FIRST STUDY OF CARDIOVASCULAR RISK ESTIMATION USING GLOBORISK IN A LATIN AMERICAN GERIATRIC COHORT WITH COPD
Introduction: It is expected that by the fourth decade of the 21st century, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide. These data require awareness among treating physicians of these patients. Material and Methods: A pilot study was conducted from January 2020 - December 2022 in a South American health institution in which cardiovascular risk was estimated using GLOBORISK and ATP-III criteria. Data derived from the metabolic profile included in the ATP-III criteria were collected. Quantitative variables are presented as mean ± standard
Drug classes associated with geriatric readmissions: the canary in a coal mine
Introduction: Older adults are at increased risks of drug-related problems, contributed by increasing incidence of multimorbidity with age, and the consequent polypharmacy. We aim to investigate the drug classes associated with 30-day readmissions in hospitalised older adults. Method: We prospectively studied patients aged 65 years and above admitted to a general medical department in Sengkang General Hospital, Singapore, between October 2018 and January 2020. Medication lists were obtained from electronic medical records at admission. Unplanned readmission within 30 days of discharge was
Improving the identification of osteoporosis in patients attending the South Edinburgh Parkinson’s clinic.
Background This quality improvement (QI) work was done at the South Edinburgh Parkinson’s clinic. Introduction Idiopathic Parkinson’s disease (IPD) is a secondary risk factor for osteoporosis (Torsney KM et al. Journal Neurology Neurosurgery Psychiatry 2014; 85: 1159–1166). The 2022 UK Parkinson’s audit highlighted bone health as an area of QI for IPD ( www.Parkinsons.org.uk). Methods A Plan-Do-Study-Act (PDSA) structure was adopted and project charter created. Baseline data was collected from 20 patients attending the IPD clinic between June- September 2023, reviewing details of assessments
Delirium Assessment and Management Protocols in Scotland: a Secondary Analysis of World Delirium Awareness Day 2023 Survey Data
Introduction: Delirium, an acute neuropsychiatric syndrome, affects one in four hospitalised older adults. Effective management requires timely detection using validated tools and a structured approach to causes and sequelae. There is limited evidence on contextual factors surrounding assessment tool implementation and delirium management. The primary aim of this study was to describe the use of validated delirium assessment tools across Scotland, with a secondary aim of describing protocols for delirium management and barriers to implementation. Methods: This was a secondary analysis of
Delivering Safe Admission Avoidance via Comprehensive Geriatric Assessment under an Emergency Department Frailty Service
Background Older people account for >40% of acute hospital admissions. Delivering alternatives to hospital admission and community-integrated care closer to home are increasing priorities. We aimed to develop an Emergency Department (ED) Frailty MDT to provide rapid assessment, early Comprehensive Geriatric Assessment (CGA), and reduce inpatient admission rates for frail older people. Methods From November 2023 to April 2024, a newly formed Royal Infirmary of Edinburgh ED Frailty team delivered CGA for older adults aged ≥75 (≥65 if care home resident) with Clinical Frailty Scores ≥5 in the ED
Small vessel disease contributions to acute delirium: a pilot feasibility MRI study
Background and aims Delirium carries an eightfold risk of future dementia. Small vessel disease (SVD), best seen on MRI, increases delirium risk, yet delirium is understudied in MRI research. We aimed to determine MRI feasibility, tolerability, image usability, and prevalence of acute and chronic SVD lesions in acute delirium. Methods This case-control feasibility study performed MRI (3D T1/T2-weighted, FLAIR, Susceptibility-weighted, and Diffusion-weighted imaging (DWI) on 20 medical inpatients >65 years: 10 with delirium ≥3 weeks and 10 without delirium, matched for vascular risk, Clinical
Barriers perceived by medical students when considering a career in geriatric medicine.
Introduction Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8,031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality. Method The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career
Development of an intervention to improve adherence to medication in older patients with heart failure.
Background: Heart Failure (HF) is a major cause of poor health, hospitalisation, and death, particularly amongst older people. Routinely prescribed HF medication can improve these outcomes, but many patients do not take their medications. Aims: To develop a tailored multi-component intervention to enhance medication adherence in older HF patients in preparation for a future pilot RCT. Objectives: To determine what intervention components and strategies are necessary and acceptable to create a support package to help and encourage HF patients to take their medication regularly. To develop an
Risk stratification of comorbidities associated with recurrent high dose oral steroid use for patients with COPD
Introduction High-dose corticosteroids have significant benefits for infective exacerbations of COPD, reducing risk of relapse, length of hospital stay and earlier symptom improvement. However, recurrent use has been shown to increase risk of comorbidities including osteoporosis, type two diabetes mellitus (T2DM), cardiovascular disease, hypertension, and elevated body mass index (BMI). This audit assessed how many patients at Anchor Mill Medical Practice in Paisley, who had been prescribed two or more courses of prednisolone in the six months prior to the start of data collection, had been
Developing Frailty Services for the People of North-East Glasgow.
