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Impact of delirium and dementia on 30-day readmission to hospital by place of residence in older adults: ORCHARD-EPR cohort

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Emily L Boucher1,2, Sasha Shepperd3, Sarah T Pendlebury2,4
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Background: Cognitive frailty, defined as dementia, delirium or low cognitive test score, is prevalent in older in-patients. Current guidance (eg National Audit Dementia 2022) suggests hospital readmission as a performance metric in dementia care but reliable data are lacking. We therefore determined readmission risk by cognitive frailty status in care home residents vs those living at home. Methods: ORCHARD-EPR (2017-2019) includes de-identified EPR data for patients ≥70 years with length of stay (LoS)≥1 day (2017–2019) admitted to four Oxfordshire, UK hospitals. Cognitive frailty was
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Prevalence and outcomes of physical frailty by cognitive status in older people with emergency hospitalisation in ORCHARD-EPR

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Emily L Boucher1,2, Sasha Shepperd3, Sarah T Pendlebury2,4
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Background: Over one-third of older people with unplanned admissions to hospital have physical frailty, but there are few data on prevalence and outcomes by cognitive status necessary to individualise care. Methods: ORCHARD-EPR includes consecutive patients ≥70 years with length of stay (LoS) of ≥1 day (2017–2019) admitted to four Oxfordshire, UK hospitals. Physical frailty was determined using a modified Hospital Frailty Risk Score excluding dementia and delirium (mHFRS). Cognitive frailty was defined using a mandatory on-admission cognitive screen as one or more of 10-point Abbreviated
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Distinct Clinical Phenotypes of Long COVID: Autonomic vs Inflammatory Presentations in Younger and Older Adults.

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E OGBEBOR1,2; S H X CHEONG3; S J LINNANE1
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Introduction While Post-Acute Sequelae of SARS-CoV-2 (PASC) is a recognised global priority, clinical definitions derive largely from working-age cohorts. Older adults face high acute severity risk, yet long-term survivorship remains under-characterised. We aimed to characterise and compare clinical PASC phenotypes in older (≥65 years) versus younger (<65 years) adults, distinguishing autonomic, inflammatory and psychosocial manifestations. Method We conducted a retrospective single-centre cohort study of 336 patients attending a dedicated Long COVID clinic at The Beacon Hospital, Ireland

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An overview of the Dementia UK Consultant Admiral Nurse service supporting families affected by frailty and dementia

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Melissa Grundy Marie Mumby
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Abstract Content : An overview of the Dementia UK Consultant Admiral Nurse service supporting families affected by frailty and dementia Introduction: Emerging and increasing frailty often goes unidentified, and families living with dementia and frailty are missing vital opportunities to receive the right support at the right time. People living with frailty are less able to adapt to stress factors such as acute illness, injury, or changes in their environment, personal or social circumstances, leading to adverse health outcomes and an earlier loss of independence. Method: We have developed a

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Physical activity is reduced in UK Biobank participants that develop postural hypotension

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Jay Rothery1, Maedeh Mansoubi1, Helen Dawes1, Sinead McDonagh1, Jane Masoli1 2
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Introduction Up to 30% of adults over 65 experience postural hypotension (PH) – a significant drop in blood pressure (BP) upon standing. PH is associated with increased risk of falls, frailty, and mortality. Using derived accelerometer data and linked healthcare records, we assessed the relationship between PH and physical activity (PA) in UK Biobank participants. Methods We used UK Biobank derived accelerometery data detailing the average time participants spent sleeping (SlA), sedentary (SeA), doing light activity (LA), or moderate & vigorous activity (MVPA). We ascertained participants with

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The Discrepancy Between Perceived Fall Efficacy and Actual Physical Performance Using TUG and Chair Rise Tests

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Indri Hapsari Susilowati1*, Susiana Nugraha2, Rosy Armelia3, Robiana Modjo1
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Background: Falls are a leading cause of morbidity among older adults and are influenced by both physiological declines in mobility and psychological factors such as fall-related self efficacy. Previous studies suggest that subjective confidence in avoiding falls does not always align with objective functional performance. However, few studies have concurrently examined perceived fall efficacy alongside standardized physical performance measures such as the Timed Up and Go (TUG) and chair rise tests. This study aimed to examine the relationship between fall efficacy and objective functional
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Improving the Diagnosis and Treatment of Mood Disorders in a Delirium Clinic

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Shona Mitchelmore; Graham Lamph; Claire Cullen
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Introduction Evidence suggests a significant relationship between delirium and mood disorders. Pre-existing depression is a risk factor for delirium, and depressive symptoms frequently emerge as a sequela of an acute episode. Despite considerable symptom overlap, these conditions are distinct and require targeted management. This audit evaluated whether the introduction of formal mood assessment tools improves the detection and early treatment of mood disorders in a delirium follow-up setting. Methods A two-cycle clinical audit was conducted at a specialist delirium follow-up clinic. In Cycle

