Posters

Re-evaluation of National Institutes of Health Stroke Scale (NIHSS) Score <5 at Sunderland Royal Hospital Author: Dr Fruzsina Bako (FY2) Supervisor: Dr Min Myint (Stroke Consultant) Clinical Audit Registration: CA11032 Cycle 2 INTRODUCTION Controlling BP minimises the rate of ICH and reperfusion to promote adequate cerebral perfusion (2). Antiplatelets reduce the risk of recurrent stroke and other vascular events (3). Cholesterol reduction reduces the risk of stroke by reducing harming lipids (4). Diet and exercise are independent stroke reducers and positively impacts both weight and blood

Introduction  Orthostatic hypotension is a significant risk factor for falls and is associated with increased morbidity and mortality in older adults. The National Institute for Health and Care Excellence (NICE) recommends recording Lying-Standing Blood Pressure (LSBP) for all patients ≥65 years, with the Royal College of Physicians (RCP) advising readings after 1 and 3 minutes. On a geriatrics ward,  LSBP  assessments were frequently delayed, missed , or performed incorrectly. This Quality Improvement Project (QIP) aimed to improve the timeliness and quality of LSBP assessments to enhance

Background: Antibiotic stewardship is critical to combating resistance. Our Quality Improvement Project (QIP) aimed to evaluate and enhance antibiotic prescribing practices across three DME wards by assessing guideline adherence, therapy duration, end date documentation, and concurrent proton pump inhibitor (PPI) use. Older adults are at higher risk of antibiotic associated complications, especially C. diff infection. Methods: Baseline data were collected from the hospital's electronic prescribing system, evaluating prescriptions for indication appropriateness, duration compliance

Introduction Simulation is widely considered as a valuable tool in medical education. It offers a controlled 'practice' environment for all medical professionals to develop their skills clinically and in communication. Geriatric medicine is a complex speciality in which simulation can be particularly beneficial, allowing trainees to manage age-related conditions and multimorbidity in a safe setting, where errors can be corrected and through reflection, practice can be improved. By using simulation, Mersey trainees have enhanced their confidence in managing the unique challenges of caring for

Introduction: Constipation affects up to one-third of adults over 65, with prevalence nearly doubling amongst hospitalised patients. Effective bowel management is crucial in older patients recovering from neck of femur (NOF) fractures, as postoperative constipation can delay mobilisation, increase complications, and prolong hospital stay. Despite debate on the reliability of pelvic X-rays (PXR) for assessing faecal loading, they offer an opportunity for early identification and proactive management. Aim: To evaluate and improve constipation management in patients admitted with NOF fractures by

Introduction: In 2023, we introduced a new interdisciplinary clinic to raise awareness of the choices available for older patients with advancing, near end-stage kidney disease. Patients and their close family were invited to attend the clinic for assessment and discussion of future options. Rationale and Method: Many older patients with advanced kidney disease are relatively asymptomatic and have not considered what might happen and what would be their preferred option when they do become symptomatic. A proportion of such patients develop end-stage kidney failure in the context of an

Introduction: Parkinson's disease is a progressive neurological degeneration of certain cells (called dopaminergic cells) within a specific part of the brain (substantia nigra). (1) Withholding PD medication or a prolonged delay in administering PD medication can lead to an increase in care needs and increases the risk of neuroleptic malignant type syndromes, which can be fatal. (2). Method: Prospective data was collected amongst doctors of different grades working in the Trust using Google forms. Results: Baseline data was collected in January 2025. 88.9% responders managed PD patients in

Delirium – Getting the Basics Right on a Busy Care of the Elderly Ward Introduction: Delirium is a disorder of attention and cognition that is commonly encountered on Care Of the Elderly wards. It is associated with a significantly increased risk of morbidity and mortality, both during and after hospital stays. Best practice guidance from NICE (National Institute for Health and Care Excellence) outlines standards for screening and preventing delirium. Where possible, appropriate preventative measures should be implemented to address underlying causes such as pain, hypoxia, constipation, and

Introduction: Falls are a leading cause of death in older adults, with hypertension (HTN) potentially increasing this risk. However, trends in fall-related mortality with co-existing HTN remain understudied. We hypothesize an increasing trend in fall-related mortality among older adults with HTN, with disparities by sex, region, and place of death. Methods: A retrospective analysis of adults ≥65 years was conducted using CDC WONDER (1999–2023). Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, region, and place of death. Trends were assessed using annual and average

Introduction The cumulative effect of medications with anticholinergic properties is known as anticholinergic burden (ACB). Adverse effects of anticholinergic drugs include increased risk of cognitive impairment, dementia, falls, and mortality among older people. Despite its serious implications for quality of life of older people, deprescribing to reduce anticholinergic burden is not guided by a single standardised guideline. Hence, practice remains variable. The aim of this service evaluation was to assess how effectively deprescribing is undertaken on Healthcare of Older People (HCOP) wards

