Michelle Brennan

Background Patients with Chronic Obstructive Pulmonary Disease (COPD) are at increased risk of osteoporosis. Vertebral Fractures (VF) are the most common manifestation of osteoporosis. Only one fourth to one third of incident radiographically identified VF are clinically diagnosed. The aim of this study is to evaluate patients the prevalence of VF...

Background Obstructive Sleep Apnoea (OSA) is common yet often undiagnosed in older people as symptoms of fatigue and poor sleep are common and non-specific. OSA screening tools also lack validity in older patients. This study aims to review the clinical presentation, use of screening tools and treatment adherence in older people. Methods A retrosp...

Background Late-Onset Sarcoidosis (LOS) accounts for up to one-third of cases and is diagnostically challenging due to the difficulty in satisfactorily excluding malignancy and infection, often necessitating repeated investigations. Endobronchial Ultrasound (EBUS) is the gold standard for diagnosing pulmonary sarcoidosis. This study aims to compare...

Background Sarcoidosis is a multi-system disorder with an increasing propensity to present in older patients. Diagnostic uncertainty is common and understandable given the higher prevalence of co-morbidities in older patients and broad differential for multi-system clinical presentations. Excluding malignancy and infection with a high degree of cer...

Background Unfortunately, many COPD patients continue to exacerbate despite good adherence to GOLD Class D recommended therapy. Acute exacerbations lead to an increase in symptoms, decline in lung function and increased mortality rate. The purpose of this review is to do a literature search for any prophylactic anti-microbial treatment trials in GO...

Purpose OSA-COPD overlap is an important and prevalent condition yet remains under-recognised among the vast majority of respiratory health professionals. Patients with OSA-COPD overlap experience more severe respiratory symptoms and worse quality of life, and the relative risk of exacerbations, hospitalisations, and mortality is higher than in eit...

Cough peak flow (CPF) is a useful clinical measurement to assess neuromuscular activity and effective coordination, yet it is rarely used in clinical practice outside of the management of patients with neuromuscular disorders. A CPF of above 160 L/min is required for an effective cough and less than 270 L/min is associated with increased secretion...

Hypernatraemia is associated with high morbidity and mortality and is more common in patients of older age, nursing home residents and those with cognitive impairment and restricted mobility. The most common cause in hospital settings is water dehydration due to reduced intake although other causes should be identified. Once identified, prompt mana...

Background Hypernatraemia is associated with a short-term mortality of 20-60%. Age-related physiological changes predispose patients to hypernatraemia. This study reviewed acutely admitted patients comparing those with community-acquired (CAH) and hospital-acquired hypernatraemia (HAH). Methods A retrospective study of 102 consecutive acute medical...

Background: Hypernatraemia arises commonly in acute general medical admissions. Affected patients have a guarded prognosis with high rates of morbidity and mortality. Age-related physiology and physical/cognitive barriers to accessing water predispose older patients to developing hypernatraemia. This study sought to perform a descriptive retrospec...

In December 2019, in Wuhan, China, the novel coronavirus “severe acute respiratory syndrome 2” (SARS-CoV-2) was discovered as the cause of a pneumonia-like illness and subsequently named coronavirus disease 2019 (COVID-19). COVID-19 spread and is now a global pandemic. With few exceptions, countries in the Northern hemisphere have higher mortality...

Extreme weather events including recently experienced prolonged heatwaves are predicted to increase in frequency and intensity as a result of climate change. Vulnerable groups, and particularly older persons, are at increased risk of heat-related illness and mortality. Multimodal interventions that incorporate community, primary and secondary care...

Purpose of Review In the early twentieth century, bronchiectasis (BE) was not a disease seen in the elderly population as life expectancy was usually < 40 years. A century on, however, and this is now a disease much more prevalent in the elderly and as patients live longer, this trend will almost certainly continue. Why is this so? (1) BE is irreve...

Toxic epidermal necrolysis and Staphylococcal scalded skin syndrome (SSSS) are potentially life-threatening dermatological emergencies that present in a similar clinical fashion. Toxic epidermal necrolysis is typically triggered by anticonvulsant and other neurological medications and reports clindamycin inducing the disease is exceedingly rare. SS...

Background: Hypernatraemia is associated with morbidity and mortality, particularly in

Background: Hypernatraemia is associated with morbidity and mortality, particularly in the older person. Last summer, Ireland experienced prolonged periods of excessive heat. The Irish meteorological service defines a heatwave as temperatures exceeding 25 °C for 5 consecutive days. Aim: This study sought to compare the frequency of hypernatraemi...

Background Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1) National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment...

Background Hypernatraemia is a surrogate marker of morbidity and mortality, particularly in the older person.(1) Met Eireann defines a heatwave as 5 consecutive days >25°C. HSE guidelines outline preventative strategies for community-dwelling adults and inpatients during heatwaves.(2) Our objective was to compare the prevalence of hypernatraemia (N...

Extremes of temperature are likely to increase in frequency associated with climate change. Older patients are particularly vulnerable to the effects of heat with excess mortality well documented in this population. Age-associated neurohormonal changes particularly affecting the renin angiotensin aldosterone system (RAAS), alterations in thermoregu...

We present the case of a morbidly obese 74-year-old gentleman who acutely deteriorated during a hospital stay for treatment of discitis with intravenous flucloxacillin. Arterial blood gas sampling revealed a severe high anion gap metabolic acidosis. Investigations confirmed a diagnosis of pyroglutamic acidosis. He made a complete recovery with supp...

Spontaneous insufficiency fractures are caused by normal or physiological stress on weakened bone. The leading cause of insufficiency fractures is osteoporosis which has a propensity to affect older patients. Other causes or associated factors are disorders which affect bone metabolism, collagen formation, bone remodelling and medications such as b...

Purpose The value of the home (domiciliary) visit (HV) by geriatricians at the request of general practitioners has been questioned. We analysed HVs conducted by geriatricians in a west of Ireland hospital over a 14-year period. Methods From 2002 to 2016, a systematic record was maintained of all HVs conducted by a geriatrician. Results Consent t...

This case describes a 103-year-old lady who presented from home with an incidental diagnosis of a left femoral fracture. She had no history of trauma and denied pain. She had a known diagnosis of osteoporosis, and sustained a fracture of the contralateral femur aged 93 which was managed conservatively. She was bed-bound with fixed contractures, poo...