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A Systematic Review of Interventions to Reduce Falls and Improve Staircase Safety for Older People

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Joanna Wootton1; Toni Hall 1,2; Constantinos Maganaris 1; Theodoros M. Bampouras 1; Richard J. Foster 1; Mark Hollands 1; Vasilios Baltzopoulos 1; Thomas O’Brien 1
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Background Stairs are a serious safety hazard for older adults, with stair falls being the leading cause of accidental death [1,2]. Mechanistic, proof-of-principle, research has examined the development of interventions to improve staircase safety. The aims of this systematic review are to synthesise and evaluate stair fall interventions and identify those showing effectiveness and to establish a pathway to implementation for these interventions. Methods Five databases were searched for interventions seeking to reduce risk or occurrence of falls on stairs. Quality of the studies was assessed
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Supporting Safer Falls Management Through Guideline Implementation at the Whittington Hospital, London

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M Knight 1; Millie Hetherington 1; Martin Nemec 1; Rosaire Gray 2; Charlotte Ainscough 2; Emma Jenkins 2
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Introduction: Inpatient falls are a common cause of harm in hospitalised older adults. National guidance from the 2024 National Audit of Inpatient Falls (NAIF) and Royal College of Physicians (RCP) outlines standards for timely and structured post-falls care. This quality improvement project aimed to assess local adherence to these standards and to implement a guideline to support safer, more consistent inpatient falls management. Method: A retrospective audit reviewed all inpatient falls reported via the Datix system in May 2024. Falls in clinical areas requiring medical review were included

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Visual Assessment in Patients Presenting with Falls in a Geriatric Medicine Ward: An Audit of Current Practice

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Mohamed Morgan; Azza Fadl; Tahir Masud
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Introduction: Approximately half of individuals aged 80 years and older experience at least one fall per year, costing the NHS an estimated £2 billion annually. Visual impairment is a recognised potentially modifiable risk factor for falls and their resulting consequences including injuries and hospitalisation. Despite this, visual assessment is often overlooked by clinicians when managing these patients, potentially due to the absence of standardised guidelines. Method: A first-cycle clinical audit was undertaken in an acute Geriatric Medicine ward between January 2025 and March 2025

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Opportunistic Review of CT scans to Identify Unreported Vertebral Fractures in Patients with Parkinson’s Disease

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S Ow1; A Kitson1; H Ali2; B Mohammed3; J Boylan3; S Jones4
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Introduction Patients with Parkinson’s Disease (PD) are at an increased risk of developing osteoporosis. Vertebral fractures (VFs) are the commonest type of osteoporotic fracture and are frequently underdiagnosed, up to 70% going unreported. Individuals with VFs are at a significantly higher risk of experiencing subsequent fractures (relative risk increase of 2.8 for hip fractures and 5.4 for additional VFs). The presence of VFs are often not formally reported. VFs are also associated with an eightfold increase in morbidity. These complications could result in reduced independence and

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Quality Improvement Project on Fragility Fracture Risk Assessment using FRAX score in Older Adults in Inpatient Psychiatry Unit

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Noel Shaju1,Alice Thankachan2
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Introduction Annually, around 130,000 people in Wales are reported to have at least one fall incident. Existing evidence suggests that Mental Health inpatient units, on average exhibit higher incidence of fragility fracture than acute hospital wards which could be contributed by medication such as antipsychotics and anti-depressants. Consequently, a quality Improvement project was formulated to evaluate fragility fracture risk among Elderly inpatient Mental Health unit and to analyse their adherence of treatment to the National Standards. Method Patients admitted to old age psychiatry ward at
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A review of bone health assessment on an Older Person's Acute Medical Unit

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Alice Amin1; Dr Siobhan Lewis2
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Introduction Bone health declines with age, with almost 3 million people in the UK living with osteoporosis. Osteoporosis is a common condition affecting older people where bone density is reduced, increasing the risk of fragility fractures. Most patients are diagnosed following a fracture, and only then prescribed bone protection. Older people have an increased falls risk due to muscle weakness, impaired vision and balance, pain, postural hypotension and medications; increased falls frequency correlates to increased fracture incidence. We aimed to evaluate whether bone health was routinely

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Postural hypotension in the Elderly: Audit of diagnosis and management in Frailty Same Day Emergency Care