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Systematic review and meta-analysis on the prevalence and determinants of decision regret in older people with chronic diseases

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Liying Men1, Zhiyi Chen1, Yang Bai1, Chen Yang1
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Introduction Treatment decision regret (DR) in chronic disease is linked to suboptimal adherence and poor health outcomes. However, evidence for older people remains fragmented across diseases and lacks consistent synthesis of determinants. This study aimed to estimate the pooled prevalence of DR and identify factors associated with regret in this population. Method Seven English and four Chinese databases were searched from inception to August 2025. Two researchers independently screened studies reporting the prevalence or determinants of DR among older people with chronic diseases. Study
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Trends in secondary prevention of hip fracture: National Hip Fracture Database (NHFD) data for England, Wales and Northern Ireland

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Antony Johansen, Will Eardley, Liz Fagan
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Trends in secondary prevention of hip fracture: National Hip Fracture Database (NHFD) data for England, Wales and Northern Ireland Antony Johansen, Will Eardley and Liz Fagan Introduction Patients with a hip fracture are at ‘imminent risk’ of further fragility fractures. In 2021 the NHFD introduced a new ‘key performance indicator’ (KPI7: the proportion of people known to be on bone protection 120-days after hip fracture) specifically to address this. In 2023 the ‘Call to Action’ paper published in Age and Ageing challenged clinicians to respond by giving a first dose of intravenous

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Management of patients who have “Eating and Drinking with Acknowledged Risk” decision made during hospital stay - QI

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Đula Alićehajić-Bečić (Consultant Pharmacist Frailty), Feruza Soxibova (Junior Clinical Fellow), Rachel Doran (Lead Speech and Language Therapist), Sophie Price (CMT1 Surgery)
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Introduction: Eating and Drinking with Acknowledged Risks is an individualised clinical decision balancing risks (may refer to aspiration, malnutrition, dehydration and choking) and benefits (quality of life, pleasure of eating). It may be applied in patients who have irreversible swallowing difficulty, with swallow reflex present where alternative means of providing nutrition are not appropriate. Method: Previous work completed in 2023 looked at cohort of patients where “Eating and Drinking with acknowledged risk” decision was made on Ageing and Complex Medicine ward over 12month period (n=22

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Reducing the environmental impact of medications in frail patients on Ageing and Complex Medicine ward at WWL

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Đula Alićehajić-Bečić (Consultant Pharmacist Frailty), Samuel Farrier (Pharmacist), Donna Hewitt (Ward Manager), Martin Farrier (Director of Digital Medicine, Trust Lead Sustainability)
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Introduction: NHS England has set out an ambitious target of delivering the world’s first net zero health service and responding to climate change, improving health now and for future generations. Medicines account for around 25% of emissions from the NHS, from inhalers. anaesthetic and medical gases (5%) and emissions that are embedded in the supply chain of pharmaceuticals (20%). Reducing waste and ensuring appropriate polypharmacy are cornerstones of the NHS strategy to address this, as summarised in the Overprescribing Report. Method: The 3 aims of the project were: Improve deprescribing

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Mitigating Fall Risk: Survey Findings and Suggestions from an ISAT-Driven Integrated Care Strategic Approach

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SURESH KUMAR SWAMINATHAN
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Abstract title : Mitigating Fall Risk: Survey Findings and Suggestions from an ISAT-Driven Integrated Care Strategic Approach. Background and Objectives Falls remain a leading cause of injury in older adults within community units. This project aimed to assess the readiness and scalability of fall prevention strategies—including floor beds, safety mats, and music-enhanced therapy—across Dublin and Midland Region HSE units using the Intervention Scalability Assessment Tool (ISAT). The goal was to identify effective, acceptable, and sustainable interventions that can be adapted system-wide
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Acceptability of High Intensity Functional Training in people with Parkinson's: a randomised feasibility trial protocol

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D Pendry-Brazier1; L Walker1; A Nodehi1; Y Ben-Shlomo2; MD Smith1,3
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Background & Rationale Parkinson’s disease prevalence is rising globally, driven by an ageing population. High intensity exercise may slow symptom progression and improve physical function, bone health, and quality of life. One way of delivering this is through High intensity functional training (HIFT) via community providers such as CrossFit and PD Warrior relieving pressure on NHS resources. Objectives To assess the acceptability, safety and feasibility of delivering HIFT to people with Parkinson’s through external providers, providing foundational information for future definitive trial

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Managing Risk Factors in Patients with Mixed and Vascular Dementia

