Understanding the COTE lingo: a quality improvement project
Introduction: The terminology surrounding manual-handling equipment and discharge planning is rarely taught in medical school. Yet, it is crucial for medical staff, particularly those working on Care of the Elderly (COTE) wards, to comprehend these terms to accurately assess a patient's function and optimise discharge planning. Methods: A 17-question survey was distributed to establish the baseline knowledge of medical staff in a district general hospital, with the aim of using PDSA (plan, do, study, act) cycles for improvement as needed. Following preliminary data analysis, a lunchtime
The association of heart rate and cholinesterase inhibitor use among elders living with dementia: A retrospective cohort study
Abstract Background: Cholinesterase inhibitors (ChEIs) are the primary medication for dementia treatment. Bradycardia is a possible adverse effect associated with ChEIs. However, the relationship between ChEIs and bradycardia has not been definitively established, particularly in the Asian population. We conducted a study investigating the association between ChEIs and heart rate. Methods: We retrieved data from electronic medical records (EMR) of patients aged over 60 who were diagnosed with mild cognitive impairment or dementia at Ramathibodi Hospital between January 2009 and December 2022
Experiences of Healthcare Staff in an Acute Hospital-Nursing Home Collaboration: A Qualitative Study
Experiences of Healthcare Staff in an Acute Hospital-Nursing Home Collaboration: A Qualitative Study
Introduction: Many countries are facing an ageing population, and this is also evident in Singapore. To alleviate this matter and to cope with the increasing number of older persons today, nursing homes are also expanding. Residents of nursing homes are often frail and are at higher risk of multiple hospital admissions. On many occasions, the benefit of conveying the frail residents to acute hospitals is unclear and may even cause more harm. We implemented an acute hospital-nursing home collaborative pilot in two nursing homes with an objective to reduce emergency department visit and
Making Frailty Practice Robust – Using e-Learning to Facilitate Frailty Education
Introduction Frailty is a condition with increasing prevalence in the UK and significantly impacts the lives of those affected and their families. Frailty is a condition best managed by teams of skilled multi-disciplinary health and social care professionals (HSCPs). It is therefore essential that all HSCPs working with older people living with frailty are equipped with the appropriate knowledge and attitudes to look after affected persons. Methods The British Geriatric Society (BGS) and NHS England (NHSE) collaborated to produce an online e-learning module to support HSCPs to provide frailty
Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England
Purpose To investigate physiotherapists’ perspectives of effective community provision following hip fracture. Methods Qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. Results Four themes were identified
Assessing Quantitative Sonographic Changes in the Muscle Mass of Geriatric Patients Hospitalised Using Point of Care Ultrasound
Introduction: One of the most important consequences of hospitalisation in older patients is sarcopenia. This study aims to determine the impact of hospitalisation on muscle mass, functional status, nutritional status, and short-term clinical outcomes. Methods: A prospective study of patients admitted to an Acute Geriatric Ward between 1st November and 30th December 2022. Muscle ultrasound, utilising Point of Care Ultrasound (POCUS) at the bedside, was employed to estimate rectus femoris muscle thickness (MT), area (Ar), pennation angle (PA), and fascicle length (FL) at the time of hospital
Geriatrician-led Perioperative Services: an example of Value-Based Care
Background Perioperative services must adapt to the needs of an increasingly older surgical population. Perioperative medicine for Older People undergoing Surgery (POPS) services integrate geriatric medicine teams into surgical pathways to provide quality and cost-effective medical care. This project aims to examine value-based outcomes (clinical and financial impact) of embedding a POPS service at a district general hospital. Methods Following a period of implementation on an acute Trauma and Orthopaedic (T&O) ward, a two-week pilot was undertaken. All emergency fragility fracture admissions
Minimal Ingredient Wipes for Geriatric Care
Wipes are a practical solution for cleansing skin and widely used in children, neonates, and in geriatric care. Some wipes contain compounds may cause dryness, itching, irritation, and inflammation. This abstract looks at the efficacy of wipes that do not contain multiple unnecessary added ingredients.