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Ruqaiyah Behranwala1, Caitlin Wilson2, Kyaw Myat Thu3, Michelle Carr4
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Introduction: Postural hypotension (PH) is a significant predictor of mortality and is associated with increased risk of falls, functional decline and hospital admission among elderly patients. The National Institute for Health and Care Excellence (NICE) recommends routine assessment of PH in patients presenting with falls alongside a comprehensive review of contributing factors such as medication and hydration. This audit aims to evaluate current practice in the diagnosis and management of PH for patients presenting to Frimley Park Hospital’s Frailty Same Day Emergency Care (SDEC) against
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Management of acute urinary retention in older males

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NiamhMcCourt1, MariaaAkulich2, BreonSamuels3, NicholasSaxton2
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Background This audit was conducted on a Care of the Elderly (COTE) ward in a district hospital focusing on males over 65 years of age who developed acute urinary retention (AUR) during their admission. Introduction AUR is a common emergency in males that is responsible for 30,000 hospital admissions a year. The suboptimal management of AUR can lead to failed TWOC, recurrence of AUR, as well as an increased risk of urinary tract infections and multiple hospitalizations. The aims of this audit were to review management of AUR on a COTE ward over a 3 month period and compared this against NICE
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‘Decaf by Default’ and Its Wider Impact: Reducing Toileting Falls, Supporting Continence and a Positive Care Environment

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E Francis1;C Collins2;I Constable3;S Coombes4
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Introduction Caffeine can adversely affect patient safety by increasing bladder urgency and agitation, raising fall risk, especially among older people. NICE guidance (2019) recommends reducing caffeine intake for individuals with overactive bladder. However, caffeinated drinks often remain the default in healthcare settings. In 2021, University Hospitals of Leicester NHS Trust (UHL) achieved a 30% reduction in toileting-related falls after making decaffeinated hot drinks the standard. In 2023, staff at Northumbria Healthcare NHS Foundation Trust (Northumbria) identified similar concerns. A

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Medication Management: An overlooked aspect of the Hospital Acquired Deconditioning Syndrome? A Quality Improvement Project

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B Moor; S Fadelallah; S Wells; T Ahmed
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Introduction: Hospital Acquired Deconditioning (HAD) describes a patient’s reduction in performance following hospital admission. Medication review and assessment of medication management is a component of Comprehensive Geriatric Assessment. Hospital admission may necessitate the temporary transfer of medication administration to healthcare staff. For some patients, this may result in deterioration in medication management skills that impact discharge planning. This may be avoidable if individuals are supported to maintain these skills in hospital. Method: Two PDSA cycle quality improvement
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Improving opioid and laxative prescribing safety in older surgical inpatients

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Anjali Pradeep1, Aaliya Khan2, Alexandra Price3
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Introduction Older adults are particularly vulnerable to adverse drug effects from opioids, including constipation, delirium, immobility, and delayed discharge. Despite NICE guidance recommending prophylactic stimulant laxatives with opioid prescriptions, older surgical inpatients frequently receive inadequate bowel care. Prescribing must also consider comorbidities such as renal impairment and cognitive decline. This quality improvement project aimed to optimise opioid and laxative prescribing safety in an elderly surgical population. Methods A two-cycle audit was performed on a long-stay

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Auditing Acute Heart Failure Management: Informing an Integrated Pathway Between Hospital at Home and Heart Failure Services

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Ruqaiyah Behranwala1, Pippa Sechi2, Kyaw Myat Thu3, Michelle Carr4
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Introduction: Acute heart failure (HF) is the leading cause of hospital admission in people aged 65 years or older in the UK. Hospital at Home (HAH) is an admission avoidance service for frail older patients with the capabilities of administering intravenous diuretics and carrying out blood test including NT-proBNP. We aimed to audit the diagnosis and management of patients presenting with acute HF to Frimley Health’s HAH services against NICE guidelines (CG187). Methods: A retrospective analysis was carried out for all patients referred to HAH with decompensated HF between January and
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Falls Prevention Guidelines Adherence in Older People Assessment Unit- A Two-Cycle Quality Improvement Project

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S Ejaz1; S Benipal1; M Gulraiz1; C Htet1; M Collins1; A Iqbal1
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Background This QIP was conducted in the Older Person Assessment Unit (OPAU) at Whipps Cross Hospital, acute care unit serving a diverse older adult population in East London. The project was led by resident doctors under consultant supervision. Introduction Falls are a leading cause of admission to the unit, contributing to injury, prolonged hospitalisation, and physiological decline. NICE CG161 provides evidence-based recommendations for risk prevention. Inconsistent documentation and low referral rates for preventative measures contributed to varied care quality and reduced effectiveness in
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Improving Inpatient Falls Reviews at North Manchester General Hospital – A Local Quality Improvement Project

