Posters for 2025 G4J (Geriatrics 4 Juniors)

Older patients admitted to hospital with a surgical pathology often have multiple medical comorbidities, or develop medical complications during their admission. Such issues include delirium, electrolyte derangement, acute kidney injury, respiratory complications and diabetic or haematological pathologies. Where geriatricians are not integrated into the surgical team, the senior surgeon will often rely on junior doctors to manage these conditions. This can leave Foundation Year 1 doctors feeling overwhelmed and under-supported in the management of the frail and co-morbid surgical patient. Our

Introduction Blood tests are frequently ordered in geriatric wards, often without clear clinical justification. This can lead to patient discomfort, increased costs, and unnecessary workload on staff and laboratory services. This audit aimed to evaluate the frequency and appropriateness of blood test ordering and reduce unnecessary investigations in geriatric wards. Method We reviewed blood tests ordered over a 2-week period across the four geriatric wards at Leicester Royal Infirmary. Seven commonly requested tests were included: full blood count (FBC), urea and electrolytes (U&E), C-reactive

Introduction The transition period for new resident doctors is often overwhelming, requiring rapid adaptation while maintaining safe and effective patient care. The British Medical Association (BMA) advocates new resident doctor for induction. To support this process and improve efficiency, we developed an “Older People’s Handbook”, designed to familiarise new resident doctors with common conditions in geriatric medicine, provide practical guidance on navigating the hospital’s computer systems, and offer clear instructions for completing essential documentation. Method Resident doctors

Co-amoxiclav is a commonly prescribed, semisynthetic, empirical antibiotic. It is metabolised in the liver and eliminated via the kidneys. According to the trust guidelines, patients with severely reduced eGFR should receive a reduced dose of intravenous (IV) co-amoxiclav. This audit was conducted to assess whether IV co-amoxiclav dosing in elderly patients with an eGFR less than 30 ml/min was appropriately reduced in accordance with these guidelines. The standard dose is 1.2 g every 8 hours, but in patients with an eGFR <30, a reduced dose of 1.2 g every 12 hours is recommended. This is to

Introduction: Thorough clinical evaluation is crucial in all specialties, but especially in geriatrics. Frailty, cognitive impairment, and reduced patient cooperation can obscure typical features, making diagnosis more challenging. Musculoskeletal, neurological, and cognitive assessments are particularly important for falls or confusion, where missed diagnoses such as delirium or fractures can worsen outcomes. This audit evaluated the quality of clinical examination during clerking and subsequent senior review on the Geriatric Assessment Unit (GAU), focusing on musculoskeletal, neurological

Background This project at St James’s University Hospital involves resident doctors, advanced care practitioners, and patients on Elderly Care Wards where advance care planning (ACP) is commonly needed. Introduction ACP helps patients express future care preferences but can be challenging to initiate and document. The ReSPECT form standardises the recording of patient wishes, and the Clinical Frailty Score (CFS) predicts mortality risk, particularly if ≥5. This project aims to improve ACP discussions and documentation for patients with CFS ≥5 and to boost doctors’ confidence in leading these

Introduction: Patients over 65 often have multiple comorbidities and complex polypharmacy regimens, many including falls-risk-increasing drugs (FRIDs). Falls are a leading cause of morbidity in this group and are frequently associated with polypharmacy. A quality improvement project on Marjory Warren ward, King’s College Hospital, reviewed FRID prevalence and aimed to de-prescribe them where appropriate. A retrospective review revealed that all patients were on at least one FRID. Using the STOPP-FALL criteria, we systematically identified and reviewed FRIDs during hospital stays to reduce

Introduction: Some institutions have established Perioperative Medicine for Older Persons undergoing Surgery (POPS) services, demonstrating clinical benefits for frail and multimorbid patients over 65 years-old. As part of a national upscale (POPS-SUp), University Hospitals of Leicester geriatricians piloted a vascular-liaison service for those with a clinical frailty score (CFS) of five or more and lower limb pathology. We aimed to improve CFS accuracy by the vascular team and enhance their confidence in identifying and managing geriatric syndromes. Methods: We conducted a mixed-methods

Background: Constipation is common in older inpatients due to immobility, illness, dietary changes and dehydration. Poor bowel health can result in pain, faecal impaction, urinary retention and even bowel obstruction. Daily stool chart documentation supports early detection and management, but compliance is often poor. Aim: To improve daily stool chart documentation in a geriatric ward by 10%. Methods: Weekly retrospective reviews of stool charts were undertaken. Compliance was calculated as stool chart entries ÷ total admission days. Interventions were introduced using PDSA methodology: Day 0

Background Postural hypotension, defined as a systolic blood pressure drop of ≥20 mmHg or diastolic drop of ≥10 mmHg within 3 minutes of standing, is common in older hospitalised patients and is a major risk factor for falls, injury and mortality. Management is often complicated by coexisting supine hypertension, for which national guidance is limited. An internal audit (n=28) highlighted low resident doctor confidence in managing these conditions. Our aim was to improve clinician knowledge and confidence through the introduction of a clear guideline and educational materials. Methods A Plan