Improving the proportion of patients >65 years presenting with delirium who have appropriate bloods checked within 12 hours of admission
Introduction: Early identification and management of all contributory factors is vital in the management of delirium. Delay in investigation can lead to morbidity, mortality, longer length of stay or inappropriate discharge from hospital. We carried out a Quality Improvement project looking to ensure all patients with delirium had appropriate blood tests taken in the Emergency Department (ED). Methods: For the first cycle, 25 patients > 65 years admitted through ED in December 2022 and January 2023 with delirium were identified based on medical clerking and post take ward round diagnosis
ED inreach pilot
At University Hospital Monklands, a district general hospital in Lanarkshire, an ED in-reach pilot was set up to deliver the best possible outcomes for frail older adults by proactively reducing unscheduled admissions, thereby reducing the time they spend in the hospital. Aim To reduce unscheduled admissions for patients with a clinical frailty score (CFS) ≥ 6, admitted to ED between 8am – 3pm, Monday to Friday, by 50%. Method An ED Frailty MDT was formed, comprising of Acute Care of the Elderly (ACE) nurses/ Advanced Nurse Practitioners (ANP) and Consultant Geriatricians. Patients ≥ 65 years
Assessing vision as part of the CGA in frail patients admitted with fractures
Introduction Falls are a common cause of morbidity and mortality in frail patients, with visual impairment doubling the risk of falls. NICE advises a multifactorial approach to identify risk factors to be treated, improved and managed. This includes sensory/visual assessment, which is poorly done in practice. The aim is for 50% of relevant patients admitted with fractures following falls to have a vision assessment within 5 days of admission. Methods A modified RCP ‘Look out! Bedside vision check for falls prevention’ aid for healthcare professionals was utilised. Patients excluded were those
Improving Physician Associate Students confidence in managing geriatric patients with a bespoke teaching programme and a novel bleep simulation
Introduction: BGS reports in its 'Case for more Geriatricians' that the number of people age over 85 is set to double by 2045. As well as Geriatric specific policies in the Ageing Well programme of the NHS Longterm Workforce Plan there are plans to expand the number of allied health professionals including Physician Associates (PA). We set out to improve PA students knowledge of and confidence in managing geriatric patients with a bespoke teaching programme culminating in a novel bleep simulation. Methods: We identified the students needs with a preliminary survey and then created a teaching
Healthcare Professionals Perceptions of Home Monitoring Technology to track recovery in Older Adults with Traumatic Brain Injury
Introduction: Traumatic Brain Injury (TBI) is the most common fall-related injury among adults 65 and older, despite the high incidence there is a paucity of research to guide management of older adult TBI . Simple passive remote home monitoring systems can be used to unobtrusively track markers of health and function in older adults and enhance clinical decision making in community-based care models, such as ‘hospital at home’. There are few studies to-date examining healthcare practitioners (HCPs) views on this technology. We aimed to explore HCPs insights on how to best develop the
Introducing simulation-based education to enhance undergraduate medical student learning of geriatric medicine themes
INTRODUCTION Medical graduates should be capable of providing good quality care for older adults who present with multi-morbidity, frailty and challenging long-term conditions, as recommended by the GMC’s “Outcomes for Graduates” guidance. Simulation-based education (SBE) is a recognised modality for replicating experiences to enhance and consolidate learning in a safe environment. We have developed an undergraduate geriatric medicine themed SBE experience, which aims to consolidate learning for core geriatric medicine concepts. METHODS Three geriatric medicine simulation scenarios have been
Frailty factors and comorbidities in Benign paroxysmal positional vertigo
Introduction: BPPV is a condition characterised by the displacement of the calcium crystals within the vestibular system. Whilst BPPV itself is not life-threatening, symptoms can cause complications and lead to falls, injuries, and in severe cases, head injury. The diagnosis and treatment for BPPV are manoeuvres, which in some patients especially the elderly cannot be performed adequately leading to untreated BPPV. This study aims to assess whether patients are being affected by frailty factors and comorbidities which is hindering their treatment. Methods: This study was part of a prospective
Investigating the effects of COVID-19 on memory: The relationship between age and short-term memory
Introduction: The COVID-19 pandemic has raised concerns about its long-term effects, leading to conditions such as "Long COVID." Neurological manifestations, including "Brain Fog" with impaired cognitive function, have been reported, but their relationship with age and memory decline remains unclear. Method: This study aimed to investigate the effects of COVID-19 infection on memory function and explore the relationship between age and memory scores. The research utilized data from the 'COVID-19 Online Rapid Objective Neuro-memory Assessment' (CORONA) study, employing an online survey with a
Improving patient awareness of modifiable lifestyle risk factors for ischaemic stroke
Introduction: Modifiable risk factors are an important part of secondary prevention of ischaemic stroke. Many of these are modifiable lifestyle choices. We identified a lack of provision of written information to patients on the stroke ward regarding modifiable lifestyle risk factors, and undertook a quality improvement project which aimed to improve provision of information - both written and verbal - via a "Stroke Passport" document to help patient understanding. Method: Data was collected from inpatients admitted with ischaemic stroke in the stroke ward in Prince Charles Hospital (District
Improving Clinical Frailty Scale Calculations in Non-Geriatric Specialities
Frailty is defined as a state of increased vulnerability to poor resolution of homoeostasis after a stressor event, increasing the risk of adverse outcomes (1). The Clinical Frailty Scale (CFS) is a validated infographic tool used to assess frailty in clinical settings (2). It aims to provide a standardised framework for frailty assessment, however determining the CFS is primarily subjective in nature, relying on clinical judgement and observation. NHS Elect have launched a CFS application, helping to improve the objectiveness of the CFS outcome. A quality improvement project performed at
More than just words : The development of a Welsh Language Clinical Frailty Score
Swansea is one of oldest cities by population in the UK (more than 1 in 5 people over 65) leading to an increasing number of frail patients and has a high prevalence of Welsh speakers in the over 65 age group 12% of Swansea Bay employees identify as speaking Welsh. The Welsh language act awarded equal status to both English and Welsh, encouraging public bodies to publish official documents bilingually.As part of our work in developing frailty screening for elective surgical patients we use the clinical frailty score (CFS) and noted there was not a Welsh language version available. As we are
Is an integrated Parkinson's Dementia Service the way forward?
INTRODUCTION The Cardiff and Vale Parkinson's service is an integrated, multidisciplinary service providing support and input from initial diagnosis to end of life care, undertaking comprehensive, specialist assessments for patients. Traditional care models have focused on physical disease, with neuropsychiatric symptoms often requiring input from other (e.g. Mental Health) teams to manage even the less- complex symptoms of dementia. Our service aims to manage both physical and neuropsychiatric symptoms via non-pharmacologic and pharmacologic means. METHODOLOGY From our total clinic population