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Improving Delirium assessment in the Elderly; a systematic approach 4AT as a screening tool for delirium

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GJayakumar, MAbdulaziz, ASalem
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Abstract Content - Introduction: Delirium, characterized by disturbances in attention and consciousness, is common in individuals with pre-existing medical conditions, particularly the elderly, but can affect people of any age. It can lead to significant morbidity, mortality, prolonged hospital stays, increased healthcare costs, and long-term cognitive decline. Despite its impact, delirium is often underdiagnosed and undertreated, underscoring the need for better diagnostic strategies. The 4AT tool, recognized by NICE, is valued for its rapid delirium assessment, unlike the AMT-10, which is

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The effect of COPD and mortality in a frail population

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B Hay1, HL Cheah2, Alhouti L1*, Khan F1*, Siddiqa A1*, Tully H1*, J Hewitt3 and Verduri A3,4
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Introduction Frailty is a clinical state that predisposes to patients to clinical deterioration in response to minor stressor events. Frailty tends to be more prevalent in patients with chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD). Therefore, we aim to investigate the influence of clinical frailty on mortality in COPD patients. Methods Data collection from electronic records for patients seen in Ysbyty Ystrad Fawr, Neville Hall Hospital, Grange University Hospital or Royal Gwent Hospital between 5-17th June 2024 was completed as part of patient input to the National

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The Impact of introducing 'What matters to Me' meetings in a community hospital setting.

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E. Roohi, L. Easton, Dr A. Puffett
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Background A mechanism for improving inpatient communication with patients and their families by the multidisciplinary team was desired. Introduction Patients and their families were invited to a 'What Matters to Me' meeting within a few weeks of transfer to a 43 bed community rehabilitation hospital. The 'What Matters to Me' meetings were booked by nurses with families via an invitation letter given during visiting. The letter outlined the purpose and format of the meeting. The patient, family, nurse, therapist, physician associate or junior doctor and consultant participated. A small number

Evaluating the Use of Anticholinergic Burden (ACB) Score in the Elderly

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Dr Yashwanth Nabh -1, Dr Harshitha Bhushan -2 , Dr augustin Aranda Martinez -3 , Jawahar Pathi -4 .
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The aging population is often burdened with multiple comorbidities, leading to polypharmacy, which increases risk of adverse drug reactions . Anticholinergic medications are commonly prescribed to elderly patients for various conditions, yet they are associated with a range of adverse effects, including cognitive impairment, falls, and even increased mortality. The Anticholinergic Burden (ACB) score is a validated tool used to assess the cumulative burden of anticholinergic medications in patients. This clinical audit is aimed to evaluate the use of the Anticholinergic Burden (ACB) score as a

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How does a 'Do Not Attempt CPR' decision impact clinical management of CPR during anaesthesia and hip fracture surgery?

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Amelia Collins, Ioan Hughes, Yuen Kang Tham, Antony Johansen
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Aims Understanding patients’ wishes regarding CPR before surgery is crucial. This study aims to assess the impact of a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision on anaesthetists' actions during theatre. Methods We used WhatsApp, to present a scenario of an 83-year-old with ischemic heart disease, cognitive impairment, and an acute hip fracture. Anaesthetists were asked how they would handle various intraoperative events and whether a prior DNACPR decision would influence their actions. Results A total of 74 UK anaesthetists, all but one of them consultants, completed the

An Alternative rapid and effective regimen for treating Vitamin D Deficiency in Older People

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Tayyab Mahmood & Daniel Enwereji
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Vitamin D deficiency has become commonplace, especially in older people. Given the role it plays in bone health and falls prevention, as well as the growing evidence of its extra-skeletal actions, it is important to treat vitamin D deficiency adequately. Our practice has been 2 to 3 weeks of daily treatment with 50,000IU ergocalciferol as a loading dose. However, recent guidelines recommend half this total cumulative dose given over a period of 6 to 8 weeks. Rather than promptly following the guidelines and changing our practice, we opted to conduct a quality improvement project (QIP) looking

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Surgical care through virtual wards; a new model of care for surgical inpatients

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A Ashish1; M Fani1; N Mackenzie1; P Asaad1; N Zahradka2; B Zaniello2; J Pugmire2
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Introduction Surgical interventions for older adults are increasing as the population ages. This demographic has a higher perioperative risk. Perioperative care through virtual wards (VWs) is a new service, allowing patients to remain at home. We compared operational and clinical metrics between two age groups (65+ and <65 years) receiving surgical inpatient care through a VW service to evaluate safety and efficacy. Methods The VW service at Wrightington Wigan and Leigh (WWL) NHS Foundation Trust cared for patients at home using the Current Health (CH) platform for medical and surgical