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Maria Tuohy1, Cherry Shute2, Biju Mohamed2,
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Introduction: Vascular dementia is the second most common subtype of dementia, yet perhaps the most preventable as the underlying pathology is cerebrovascular damage. Therefore, managing vascular risk factors is vital to reduce disease progression. The aim of this study was to assess the management of various risk factors contributing to vascular and mixed dementia patients of the Cardiff and Vale memory clinic. Methods: A retrospective cross-sectional study was conducted, collecting data from 100 patients diagnosed with mixed or vascular dementia between 2022-2024 using WCP and PARIS. Factors

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Battle Audit: Rib Fracture Management in Older Adults living with Frailty in a Secondary Care Setting

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Gabriel Ide1, Peter Brittain1
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Introduction The Battle score is a validated risk stratification model for traumatic rib fracture presentations to secondary care. When combined with the Clinical Frailty Score (CFS), it aids identification of older patients living with frailty with increased risk of rib fracture complications. Multimodal analgesia is central to rib fracture management. NICE guidance states Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) should not be prescribed for these patients. The audit aimed to determine whether Rib Fracture Risk Stratification Scores (RFRSS) were used, if appropriate analgesia was
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The Geriatric Rehabilitation And Care Enhancement Pilot (GRACE)

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L Stanton Hughes1, H Pun1, S Swain1, H Payne1 , H Foxley1, C Colby1, P Draper1
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Introduction The GRACE initiative was a pilot designed to enhance inpatient experience of older adults. Proportionate moving and handling techniques were introduced as well as increasing the number of therapy staff on a ward reducing reliance on multiple staff for routine ward care. We aimed to improve patients’ functional independence and prevent deconditioning. Methods A ward of 26 patients was chosen with a control comparison and nursing staff were upskilled in proportionate manual handling. For 4 weeks, therapy staffing was increased from 2 therapists to 4 and patients given additional

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Modelling the resource implications of starting IV Zoledronate after a femoral fracture.

Authors' names
C Grose; A Johansen; D Brooks; W Havelock.
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Introduction In 2023 the ‘Call to action’ paper recommended giving a first dose of intravenous zoledronate (IV Zol) during hip fracture patients' inpatient stay. However the HORIZON study demonstrated the benefit of annual infusions. To help plan service provision we set out to define the constraints on patients reattending for repeated outpatient IV Zol. Method We reviewed local National Hip Fracture Database (NHFD) data for all patients presenting with a femur fracture in 2024. At 120-days a follow-up questionnaire is sent to all patients and we used this to identify those most physically

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Hospital At Home self-referral pathway: admission avoidance for older adults

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Catrin Kunemund-Hughes1, Melissa Watters2, Rebekah Schiff3
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Introduction Hospital At Home (HaH) provides hospital-level care for acute medical issues that would traditionally require admission to an acute hospital bed. HaH with Comprehensive Geriatric Assessment has shown similar outcomes for older people living at home compared to those admitted to an acute hospital (Shepperd et al, 2021). Referral to an alternative from hospital can be slow and tortuous. To reduce this delay and chance of hospital admission, a pilot scheme of patient self-referral into HaH was launched in May 2024 and evaluated. Method Anonymised patient data was retrospectively

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CENTRING PERSONAL IDENTITY IN GERIATRIC CARE: IMPLEMENTING THE “ABOUT ME” FORM TO SUPPORT OLDER ADULTS LIVING WITH DEMENTIA

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N Asim; C Connor; I Najeem; K Nauman; E Goudie; Z Khatoon
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Introduction: Dementia affects approximately 40% of hospitalised older adults (1-2) often leading to distress, communication challenges, and a decline in functional independence during admission (3). Although multidisciplinary team (MDT) geriatric care improves clinical outcomes,(4) the psychosocial and biographical needs of patients are overshadowed by immediate medical priorities. To address this, our QIP implemented the “About Me” form, a document capturing individual preferences and daily routines, with the aim of increasing staff confidence and supporting more personalised, meaningful
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Using Universal Design for Learning (UDL) as a framework to understand Medical Students’ needs and preferences for teaching in Geriatric Medicine

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Raihaan Biju1 , Azhar Khan1 , Elizabeth Morgan2 , Emma Lewis2 , Rishal Rahman1 , Susan White1, Professor Antony Johansen1
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Background: Universal Design for Learning (UDL) is an educational framework promoting multiple means of engagement, representation, and expression to align with diverse learning needs. We applied UDL principles to evaluate teaching methods within the Geriatric Medicine placement at Cardiff University’s School of Medicine, aiming to identify student preferences, explore factors influencing engagement, and inform development of a more inclusive teaching portfolio. Methods: Fourth-year medical students on their Geriatric Medicine placement completed a structured survey about teaching modalities

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