Introduction: 1 in 2 women over the age of 50 will have an osteoporotic fracture in their lifetime. Romosozumab is approved for the treatment of post-menopausal osteoporosis with very high fracture risk and recent fragility fracture (1). At Leeds Teaching Hospital Trust (LTHT), patients are referred to the Fracture Liaison Service (FLS) via an electronic referral form. One key question on the form is whether the patient might be suitable for anabolic agents, such as Romosozumab. If marked as ‘yes’, the referral is fast-tracked for a quick clinic assessment. This study evaluates identification

Introduction The elderly are susceptible to the adverse effects of anticholinergic drugs. A high anticholinergic burden from their use has been linked to falls, delirium, functional decline and death. NICE guidelines urges review of these drugs in vulnerable elderly with diagnosed or suspected dementia and falls, and have highlighted the use of ACB scoring tools to facilitate our approach. Aim It was observed that ACB assessments were not routinely done in our geriatric wards. We aim to improve compliance with NICE recommendations on ACB assessment in high risk patients and encourage use of a

Introduction: Older adults with neck of femur (NOF) fractures often fast for prolonged periods, increasing dehydration, delirium risk and peri-operative morbidity. At Chesterfield Royal Hospital, ortho-geriatric department, we implemented Sip Til Send with 150-ml per hour of water Sip Til Send (S2S) pathway and evaluated feasibility, process and safety. Methods Control: subset was taken from 01/03/25-05/05/25. Following this prospective data was collected for all NOF patients put on the S2S pathway from 06/05/25-10/08/25; local contraindications were excluded. Outcomes: Age, American Society

Introduction Delirium affects up to 50% of hospitalised older adults (≥65 years) and is significantly associated with patient morbidity and healthcare burden. The 4AT is a rapid, practical, and cost-effective screening tool for delirium. This project evaluated the effectiveness of 4AT implementation on a care of the elderly ward and assessed strategies to increase its use. Methods All new admissions to a care of the elderly ward over a one-month period were reviewed. Data collected included: suspected delirium, known/suspected cognitive impairment, and completion of initial 4AT screening prior

Prolonged hospital stays for medically fit patients pending discharge destinations are a persistent problem for the national health service, depleting funds and bed availability. Crucially, patients risk hospital-acquired infection, institutionalisation and deconditioning. Discharge destinations for patients with altered need for government-funded social support are decided following submission of a universal referral form (URF), completed by the multidisciplinary team (MDT). Policy states URFs should be submitted 48 hours after a patient is deemed medically fit for discharge (MFFD). We

Introduction: Direct Oral Anticoagulants (DOACs) are increasingly prescribed for atrial fibrillation (AF), and venous thromboembolism (VTE). In geriatric populations, prescribing is complex due to comorbidities, polypharmacy, reduced renal function, and increased bleeding risk. Errors in prescribing or inadequate patient information can lead to adverse outcomes. To address this, a structured DOAC Initiation Form was introduced to standardise prescribing practices, reinforce guideline adherence, and improve patient education. Methods: A multidisciplinary team conducted two Plan-Do-Study-Act

Introduction Anticholinergic medications remain widely prescribed to older adults despite evidence linking cumulative anticholinergic burden (ACB) with delirium, accelerated cognitive decline, falls, longer admissions, and excess mortality. ACB score ≥3 signals heightened risk, yet systematic review is rarely embedded in ward routines. We designed a quality improvement (QI) project using sequential Plan–Do–Study–Act (PDSA) cycles, aiming to show that pragmatic ward-level interventions can deliver measurable clinical benefit by reducing ACB among geriatric inpatients. Method Conducted on a

Background Venous thromboembolism (VTE) is a leading cause of preventable hospital morbidity and mortality. Older adults admitted are at particularly high risk due to immobility, frailty, and comorbidities. NICE guideline NG89 recommends all hospital inpatients undergo a documented VTE risk assessment on admission and reassessment within 24 hours. An initial audit identified incomplete VTE assessments on prescription charts across two geriatric wards in our hospital. Aim To improve the completion rate of VTE risk assessments on two wards from baseline (80–86%) to 100%. Methods Prescription

Introduction: Osteoporosis is a leading cause of morbidity in the elderly, with fragility fractures risking mortality, loss of independence and lengthy hospital stays. Patients admitted to hospital are often frail, with numerous risk factors for osteoporosis. The NOGG (2021) and NICE (CG146) recommend fracture risk assessment using the FRAX score in all women ≥65 years, men ≥75 years, and any adult ≥50 with risk factors such as previous fragility fracture, glucocorticoid use, smoking and high alcohol, low BMI, parental hip fracture, or relevant comorbidities. Despite clear guidance, FRAX

Background: Zoledronic acid (Zol) is used in the prevention and treatment of osteoporotic fractures. Once IV Zol has been administered as an inpatient, discharge documentation and GP communication should be completed. However, this can be inconsistent and can compromise continuity of care. A checklist produced by the HCOP (Health Care of Older People) team aimed to standardise osteoporosis management. In addition to the metrics reviewed in the previous 4 audit cycles, this audit looked at vitamin D correction before Zol. Methods: Data was collected from 55 patients receiving their first dose