Posters for 2024 Wales Spring Meeting

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

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

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

INTRODUCTION Dementia in Parkinsons is common and under-recognised with a significant impact on person and their carer. Contrary to other services, Cardiff and Vale Parkinson's services run an integrated Parkinson's clinic where People with Parkinsons (PwP) developing dementia continue to be managed by the same clinical team. METHODOLOGY An review of 425 patients diagnosed with dementia with a background of Parkinson's over last 10 years was undertaken. A random sample of 50 patients assessed for demographics, duration of Parkinson's, presentation of dementia and outcomes including place of

Introduction High number of clinically optimised patients in a DGH were having daily clinical input. RAAC clinical incident resulted in movement of clinically optimised patients from the district general hospital to a community hospital increasing the community bed base from 32 to 72. This gave the opportunity to review how these patients were managed. Method It was recognised that a daily medical ward round for clinically optimised patients was neither necessary or optimal and potentially perpetuated the impression that patients required in hospital care. National guidance supports delegation

Introduction During 2022, non-femoral fractures that didn’t require operative management had 30 days median inpatient length of stay (LOS) at SBUHB. Femoral fracture patients >65 years had LOS 36 days (GIRFT average 19 days), with 720 admissions. High local incidence is believed to be contributed by historical failures to identify and treat non-femoral fragility fractures. A new service was created from a collective effort to do better for our patients and prevent avoidable harm by breaking down barriers between services and promoting effective collaborative working. Methods A collaboration

Aim: Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that existing scores e.g. Glasgow Admission Prediction Score, Sydney Triage to Admission Risk Tool and the Ambulatory Score were not able to predict admission in our population(1). We have developed a novel, frailty-focused score. Methods: The Older Person’s Assessment service (OPAS) is ED based, accepting

Introduction Swansea Bay Health Board is covered by eight community clusters (240 virtual beds), each with their own Virtual Ward (VW) MDT which provides community based Comprehensive Geriatric Assessment and reablement. The VW governance structure includes the routine collection of person centred metrics. There is no recognised PROM or PREM specifically designed for needs of frail older people and PROMs and PREMs are rarely used to inform quality and continuity in services at transitions of care (e.g. at discharge from hospital) Methods VW data from June 2023 to February 2024 was analysed

Introduction – NHS England have included the identification and response to frailty in emergency departments (ED) as an area of clinical priority, producing the CQUIN05. At the Oxford University Hospitals Trust (OUH) we have designed a front door frailty service and are participating in the CQUIN05 scheme. The Clinical Frailty Scale (CFS) score is recorded by nurses in ED. Following the CQUIN05 criteria, patients aged above 65 years old and scoring 6 or above on the CFS (moderately frail) are identified by the front door frailty service and a comprehensive geriatric assessment (CGA) initiated

Introduction  The National Hip Fracture Database (NHFD) is the mandatory national clinical audit for patients presenting with hip fracture. Since 2007, the NHFD has made admission cognitive assessment using the Abbreviated Mental Test Score (AMTS) routine for people presenting with this injury. In 2024, the NHFD plans to replace the AMTS with the 4A test (4AT), so all patients are additionally assessed for delirium on presentation. This study aims to compare the AMTS and 4AT for this patient group, so the NHFD and our local team can anticipate the consequences of this change in patient

Introduction With recent advances in surgical techniques and immunosuppressive therapy, solid organ transplantation (SOT) is increasingly accessible to older and more complex patients. Multiple previous studies have shown quality of life improvements in SOT patients post-transplant across age group and despite significant pre-transplant frailty. As such, we are investigating if SOT is associated with a reduction in frailty status post-tranplant. Methods Studies across five databases between 2000 and 2023 were included if an objective frailty status measurement was used, SOT was performed

Introduction Current NICE guideline recommends the use of either the FRAX or Qfracture score to assess the probability of future fragility fractures before measuring a patient’s bone mineral density. However, Qfracture has poor predictive ability in patients above the age of 85. As such, we investigated if the addition of clinical frailty status may enhance Qfracture risk prediction in an older age group. Methods Data were collected from consecutive admissions to an Emergency Frailty Unit (EFU) ofoin Ysbyty Ystrad Fawr Hospital, between 1 April 2015 to 31 March 2017. Demographic information

Introduction: Metabolic syndrome has been associated with an increased risk of cancer. This study evaluated this association in a South American cohort. Methods: Retrospective observational study in 100 patients older than 60 years with metabolic syndrome for more than 10 years from a hospital outpatient center. Anthropometric (waist circumference, body mass index), biochemical (triglycerides, HDL cholesterol, fasting glucose) and clinical (arterial hypertension, type 2 diabetes mellitus) parameters were evaluated. The association between metabolic syndrome, its components and cancer risk was

Introduction A quarter of people with hip fractures sustain another fragility fracture within 5 years, but most receive no osteoporosis medication as secondary prevention. To coincide with the publication of ‘A call to action: a five nations consensus on the use of intravenous zoledronate after hip fracture" Age and Ageing, September 2023, we set out to explore clinicians’ reasons for not previously using zoledronate (IV Zol). Methods Prior to first presentation of the ‘Call to Action’ at the Global Fragility Fracture Network (FFN) and British Geriatrics Society conferences in autumn 2023, we

Introduction: Symptom heterogenicity in dementia subtypes can pose diagnostic challenges, leading to potential misdiagnoses and significant implications on patient management. The NICE Guidelines for Dementia 2018 [NG97] recommend FDG-PET where diagnostic uncertainty remains after initial assessment. From 2021, a national and collaborative initiative supported using FDG-PET brain imaging for dementia in Wales to facilitate more accurate and timely diagnoses with higher degrees of confidence. This project aimed to evaluate the temporal aspects and diagnostic accuracy of FDG-PET utilization in

Introduction Inpatient fallers make up the minority of neck of femur fractures (NOF) in Morriston Hospital but it was observed that outcomes were less favourable than those in patients who sustained their fracture outside of hospital. Method Retrospective analysis was conducted of all NOF patients managed in Morriston Hospital whose injury was the result of an inpatient fall between January 2022 and December 2023. Outcomes were compared to those in all other NOF patients including pathological and occult fractures managed in the centre over the same two year period. Anonymised data were

Introduction Information-sharing between primary and secondary care is vital for patient safety and reducing duplication. The Electronic Discharge Summary (EDS) enables this but is often incomplete due to time pressures and poor team continuity. Information from the Comprehensive Geriatric Assessment (CGA) by the Perioperative care of Older People undergoing Surgery (POPS) team is often omitted, leading to queries from primary care colleagues and duplication of work on readmission to hospital. Methods Eight core CGA components were determined for inclusion in the EDS. Twenty EDS were reviewed