turnout today at our delirium champion launch in the @MaterTrauma thank you all for attending, exciting times ahead @SuzanneDempsey5 @colmpbyrne @MaterFIT @lorrainemkyne @CahenyO @AnpMater @MaterHSCPs #delirium

[The Medication Safety Minute @medsafetymin]

Doppelgänger Drugs
@stjamesdublin #FOAMed

[Sean Kennelly @SPKennelly]

Incident dementia risk was more than three times higher in those who experienced just one episode of delirium, with each additional episode linked to a further 20% increase in dementia risk. The association was strongest in men. ⁦ https://t.co/6LNFKg9rW4

[Roisin Riches @riches_roisin]

Happy World Delirium Awareness Day from the MMUH Delirium Committee #WDAD2024 #delirium a special day celebrating and launching our New Hospital Delirium Guidelines @MaterTrauma @lorrainemkyne @colmpbyrne @CahenyO @SuzanneDempsey5 @dbreslin @MaterFIT @MaterNursing