Posters for 2025 G4J (Geriatrics 4 Juniors)

Introduction: Deconditioning, the progressive loss of physical and functional capacity during hospital admission, is a well-recognized but often under-addressed risk factor for poor patient outcomes. It can lead to increased dependency, delayed discharge, and higher rates of hospital-associated complications. Despite its importance, barriers such as invasive lines, limited staff awareness, and entrenched ward routines often prevent patients from engaging in early mobilization. Objective: Our quality improvement project sought to evaluate whether small and simple, multidisciplinary

Introduction Fragility fractures are a frequent presentation to the acute medical take. Defined as a fracture following a fall from standing height or less[1], they represent up to 10% of acute admissions. Despite this, we identified no standardised protocol for commencing bone protection in our unit. Our project aimed to improve the management of bone health in this cohort. Methods Data was collected across an 18-week audit cycle, with 6 weeks of baseline data collected prior to any interventions. Patients with radiologically proven fractures sustained from standing height or less were

Introduction: Osteoporosis affects approximately 3.5 million individuals in the UK, with prevalence increasing with age—particularly among women over 75. Hip fractures carry a one-year mortality rate of nearly 33%, underscoring the importance of primary prevention over reactive treatment. However, many elderly patients do not proactively engage with their GP regarding bone health. Objective: This audit aimed to Identify elderly inpatients at elevated risk of osteoporotic fragility fractures using the FRAX tool Communicate these findings to their GPs to support early intervention. Methodology

Introduction Delirium is common in older inpatients and associated with cognitive decline, underlying dementia, and mortality. NICE recommends that current or resolved delirium diagnosis is communicated to general practitioners (GPs) upon discharge. A 2021–22 quality improvement project at Lister Hospital improved the delirium assessments consistently to over 95% across the Trust. However, this study found that only 25% of delirium cases were documented in discharge letters. This gap poses significant risks to patient safety, as unresolved delirium may be overlooked, and underlying dementia

Introduction In our hospital, 40% of Foundation Year 1 (FY1) doctors reported a lack of confidence in geriatric medicine. To address this gap for new doctors starting in geriatrics, an FY1 Doctors Handbook for Geriatrics was developed. This need was identified during a baseline survey to understand the starting point of the quality improvement work, with the aim of increasing FY1 confidence and preparedness in geriatric medicine. Methods The handbook was created collaboratively with members of the multidisciplinary team (MDT), including outgoing FY1 doctors, registrars, consultants

Introduction: Falls are a leading cause of morbidity in older adults. NICE guidelines recommend that all older patients admitted with a fall undergo a vision assessment as part of the multifactorial falls risk evaluation. Despite this, compliance in clinical practice is often suboptimal. We undertook a quality improvement (QI) project to assess and improve adherence to this guideline at Wythenshawe Hospital. Method: A retrospective audit of case notes and electronic records was conducted over a 3-month period to evaluate the proportion of patients admitted with falls who had a documented

Introduction Elderly inpatients are particularly vulnerable to complications from prolonged antibiotic therapy, such as adverse drug reactions, Clostridium difficile infections, and antimicrobial resistance. On the Care of the Elderly (COTE) wards at Lister Hospital, prolonged antibiotic use beyond guideline recommendations was frequently observed. This quality improvement (QI) project aimed to reduce inappropriate antibiotic durations in patients aged ≥65 using the Plan-Do-Study-Act (PDSA) methodology. Methods: Conducted on Level 9 of Lister Hospital, data were collected from four wards on

Introduction Urinary catheterisation is frequently required in older patients on the Stroke Unit. However, inappropriate use significantly increases the risk of catheter-associated urinary tract infections (CAUTIs), which are particularly harmful in frail, geriatric populations. The appropriate use of catheters is necessary and strict documentation of the indication should be noted upon insertion. Research suggests more than a third of catheters are unnecessary (Saint et al., 2000). Recognising the need for timely review and if appropriate, removal of indwelling catheters is imperative in

Introduction Falls are a significant cause of patient harm in hospitals. Effective fall management requires timely assessment, early identification of risk factors, intervention, and thorough documentation. A quality improvement project (QIP) assessed compliance with key fall management measures through audit cycles. The second audit cycle evaluated progress following interventions implemented after the first audit. Methods A retrospective audit was conducted to assess adherence to post-fall assessment protocols. Key areas examined included timeliness of assessment, documentation of vital

Introduction Inpatient falls in older adults frequently lead to fragility fractures, with femoral fractures occurring in up to 82% of cases (RCP, NAIF 2023). These injuries significantly impact long-term morbidity and cost the NHS £4.4 billion annually (ROS, 2022). Despite tools like FRAX and national guidance (NOGG, 2021; NICE, 2022), bone health assessments remain inconsistently performed after a fall. Objectives To evaluate whether inpatients who fell received appropriate fracture risk assessment and bone protection in line with NICE and NOGG recommendations. Methods We conducted a

