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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.

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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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How might a 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decision affect other aspects of patient care?

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YuenKang Tham1; Dafydd Brooks1; Ashwin Venkatesh1; Antony Johansen1.
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Introduction Clinicians are regularly encouraged to make discussion and documentation of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) status a routine part of their assessment and care of older patients. However, patients, their families and clinicians often question whether a DNACPR decision may affect the attention paid to other aspects of patient care, or their access to interventions unrelated to CPR. We set out to directly test and address this question using a randomised controlled study of a clinical vignette. Methods We presented a clinical scenario of a deteriorating patient

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Imminent fracture risk before and after commencing Anabolic treatment for osteoporosis

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Rashpinder Kaur1, Amara Williams1, Avtar Singh1, Chris Edwards1, Gavin Rose2, Inder Singh3
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Introduction: The very high-risk patients remain at a comparatively higher risk of sustaining a subsequent fracture following an initial fragility fracture, with the risk being greatest within the first 1-2 years. The current guidance advocates a “treat-to-target” strategy, recommending initiation of anabolic therapy followed by sequential antiresorptive treatment. The objective of this study was to quantify imminent fracture risk before and after commencing anabolic agents. Materials and Methods: We conducted a retrospective review of all patients who were commenced anabolic therapy between

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Impact of a Dedicated Fracture Liaison Service (FLS) Pharmacist: A Quality Improvement and Innovative Learning

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Inder Singh1, Gavin Rose2, Avtar Singh3; Sophie Maggs3, Rashpinder Kaur3; Amara Williams3, Deb Collier3; Thomas Howson4, Sarah Owen4, Richard Bowen5
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Introduction: Osteoporosis affects approximately 3.5 million individuals in the UK, resulting in over 500,000 fragility fractures annually. An initial fracture significantly increases the risk of subsequent fractures, particularly in very high-risk patients. Current clinical guidelines advocate a "treat-to-target" strategy using ‘anabolic first’ for individuals at very high risk of fracture. The aim of this study is to develop and evaluate an innovative approach to improve system efficiency, timeliness and prudent delivery of anabolic osteoporosis drugs. Methods: Specialist anabolic

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Sustainable impact of multi-dimensional quality improvement: Improving Dual-energy X-ray Absorptiometry (DXA) access.

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Terissa Williams1, Rashpinder Kaur2, Sophie Shah 2, Avtar Singh2, Non Pugh3 Inder Singh4
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Introduction: Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis; however, due to limited capacity it is not available to all patients with fragility fractures. A multidimensional quality improvement project, using the Plan–Do–Study–Act (PDSA) model, led to the implementation of several initiatives between 2022 and 2023. These included increasing scanning capacity, vetting repeat DXA requests, upskilling the bone health team, and strengthening partnerships with primary care. The objective of this study is to assess the sustainability of these initiatives in

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Assessing the impact of a specialist frailty ward on deprescribing rates in older adults

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M Aarons; S Benjamin; H Ramsbottom; L Whitter; J Murugesh; P McDonald
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Introduction Deprescribing is central to frailty care. We evaluated whether a Frailty Enhanced Specialist Service (FESS) was associated with higher deprescribing rates. Method Single-centre retrospective observational study using routinely collected data from inpatients admitted from care homes before the existence of FESS (January; n=78) and, post-implementation, to FESS or non-FESS wards in June (FESS n=54; non-FESS n=37) and December (FESS n=32; non-FESS n=49). We recorded total regular medicines and Anticholinergic Cognitive Burden (ACB) scores at admission and discharge, plus age, sex
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Enhancing assessment and continence care in a community hospital setting: A quality improvement project.

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Isuru Amarasinghe 1, Louise Easton 1, Angela Puffett 1
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Enhancing assessment and continence care in a community hospital setting: A quality improvement project. Introduction: It was noted that continence was frequently not addressed prior to transfer to a community hospital setting. The project aimed to recognise and offer opportunities for improved continence care. Method: Patients were screened for continence problems through comprehensive geriatric assessment on arrival at a community hospital from acute settings. The first cycle identified whether continence assessment was considered on arrival at our community site. Subsequent cycles improved

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Prevalence of Chronic Kidney Disease in patients with Fragility Fractures: Two-year retrospective study

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Vinod Pulakattu Kuzhiyil1, Aparna Vinod1, Avtar Singh1, Chris Edwards2, Rashpinder Kaur1, Inder Singh3
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Introduction: Chronic Kidney Disease (CKD) is associated with abnormal bone metabolism and increased fragility fracture risk. However, many older people often have both CKD and osteoporosis, go undiagnosed and untreated. The objective of this study is to measure prevalence of CKD among patients presenting with fragility fractures. Methods: 3839 fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and December 2023 were reviewed retrospectively. 1325 patients’ fragility fracture were excluded due to non-availability of estimated glomerular

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It’s not just a pelvic fracture – why we need to transform pelvic fragility fracture care!

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Inder Singh1, Avtar Singh2, Rashpinder Kaur2, Sophie Shah2, Chris Edwards3 Antony Johansen4
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Introduction: Pelvic fractures are a common fragility fracture but often under recognised. There is a wide range of incidence 6.9-78.6/100,000/year being reported in the UK. The objective of this study was to measure incidence of pelvic fracture and re-fracture rate for the population of Gwent (592,000). Methods: A retrospective service evaluation of all fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and December 2025 was completed. Pelvic fracture cases were extracted from the FLS-DB for analysis. Data were analysed to describe patient

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Impact of chronic kidney disease on mortality in fragility fractures patients

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Avtar Singh1, Rashpinder Kaur1, Aparna Vinod1, Vinod Pulakattu Kuzhiyil1, Chris Edwards2, Inder Singh3
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Introduction: Chronic Kidney Disease (CKD) affects 5-10% of the world population and is associated with increased fragility fracture risk and mortality. The objective of this study is to measure impact of CKD stage on one-year mortality in fragility fracture patients. Methods: 5320 fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and June 2024 were reviewed retrospectively. 1718 patients’ fragility fracture were excluded due to non-availability of estimated glomerular filtration rate (eGFR). CKD stages were classified based on eGFR (mL

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