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Hannah Parry-Jones1
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Introduction:​ Inpatient falls are a significant concern due to their impact on patient safety and outcomes. A standardised approach to reviewing falls can help identify contributing factors and improve care. Despite the recognised importance of fall reviews, inconsistent documentation and inadequate follow-up remain common challenges. This project aims to enhance resident doctors' reviews of patients after an in hospital fall, and improve their confidence and experience in responding to such calls. Ultimately it aims to determine contributing factors, and guide prompt investigation and
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Does pre-operative ECG abnormality at pre-assessment predict cardiac complications in patients undergoing major non-cardiac surgery

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R Jackson-Wade1, S Ranasinghe1, L Kandakumar1, J Jegard1
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Background Cardiovascular complications are one of the most common causes of morbidity and mortality perioperatively during non-cardiac surgery. This risk is significantly increased in those ≥65 and those who are frail. NICE and ESC both recommend that all patients ≥65 have a pre-operative ECG to assess each patient's risk of perioperative cardiovascular complications before any intermediate or high-risk surgery. This study aims to assess the risk of perioperative cardiovascular complications in those ≥65 with abnormal ECGs. Methods We analysed data from patients attending our combined
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Audit of Cardiac Arrests at Nevill Hall Hospital (October 2022 - February 2025)

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K Mountstevens1; M Islam1; N Haboubi1
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Abstract: Audit of Cardiac Arrests at Nevill Hall Hospital (October 2022 - February 2025) Introduction This comprehensive audit examined cardiac arrests at Nevill Hall Hospital, part of Aneurin Bevan University Health Board (ABUHB), over a 28-month period. The study investigated relationships between patient frailty, comorbidities, resuscitation appropriateness, and clinical outcomes in a unique step-down hospital setting. Following health board restructuring, Nevill Hall operates without on-site specialties, anaesthetics, or intensive treatment unit facilities, comprising multiple Care of the
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Survival outcomes in patients with sigmoid volvulus

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R Bock1; Z Javid1; P Vaughan-Shaw1; Edinburgh Colorectal Group1
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Aim This study aimed to assess management pathways and outcomes in sigmoid volvulus (SV). Methods A retrospective review was performed on patients first admitted with SV between 2019 and 2023 within a tertiary-level colorectal service. Demographic, management, and outcome data, including frailty, ASA (American Society of Anaesthesiologists), and National Emergency Laparotomy Audit (NELA) score, were collected. Comparative statistics were used to compare baseline demographics between those operated on and those not and to identify factors associated with survival. Results A total of 72 patients
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#WalkingAidMOTWeek at UHB

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HAYLEY WHITE 1; GRACE PEREZ DE ALBENIZ BRYSON 2; ABI BYRCHMORE 3; CARYS ANSELL 4; HELEN JACKSON 5
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Introduction: Would you drive a car with a worn tyre? Then why use a walking aid with a worn ferrule? Walking aids are essential tools for supporting and maintaining an individual’s independence, function, and safety. They provide greater stability and balance, promote a safe gait pattern by improving speed and stride evenness, and enhance confidence in mobility. However, it is well known walking aids that are incorrectly fitted or equipped with a worn ferrule can increase the risk of injury and or falls and their associated complications, but there is no evidence to suggest worn out ferrules
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Implementing a standardised approach to medication review during Comprehensive Geriatric Assessment in the perioperative setting

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Andrew McCleary1, Alison McCulloch1, Claire Sturrock1
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Introduction: The Centre for Perioperative Care Guidelines for People Living with Frailty emphasises the need for routine frailty assessment and subsequent Comprehensive Geriatric Assessment (CGA) in older adults within the emergency surgical setting. Medication review and optimisation is an integral part of the CGA. The Scottish Government’s Polypharmacy Guidance provides a 7 steps structure for patient-centred medication reviews. Utilising this structure, our aim was to establish a standardised method for documentation and recording of medication reviews as part of CGAs undertaken by our

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How well are CT Head scans following inpatient falls adhering to NICE and RCR guidelines?

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Ankit Regmi1, Riddhi Goel1, Aditi Singh1, Katie Honney1
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Introduction: Inpatient falls are common and serious issue in healthcare, often leading to complications like traumatic brain injuries. Timely and appropriate evaluation using Computed Tomography (CT) scan of the head is crucial for diagnosing and managing those injuries. Clinical guidelines, such as those established by the National Institute for Health and Care and Excellence (NICE) and Royal College of Radiology (RCR) outline when CT head should be performed after a fall to ensure timely intervention and efficient use of resources. However, adherence to this guideline varies, sometimes
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