Posters

The National Mortality Case Record Review Programme commissioned in 2016 aimed to improve the learning from deaths process. As part of this aim, several reports were published, which identified barriers in implementing the mortality review process. Mortality and Morbidity (M&M) meetings can be an important mechanism for removing these barriers, and while have been in place for a long time in surgical specialties, are only recently becoming more common in medical specialties. We have developed an innovative M&M meeting in our geriatric department to integrate Mortality case reviews with

Objective: Frailty patients undergoing emergency laparotomy (EmLap) experienced increased perioperative morbidity and mortality. We aim to explore the association between frailty scoring in EmLap older adults (>65 years) and 1-year post-operative morbidity and social care changes. Methods: Retrospective analysis was performed on the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database (2018-2019). Older adults with completed preoperative scoring markers (National Emergency Laparotomy Audit (NELA) and Rockwood Frailty Score (RFS)) were included. ‘Frail’ was defined as RFS>3 and

Introduction By 2030, it is estimated that 25% of Europeans will be aged over 65.[Dugarova;UNDevelopmentProgramme;2017] Frailty in this group is a key contributor to poorer outcomes.[Eamer;BMCAnesthesiology;2017;17:99] The term is common in healthcare but research into the issues faced by staff around assessment and management of frailty has been limited. We undertook a survey to identify challenges faced in providing care to those living with frailty and considered potential interventions. Method The survey was across three hospitals in our health board (which serves a population of around

Introduction NICE Clinical Guideline CG103 states that adults aged 65 and older should be screened for delirium within 48 hours of emergency hospital admission. The Geriatric Medicine Research Collaborative (GeMRC)'s World Delirium Day data from 2019 showed an average screening rate of 27% nationally. After an inpatient fall on the Medical Assessment Unit resulted in hip fracture for a patient who had not been screened for delirium with the recommended 4 A's Test (4AT), we decided to collect data on screening rates and devised a way of improving these. Method Baseline data was collected

BACKGROUND Physical rehabilitation is related to better surgical and medical outcomes for patients (WHO, 2021). In hospitals, the role of the rehab team is essential to promote faster and better recovery and to prevent falls (Brett et al., 2019). We wanted to review the communication between the rehab, nursing, and medical team to aid discharge planning. Better communication can reduce repetition. METHODS A baseline survey was given to doctors, nurses, and rehab staff in a geriatric ward to review communication. The intervention was an A4 template highlighting the patients’ baseline and

Introduction: Postural Hypotension is a very common presentation in the elderly population. Appropriate knowledge to record postural hypotension & non-medicinal management for this is very important among MDT members working in the care of the elderly wards. Method: We set out a questionnaire to assess the knowledge among MDT ( multidisciplinary) members. An educational programme was initiated to improve the knowledge among MDT members. A complete audit cycle was done and the knowledge was reassessed with the same questionnaire based on the principles of the PDSA (Plan, Do, Study & Act) cycle

Background: Weight loss in the older adult is often multifactorial and can be associated with increased morbidity and mortality. Our quality improvement project focused on nutritional care of patients 75 years or older. This hospital has a standardised Nutrition and Hydration Policy based on NICE guidelines to prevent malnutrition in hospital inpatients including weighing patients every 72 hours, daily screening and food/hydration charts. Our project aimed to increase adherence, with a focus on increasing the percentage of patients being regularly weighed over a 6-month period to 90%. Methods

Introduction Critical Illness Acquired weakness (ICU-Acquired Weakness (ICU-AW)) is an umbrella term used to describe Critical Illness Myopathy (CIM) and Critical Illness Polyneuropathy (CIP). The condition exerts high prevalence in the elderly admitted in the ICU and is associated with deteriorating patient outcomes, namely mortality and morbidity. The prevalence of the syndrome is highly variable in the current literature hindering our ability to objectively quantify the scale of the problem. Moreover, several preventative methods and treatment for ICU-AW as a result of sarcopenia have been

Introduction: Hip Fracture Surgery (HFS) can result in balance impairment which is associated with an increased risk of falls in the elderly as well as limitations in their mobility. Balanced Training (BT) is a rehabilitation method used aiming to minimize the balance impairments post HFS. BT options include stepping, balance task-specific exercise, standing on one leg, yoga. Our main outcome is to evaluate the effect of BT on the physical functioning of elderly patients post an HFS. Methods: We conducted a systematic review using the PubMed-Medline, Cochrane Library and Embase databases to

Background Hospital at Home (H@H) services exist across the UK to provide acute multidisciplinary care in an individual's own home. Evidence suggests this approach is safe for many older patients, and services are expanding to address expected winter challenges. We explored the views of staff working in these services. Methods We conducted 23 semi-structured interviews with multidisciplinary staff working across three H@H services in South East Scotland during March 2022. Questions focussed on service strengths and challenges aiming to identify common themes. Results There was high job