Introduction Older people living with frailty are core users of health and social care. Services attuned to the needs of people with frailty afford better outcomes, help avoid harm and improve the experience for people and those who care for them. Such services can also help with flow and capacity. The Glasgow Royal Infirmary (GRI) Team aimed to advance services in order to enhance the quality and provision of care for older people with frailty. Methods As part of the Health Improvement Scotland Focus on Frailty Programme, the GRI Team developed processes for early identification of people
Destination Frailty Unit – a QI journey
Background Evidence shows that CGA based in Frailty units is better for patient care (Fox 2012, Ellis 2011). University Hospital Wishaw (UHW) is the only acute site in NHS Lanarkshire that does not have a frailty assessment unit as part of the admission/receiving pathway. Patients are currently admitted to the Medical Assessment Unit (MAU) and seen by either Geriatrician or Medical consultant depending on the time of admission. UHW is working towards a frailty unit but has been limited by space and resource. Instead we have been on a journey of step-wise improvements to establish one. Methods
Improving the peri-operative pathway for patients with diabetes: an audit of current practice prior to the introduction of the IP3D at East Sussex Healthcare NHS Trust
Background Perioperative management of diabetes is a strong predictor of post-operative outcomes for patients undergoing major elective surgery. The national confidential enquiry into patient outcome and death (NCEPOD) has specific recommendations for diabetes care in the perioperative phase. We aimed to audit current practice in East Sussex Healthcare Trust (ESHT) against these recommendations prior to the introduction of a recognised programme designed to improve the perioperative pathway for patients with diabetes (IP3D). Methods A retrospective audit of 30 patients with diabetes who
Frailty Care: A DGH Experience
Introduction At Epsom and St Helier, a dedicated Frailty service exists during daytime hours, and not weekends, nights or Bank Holidays. During these hours, patients are reviewed primarily by a cohort of “frailty-naïve” medical junior doctors. We aimed to compare the management plans, patient outcomes, rates of discharge, documentation and care delivered by medical junior doctors to that of an established frailty service. Methodology Data on presenting complaint, demographics, degree of frailty, postcode was collected on all patients over the age of 65, presenting to A&E at Epsom and St Helier
A practical skills teaching programme for final year medical students improved their confidence about entering FY1.
INTRODUCTION: Medical students may find practical aspects of the transition to FY1 doctor challenging. In recent years medical curriculums have been updated to address this issue by increasing the emphasis on assistantships and practical learning. We explored how prepared final year medical students felt for managing common scenarios in geriatrics, such as a patient with delirium or inpatient falls. This allowed us to develop a tailored teaching programme to be delivered by junior doctors with relevant practical experience. METHODS: 1) We surveyed assistantship students in geriatrics to
The Role of Remote Ischaemic Conditioning in Orthopaedic Surgery: A Narrative Review
Introduction Orthopaedic surgery is an important treatment for musculoskeletal (MSK) conditions. In the NHS, 25% of all surgical interventions are for MSK conditions and account for 16.1% of the total cost of surgery. Complications following joint surgery include venous thromboembolism, infection, stroke, myocardial infarction, falls and delirium. Remote ischaemic conditioning (RIC) is a technique which induces intermittent ischaemia of a limb, through inflating a tourniquet above systolic blood pressure for intervals that avoid physical injury but trigger several intrinsic protective
Analysis of coding data and inpatient cause of death following hip fracture admission at two centres in South Yorkshire
Introduction Hip fracture is the most common fracture in adults over 60 years, affecting approximately 70,000 people in the UK in 2019. Mortality after hip fracture continues to be high and the cost of hip fracture is estimated at £1.1 billion per year for the NHS. It has been shown that there are key clinical indicators which can improve patient outcomes. These are monitored annually in the UK by the national hip fracture database (NHFD). Methods Our aim was to look at the demographics and clinical codes for patients admitted with hip fracture, codes when they are readmitted and cause of
Admission to specialist neck of femur fracture ward is associated with higher Best Practice Tariff achievement: a 13-month single centre retrospective analysis
Hip fractures tend to affect older, frailer people and are associated with high morbidity and mortality. The Best Practice Tariff (B PT) was introduced to recognise gold standard care. Features of the BPT include prompt surgical and orthogeriatric input, with multidisciplinary working throughout. Subsequent service changes have led to the creation of specialist hip fracture wards. However, it is not always possible to admit patients with a fractured neck of femur to a specialist hip fracture ward. We reviewed data for 691 patients admitted with a primary neck of femur fracture to a district
Cardiopulmonary Resuscitation discussions in patients with frailty undergoing Surgery
AimsTo reduce the burden of inappropriate CPR with surgical specialties and to improve the conversations we are having with patient’s and their relatives around CPR. Methods Data collection was done one one day in March, June and September 2024 across three surgical wards. Patients were included over the age of 65 and with a Rockwood Clinical frailty score over 5. A retrospective review of whether discussions with patient and/or next of kin was done. Below is the table demographics. Results Following teaching intervention to junior doctors and discussion with geriatric medicine surgical
The role of POPs teams in the management of outcomes and predictive factors in lower limb amputation in the older patient
Introduction: Chronic limb-threatening ischemia (CLTI) is defined by presence of peripheral artery disease, rest pain, and/or gangrene or ulceration.1 Management of CLTI often involves a major amputation which has a 30-day in-hospital mortality of 6.6%. Despite improvements in secondary risk management, 5-year mortality remains high.1 Understanding how comorbidity affects amputation survival may help support patient optimisation and shared decision-making. Methods: This audit assessed the outcomes of patients who were reviewed by the POPS team using a comprehensive geriatric assessment (CGA)
Do Frailer Patients use digital applications and can we use them in screening for frailty?
Following COVID and an aging population waiting lists in Swansea Bay for elective procedures along with the rest of the UK had reached an all time high. Many patients have become frailer over time and may no longer be suitable or keen for surgery. There was not an efficient mechanism in place for screening these patients and many were being cancelled on the day or having pre-op assessments close to the time of surgery and found to be unsuitable. As part screening our elective surgical waiting lists for frailty we used a number of mechanisms including a electronically screening questionnaire