Introduction The risk of Chronic Kidney Disease (CKD) increases as we age, with 1 in 2 people over the age of 75 having CKD. Previous research in London found 48% of those with CKD stage 3-5 were undiagnosed. The commonest cause of death in patients with CKD is cardiovascular events. This means that timely detection of CKD is important to allow risk-stratification and monitoring of other cardiovascular risk factors, which could help improve mortality of those with CKD. This audit consists of two cycles to see whether those 75 years or older who fit the NICE CKS criteria for CKD are diagnosed

INTRODUCTION The Surgical Emergency Unit (SEU) at John Radcliffe Hospital, Oxford assesses a wide range of patients daily, including a significant proportion aged ≥65 years. However, current clerking proformas lack a dedicated section for frailty scales, often resulting in omission. Accurate and consistent documentation of frailty using the Rockwood Clinical Frailty Scale (CFS) supports perioperative optimisation and surgical decision-making, designed to avoid age-related bias and discrimination. As per trust policy, all patients aged ≥65 with unplanned admissions should have a CFS recorded

Background A multi-disciplinary team (MDT) approach underpins patient care in a Geriatrics department. Occupational therapy, physiotherapy and discharge teams play a vital role in optimising the patients' functional independence and facilitating safe discharges. Discussions within the MDT often involve use of specialised terms and shorthand to clearly communicate patient progress. As a result, for doctors rotating through the specialty with minimal previous exposure, the MDT discussions can be difficult to follow. Aim To improve the clarity and accessibility of MDT discussions for rotating

Introduction Delirium is a medical emergency characterized by a recent (within hours or days) changing or fluctuating course of confusion. It manifests through altered arousal, inattention, and disordered thinking. Delirium had significant short- and long-term adverse clinical outcomes including extended length of stay, increased inpatient complications, elevated all-cause mortality, and reduced survival rates.(1) In January 2023, the National Institute for Health and Care Excellence (NICE) revised its delirium guidelines, endorsing the 4AT as the preferred assessment tool for detecting

Introduction Polypharmacy, defined as the use of five or more medications, is common in older adults due to multiple chronic conditions. While often necessary, it is associated with adverse drug reactions, prescribing errors, and preventable hospitalisations. Medication review at admission is essential, particularly in frail patients, to identify inappropriate prescriptions and opportunities for deprescribing. Methods A retrospective audit was conducted on 30 patients aged ≥65 years, admitted to a geriatrics ward for less than one month. Data were collected from electronic health and GP

Improving bone health assessment in a geriatrics centre: Natalie Maria Jones IMT3 Introduction: The National Osteoporosis Guideline Group (NOGG) quotes that one in five men and one in two women will experience a fragility fracture in their lifetime. The cost of fragility fractures to the NHS in 2019, exceeded £4 billion (1). An important and often overlooked aspect of falls assessment is that of osteoporosis detection and treatment. This project aimed to improve % of patients receiving a bone health assessment within a tertiary geriatric unit to 100% by September 2025. Method: The project took

Background Dementia is a syndrome of chronic progressive degeneration of the brain. Dementia causes reduced ability to self-feed due to problems with: swallow, apraxia and visuospatial dysfunction. Malnutrition in dementia patients is associated with delirium, longer admissions and functional decline. Aim To improve food intake in patients with dementia by 25% through the introduction of high-contrast coloured crockery on a Care of the Elderly ward. Methods Food charts were used on Care of the Elderly wards to assess food intake. In Cycle 1, coloured plates were introduced on Ward A, with pre

Thinking about the future: a QI project to educate and improve the understanding of advance care planning in the AMU. A Fisher; C Bruce; M Leyton; M Rainbow; J Evans Acute Medical Unit; Torbay Hospital; Torbay and South Devon NHS Foundation Trust Introduction: Advance care planning (ACP) allows patients with serious illness or deteriorating health to discuss future care preferences, supporting a more holistic, patient-centred approach. However, public awareness of ACP remains low and is cited as a key barrier to its uptake in clinical practice. A 2014 audit by the Royal College of Physicians

Introduction: An accurate stool chart is crucial to the care of older patients. Monitoring of bowels movements can help to avoid complications such as constipation, urinary retention, delirium, faecal impaction, diarrhoea, dehydration and AKI which all can lead to extended hospital admissions and deconditioning. Clear recording of bowel movements might allow the medical team to recognise the problem and promptly take action. Our project aimed to increase the accuracy of stool chart documentation on geriatric medicine wards, promoting earlier recognition of these complications. Methods: Initial

Background The study was set in a 15-bed older adult psychiatry ward. Staff involved were doctors, ward manager, nurses and nursing associates. Introduction Overall pain assessment was poor due to the under-recognised importance of recording pain. The aim of this quality improvement project was to implement strategies to improve rates of pain assessment and assess for effective change. Methods An initial review of patient records was done prior to intervention, recording when a pain assessment template used by the trust (Abbey pain scale) was documented using the following criteria: 1. within