Introduction The Fracture Liaison Service (FLS) is a multidisciplinary service for individuals over 50 presenting with fragility fractures. It is designed to assess future fracture risk, and appropriately diagnose and manage patients with osteoporosis.1 At Wrightington, Wigan and Leigh Teaching Hospitals (WWL), concerns were raised that access to this service was poor, meaning some patients presenting with fragility fractures were not receiving appropriate management to reduce risk of recurrent fracture. This project was designed to increase referrals to the service. Methods A cohort was

Background This project was completed by a team of junior doctors working across two general medical wards at Queen Alexandra Hospital. Introduction Due to persistently high bed occupancy, patients are increasingly subject to multiple moves, increasing the risk of missed or delayed communication (Toye C et al, Clin interv aging, 2019, 14, 2223-2237). Importantly, families who receive good communication from staff are more likely to feel satisfied with the care of their loved one (Ersek M et al, J pain symptom manage, 2021, 62(2), 213–222). Our aim was to increase the occurrence and

Introduction The impact of taking medications with anticholinergic activity is called anticholinergic burden (ACB). A high ACB can cause physical and cognitive impairment, especially in the elderly, and is associated with increased falls, incidence of dementia and mortality. Therefore, we audited our admissions with delirium to see if we deprescribed to reduce medication number and ACB and if this impacted sedation use. Method A list of 146 admissions over two months were analysed; 46 had a delirium diagnosis. The number of medications and ACB scores were calculated at arrival to ED, admission

Background Polypharmacy is a recognised burden on patients with frailty. Medication reviews as part of comprehensive geriatric assessment (CGA) ensure appropriate prescribing and minimise harms. This project aimed to develop and initiate a pharmacist delivered frailty medication review tool to enhance existing CGA within our acute frailty service. Methods A structured in-patient medication review tool was developed based on the STOPIT and STOPPFRAIL tools for patients with a clinical frailty score (CFS) of >4. Initial work tested this on 20 patients in our frailty ward evaluating usability and

Advance care plans (ACP) in secondary care: What are the patient outcomes following discharge from hospital with an ACP? Introduction: Treatment escalation plans are discussed in hospital but not always communicated to community care on discharge, leading to avoidable admissions to hospital and hospital deaths which may be not what the patient wants. The project aimed to review what happened to patients discharged from hospital with an ACP over a 12 month period. Method: Older person service (OPS) inpatients were identified for ACP discussions, using Clinical frailty score, presence of life

Background: Frailty and dementia have a bidirectional relationship. However, frailty is rarely reported in clinical trials for dementia and mild cognitive impairment (MCI) which limits assessment of trial applicability. This study aims to use a frailty index (FI) to measure frailty using individual participant data (IPD) from clinical trials for MCI and dementia and to quality the prevalence of frailty and its association with serious adverse events (SAEs) and trial attrition. Methods: We analysed IPD from three dementia (n=1) and MCI (n=2) trials. An FI comprising physical deficits was

Introduction NICE guidelines state that fracture risk assessment should occur in all women aged ≥65 and all men aged ≥75. This includes assessing patients’ FRAX score, measuring serum vitamin D and calcium levels. Early detection and treatment can prevent complications like fragility fractures. We conducted a Quality Improvement Project to improve bone health assessments on Geriatric Wards. Methods A baseline audit assessed: admission reason, falls history, FRAX score, CFS, previous DEXA scans, whether vitamin D and calcium levels were checked during the admission, and if treatment was

Introduction Many people with parkinsonism require care as the disease progresses with much provided unpaid by family and friends. Caring for someone can have a negative impact on physical and psychosocial wellbeing. Caregiver burden can impact ability to continue this role, which can precipitate hospitalisation or institutionalisation of the recipient. Methods In this single-site study, primary, informal caregivers, defined as those providing any care or support, were enrolled alongside the person with parkinsonism or individually. Self-reported questionnaires included the 22-item Zarit

Introduction Advance care planning (ACP) is about what matters to patients, enabling their wishes to be respected, even when they become unable to engage in decision-making. Evidence shows ACP improves end of life care for patients and reduces relatives' bereavement reactions (Detering KM et al. BMJ. 2010; 340:1345). A simulation course for multidisciplinary healthcare professionals, using actors, was developed to improve understanding of ACP, and confidence in having these conversations. In response to the COVID-19 pandemic, the course was adapted to an online format. Method Participants were

Introduction Oral frailty (OF), gradual loss of oral function combined associated with presbyphagia often in conjunction with cognitive and physical decline, has been recommended to be considered as a geriatric giant. DENTAL has been suggested as a possible screening tool for OF. We have looked at the prevalence of OF and its association with dysphagia, frailty and formal care, amongst people admitted acutely to the acute medical/frailty wards in our hospital. Methods OF, dysphagia and frailty were screened for as part of the routine clinical assessment of patients during the usual clinical