Introduction Elderly patients are prone to developing delirium, with this risk being heightened by admission to hospital. In Sunderland hospital all patients are screened on admission by the frailty team, but we suspected cases were being missed later in admission. NICE advocates that delirium is screened and appropriately investigated during a patient's admission. To aid detection, RADAR, a bedside delirium screening tool is completed with each set of observations. RADAR is an effective screening tool, with three to four RADAR screenings per day, RADAR has a 73% sensitivity and a 67%

Introduction It is estimated that the prevalence of cervical spine (c-spine) fractures following low impact falls in those over 65 is around 3.4%. These debilitating injuries carry a 12% 3-month mortality rate and a high morbidity rate. The gold standard investigation for suspected c-spine fractures is a c-spine computed tomography (CT). However, c-spine X-rays (XR) are often requested instead. As a department treating over 1000 falls a year, we suspected CT c-spines were being under-requested. Specifically, this QI project (QIP) aimed to ensure the cervical spine is being assessed with the

Background: Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric care, but is challenging to implement in low- and middle-income countries (LMICs) due to scale, workforce limitations and the absence of culturally appropriate tools. Community Health Workers (CHWs) play a critical role in rural India, yet they lack a suitable screening instrument to identify older adults who require further and detailed CGA. Objectives: To develop and validate the Elderly Health Status Assessment and Screening (EHSAS) tool—a concise, culturally adapted, and multidimensional screening tool for

Introduction Co-production approaches are increasingly used in research. However, they are not often evaluated in care home settings. The study aimed to explore how co-production occurred in a series of workshops around falls management in care homes. Methods Sixteen stakeholders (care home residents and relatives, care home staff, health and social care professionals) participating in co-production workshops in a systematic action research study were invited to take part in a qualitative evaluation. The workshops were developing a model for delivering falls training in care homes across

Introduction Magnesium is essential for regulating cardiovascular, neuromuscular and respiratory functions. Hypomagnesemia in older adults is often overlooked and insufficiently managed. Inadequate monitoring and correction of hypomagnesemia may leave old and frail patients more vulnerable to acute cognitive decline which in some cases can be preventable. This study assessed the current management of hypomagnesaemia in older adults admitted to the geriatric wards of an NHS Trust and its association with acute cognitive decline. Methods A retrospective review of old and frail patients admitted

Introduction Catheter insertion is an invasive procedure associated with significant morbidity, including urinary tract infections (UTIs), prolonged hospital stays and patient discomfort. UTI is the commonest hospital-acquired infection, accounting for 19% of cases. We conducted a clinical audit to assess patients who had a catheter during their hospital stay, focusing on the indications for catheterization and the incidence of UTIs. Based on the findings of the first audit, we introduced guidelines for out-of-hours catheter insertion and inpatient Trial Without Catheter (TWOC) protocols

Introduction As the UK population ages, the demand for effective geriatric care continues to grow. Discussions amongst resident doctors highlighted that they often feel underprepared in managing older adults with frailty and multiple comorbidities. This quality improvement project aimed to improve confidence in managing complex geriatric topics through an online teaching programme, The Comprehensive Geriatric Lecture Series, targeted towards final-year medical students and foundation doctors. Topics covered included Stroke, Mind, Falls, Medications, Frailty, Orthogeriatrics, and Matters Most

Introduction: Hospital admission exposes older adults to harms, including delirium, acute kidney injury (AKI), and mortality. Hospital at Home (HAH) services allow treatment of acute illnesses, such as infection with IV antibiotics in the home setting. Methods: We retrospectively compared patients managed in the community under HAH with those admitted to an acute frailty ward. Over a twelve-month period, we identified older adults with urinary tract infection requiring IV antibiotics. HAH patients received daily IV ceftriaxone, while inpatients were treated according to hospital guidelines and

Introduction: A fast track discharge is considered when someone has a life-limiting illness, and their condition appears to be rapidly deteriorating. The Fast Track Pathway aims to provide patients with access to NHS continuing Healthcare as quickly as possible with minimum delay. Given the nature of the needs, this time period should not usually exceed 48 hours from receipt of the completed Fast Track Pathway Tool. ICBs should ensure that they have commissioned sufficient capacity in the care system to ensure that delays in the delivery of care packages are minimal. If this discharge is

Introduction Effective communication about medication changes during hospitalisation is critical for patient understanding, satisfaction, and adherence. This service evaluation examined how older patients and their carers perceive healthcare professionals’ communication around medication changes during inpatient care. Methods A qualitative study was conducted using semi-structured interviews with 10 participants (6 older inpatients, 4 carers) across four geriatric wards. Thematic analysis was applied. Sampling was guided by information power, with data saturation achieved after 10 interviews