Beyond the Hospital Walls: Retrospective Evaluations of the CTMUHB @Home Service Patient Outcomes

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SY Ow1, S Pendlebury2, R Martin2
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Introduction: As awareness of hospital-associated deconditioning increases, services to prevent hospital admissions and provide discharge support for older adults are expanding, aiming to reduce admissions and the risks associated with prolonged hospital stays. A Welsh Government IQS titled “Older People and People Living with Frailty” published in January 2024 identifies a need to shift our health and social care system from prioritising reactive crisis management to a ‘place-based’, community-focused approach that emphasises proactive identification and management of frailty. The CTMUHB

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Frailty Screening and Optimisation of frail patients on Elective Surgical Waiting Lists

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Baral P ; Burberry D ; James K
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Introduction It is predicted that over 4,000,000 patients will be on an elective waiting list in England by 2030 (1) with increased demand, age and frailty following COVID (2). The importance of early assessment of frailty and geriatrician input to allow optimisation and shared decision making is key. A Geriatrician led perioperative clinic was established in Swansea Bay for patients on elective general surgical waiting lists in September 2023. Method Using an electronic Power Business Intelligence frailty flag, we highlighted patients and screened either electronically or via telephone using

Increasing age and frailty of patients admitted to General Surgery - an argument for increased Geriatrician input

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L Thompson; P Sawford; R Lockwood
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BACKGROUND: At Sheffield Teaching Hospitals, an Older Surgical Patients Pathway (OSPP) began in 2014, introducing a Consultant Geriatrician working in a liaison role within General Surgery. BGS reports in its 'Case for more Geriatricians' that the number of people aged over 85 is set to double by 2045. An increase in patient age and complexity is already being seen across a range of services including admissions to general surgery. We look to characterise this increase to make the case for an expansion of the OSPP service. METHODS: We identified patients aged over 75 admitted under General

Diagnosis in Memory Clinics: Evaluating the pathway of the Cardiff and Vale University Health Board Memory Assessment Service

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O Silgram1; A Kitson1; C Shute2; B Mohamed2
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Introduction In 2021, the Welsh Government launched the “All Wales Dementia Care Pathway of Standards”, which the Cardiff and Vale University Health Board (CVUHB) Memory Assessment Service (MAS) works under (1. Welsh Government, 2021). This service evaluation aims to evaluate the CVUHB MAS diagnostic pathway against these standards. Method This retrospective review analysed 299 referrals to the CVUHB MAS from August 2020-2023. Data was collected via referral and clinic letters, focusing on demographics, referral sources, diagnostic timelines and clinical outcomes. Results Patients had a mean

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Improving the Pulmonary Embolism Management: A quality improvement project aimed at enhancing adherence to diagnostic protocols

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Kirollos Philops 1;Ahmed Abouelazm 2; Sarah Scrivener 3;Najaf Haider 4;and Ramnauth Ramkrishna 5
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Pulmonary embolism (PE) is the third most common among acute cardiovascular diseases, after myocardial infarction and stroke, with a significant mortality rate. At Portsmouth University Hospital's acute medical and respiratory departments, inadequate understanding of pulmonary embolism diagnosis and management, which led to unnecessary investigations and medications putting the patients at risk of the side effects and complications of that, was the main impetus for initiating this audit. The hospital did not adhere to the NICE recommendation of regular interim anticoagulation for patients

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Augmented Reality Motion Tracking Technology for Fall Risk Assessment and Exercise Intervention in a Community Setting

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Nicole Stout PhD; Diana Veneri PhD; Minna Levine PhD; Haya Rubin MD PhD; Nate Mercaldo PhD; Phil Kalina; Renee Migdal
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One in four seniors fall annually, leading to unnecessary hospitalizations and decreased independence, with existing in-person fall prevention programs limited by access, scheduling, and cost. KINIMA Seniors is a newly developed automated interactive exercise and movement app providing real-time visual and audio feedback to assess and reduce risk of falls in seniors, using our proprietary augmented reality motion capture system. KINIMA Seniors introduces an innovative, scalable solution through a mobile app, assessing and reducing fall risks without the need for on-body sensors. It allows

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Enhancing Sleep Quality and Fall Prevention: Evaluating the Impact of Decaffeinated Beverages in an Elderly Rehabilitation Unit

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F Hussain1, K Miller1, A Rafeeq1; C Htut1; S Cherian1; B Ekere1; D Thankachan1; K Lo2; M Eghlileb2; T Hughes2; S Page1
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Introduction Lakeside unit at the University Hospital of Wales is a rehabilitation and complex discharge planning facility for elderly patients. Recognising the importance of good sleep in rehabilitation, our quality improvement project aimed to assess the feasibility and evaluate the impact of introducing decaffeinated coffee and tea as alternatives to the standard caffeinated options routinely provided to patients. Caffeine is a diuretic and stimulant that disrupts sleep and increases urinary frequency, urgency, and volume. Reducing caffeine can reduce falls related to toileting. Addressing

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High balance vigilance negatively impacts on perceptions of stability and postural control in community-dwelling older adults

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Elmar Kal, Neza Grilc, Jasmine Menant, Daina Sturnieks, Diego Kaski, Toby Ellmers
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Introduction. In older adults, dizziness is often experienced as a vague feeling of subjective unsteadiness, where people perceive themselves to be swaying more than they actually are. One factor that potentially drives such distorted perceptions of instability is (hyper)vigilance towards balance. This study aimed to investigate if older adults who report higher levels of trait balance vigilance (i) are more likely to report sensations of general unsteadiness when their balance is acutely threatened, and (ii) if this is accompanied by maladaptive changes in postural control. Methods. Forty

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Evaluation of the Parkinson’s Sialorrhoea Service

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E Coutsiouri1; B Mohamed2; J Adenwalla2; C Marquis2
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Background: Sialorrhoea is the increase of drooling due to poor clearance of saliva and is a common symptom in people with Parkinson’s Disease. It can lead to a decline in confidence, as well as increasing the risk of aspiration pneumonia. Botulinum injections are currently used in select patients to control the sialorrhoea, and the purpose of this project was to assess the benefit this treatment has had on patients. Methods: Data was collected from 40 patients who have received treatment at the sialorrhoea clinic and included Drooling Severity and Frequency Scale (DSFS), EQ5D and Visual

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Turning heads: does head motion during turning in people with Parkinson’s disease correlate with clinical measures?

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H Cox1; RZU Rehman2; J Frith3; R Morris4; AJ Yarnall1; L Rochester5; & L Alcock5
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Introduction: Turning is essential to mobility, constituting 35-45% of all daily steps. Falls during turning are more severe with 7.9x greater risk of hip fracture. Reduced quality of turning has been observed in people with Parkinson’s disease (PwP). Findings suggest head and trunk control during turning are different in PwP compared to controls, however it is unclear how this relates to clinical measures. Methods: 36 PwP completed an intermittent walking task with 180 degree turns (ICICLE-Gait). An inertial measurement unit attached to the head evaluated head rotations (>30 degrees). Turning

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Reducing Polypharmacy and Anticholinergic Burden in Elderly Patients: A Quality Improvement Audit

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V Santbakshsingh1; V Vijayakumar1; A Bashir1; N Jambulingam1; E Peter1.
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INTRODUCTION: Our QIP was conducted in the Geriatric wards at Royal Gwent Hospital by doctors working in Geriatrics. Delirium, falls, confusion and urinary retention are common reasons for hospital admission in the elderly. Anticholinergic burden (ACB) is the cumulative effect of taking multiple medicines with anticholinergic properties contributing to frequent admissions. The aim of our QIP was to increase doctor’s awareness of ACB and encourage the review and deprescribing of regular medications in elderly patients to decrease ACB. METHODS: ACB was measured on admission and discharge using

Introduction of Memory Link Worker Role within General Surgery

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R Eastwell1; K Brown1; A Chandler1; N Jardine1; S Ham1; N Humphry1
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Introduction Patients living with dementia are more likely to experience delirium and adverse outcomes when admitted to hospital (Dementia UK, 2022). The General Surgery directorate at Cardiff and Vale University Health Board secured funding for a Memory Link Worker (MLW) in the emergency stream. The aim of the MLW is to improve the hospital experience for patients living with cognitive impairment or anyone experiencing delirium. The MLW should also increase awareness and completion rates of “Read About Me” (RAM). Method Eligible patients are identified by ward staff or the Perioperative care

Home Administration of IV Zoledronic acid via Community Resource Teams (CRT) in Caerphilly, Wales

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K Arora1; A Powell1; S Fernandez2; P Fernando2; K Davies1; S Ramakrishna1
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Introduction Zoledronic acid, a bisphosphonate used primarily for treating osteoporosis and other bone-related conditions, traditionally requires hospital visits for administration, which can be burdensome, especially for frail older patients. The administration of intravenous (IV) Zoledronic acid at home via Community Rapid Response Teams (CRT) represents an innovative approach to enhance patient care and accessibility while offering significant benefits to patients and healthcare services. Service Delivery CRT team is typically composed of highly trained nurses and doctors, equipped to