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Beyond Hip Fractures: An End-to-End Model for Fragility Fracture Management

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L Heyzer1; J S Venketasubramanian2; K C C Tang3; E D Victorio2; N YH Lim4; J M L Koh5; K Y Y Chng6; S B Tan7; R Peruvemba8; B Y Tan9
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Background Singapore has a high hip fracture incidence with substantial morbidity and cost burden. At Woodlands Hospital, a new hospital, it was recognised that high-value fragility fracture care must go beyond hip fractures, beyond the inpatient episode, and beyond osteoporosis. Programme Description Building on established orthogeriatric co-management, the Programme for Osteoporosis Management, Insufficiency fractures and Sarcopenia in the Elderly (PROMISE) was implemented at hospital opening. It manages hip and non-hip fragility fractures across acute, rehabilitative, and outpatient

Cardiometabolic disease trajectories and falls risk in older adults: a cohort study using electronic health records

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R Hopkins1; Q Gu2; O Murrin1; B Voller1; J Delgado1; L Pilling1; J Masoli1; on behalf of the GEMINI collaboration
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Introduction Cardiometabolic diseases accumulate with age. Falls are a leading cause of injury, hospitalisation and loss of independence in older adults, and individual cardiometabolic conditions are known to increase falls risk. However, it is unclear how the sequence in which cardiometabolic conditions develop influences subsequent falls risk. We aimed to identify common cardiometabolic disease trajectories and estimate their association with incident falls. Method We used UK primary care data (Clinical Practice Research Datalink), linked to hospital admissions data (HES) in a cohort study

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Comprehensive Geriatric Assessment and Shared Decision Making in Older Surgical Patients: Outcomes from a COTE Perioperative Medicine Outpatient Clinic

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S Rajabally; H McDonald; V Gaunt
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Introduction: Frailty, multimorbidity and older age are associated with poorer postoperative outcomes, increased complications and greater healthcare utilisation. National guidance recommends comprehensive perioperative assessment for these patients. This study evaluates the adherence of a Perioperative Care of Older People undergoing Surgery (POPS) clinic to national standards and explores its impact on perioperative decision-making and healthcare resource utilisation. Methods: A retrospective study was conducted of patients assessed in a POPS clinic over a 1 year period (2024-2025). Data
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Staff Perceptions and Impact of a Spinal POPS Service in a Major Trauma Centre - a Qualitative and Quantitative Evaluation.

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M Merrick1; A Parmar1; R Anthony1
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Background Older spinal surgery patients often exhibit multi-morbidity and frailty syndromes. Hence, they are high risk for adverse outcomes and prolonged hospital admissions. POPS models have demonstrated efficacy in other surgical specialties. Data from dedicated spinal surgery units on staff perceptions of POPS services remains sparse. Objective To evaluate multi-disciplinary staff perceptions regarding the utility, clinical benefit, and impact of a Spinal Surgery POPS weekly in-reach service. Methods A pilot POPS service was established at a Major Trauma Centre (Leeds General Infirmary, UK

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Improving Early Recognition of Delirium Through 4AT Screening: A Single-Cycle Clinical Audit

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Hsu Lwin1, Khaled Elboraee2
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Introduction Delirium is a common and serious condition in older adults and is associated with increased morbidity, mortality, prolonged hospital stay, and institutionalisation. National guidance recommends routine delirium screening using validated tools such as the 4AT; however, delirium remains under-recognised in acute hospital settings. This project aimed to assess compliance with 4AT screening in older adults presenting with confusion and to implement interventions to improve delirium recognition. Aim To evaluate compliance with 4AT delirium assessments and documentation of delirium risk
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Optimising Cardiovascular Care in Ageing Populations: Integrating Geriatric Principles into Contemporary Cardiology

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S AGARWAL1; IN OZOR2; S CHITHANURU3; EO ODUMOSU4; OE FADIORA5; G IKWANG6; G BHANAVATH7; M SIDDIQUI8; R SULTANA9; S MURUGESAN10; EO ADEBAMBI11; R ALI12
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Introduction Cardiovascular disease remains the leading cause of morbidity and mortality in older adults. Conventional disease-focused management often fails to address frailty, multimorbidity, cognitive impairment and polypharmacy, which significantly influence clinical outcomes in this population. This narrative review evaluated current evidence for comprehensive geriatric cardiology and explored multidisciplinary strategies to improve cardiovascular care, functional independence and quality of life in older adults. Method A narrative review was performed using PubMed and the Cochrane
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Perioperative Management of Parkinson’s Disease Patients: A Clinical Audit

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Jemma Makepeace 1, Tom Lessware 2, Bastien Genet 3, Tom Boyle 2, Gayle McDonnell 2, Ching Pang 2, Guy Lumley 2, Dhanupriya Sivapathasuntharam 2
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Introduction Perioperative management of Parkinson’s disease (PD) patients warrants specific additions to standard care to prevent degeneration of motor symptoms and complications caused by delayed dosing of dopaminergic medications. Barts Health have produced clinical guidelines for management of inpatients with PD; this audit assesses adherence to this guideline in the context of elective surgical admissions. Method A database search identified patients with PD who had attended pre-operative assessment clinic (POA). Patients were analysed separately in two groups; surgery date pre-guideline

Temporal trends and demographic patterns in hypertension-related mortality with intracerebral hemorrhage in the United States

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P VASHIST1; K YOUNUS2; S ROHIT3; KS SOWKARTHICK4; AHS KSHATRI5; SV GADDE6
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Introduction Hypertension is a leading contributor to cardiovascular mortality; however, its role as an underlying cause of death when intracerebral hemorrhage (ICH) is a contributing factor remains insufficiently characterized. Identifying demographic and geographic patterns may support more targeted prevention strategies. Methods We performed a retrospective observational study using the CDC Multiple Cause of Death database from 1999 to 2020. Adults aged ≥25 years were included if hypertension (ICD-10 codes I10–I15) was listed as the underlying cause of death and ICH (I61) as a contributing
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The implementation of a Cardiogeriatrics Liaison Service at a District General Hospital: a Quality Improvement Project

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A Sanghera1, E Spencer1, E Harris1
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Introduction The involvement of geriatricians in the care of frail, older patients under other specialities, particularly within perioperative settings, has shown to improve outcomes (1). There is growing support for using Comprehensive Geriatric Assessments (CGAs) within Cardiology, due to the prevalence of cardiovascular disease within this cohort and the challenges frailty presents to clinical decision-making (2,3). Methods Our aim was to increase the percentage of CGAs carried out for patients admitted under Cardiology aged ≥65 with a Clinical Frailty Score (CFS) of ≥5 by 50%, between

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Immune checkpoint inhibitor-induced myocarditis in older adults: a systematic review of associated factors

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F Dawood¹; D Roy¹; W Adamska¹; H Rashid¹
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Introduction: As immune checkpoint inhibitors (ICIs) become standard treatment across an increasing range of cancers, older adults make up a growing share of recipients — yet they may also carry the highest cardiovascular risk from treatment. ICI-induced myocarditis is an uncommon but frequently fatal cardiac complication, with reported mortality of 30–50%. Older age has been repeatedly flagged as a possible risk factor, but no systematic synthesis has examined this alongside other predisposing factors. This review aimed to identify demographic, disease-related, and treatment-related factors
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From Pilot to Practice: Implementing Routine Digital Frailty Screening for Elective Surgical Patients Across Swansea Bay

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K James, T Lee, G Davies, C Cromey
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Introduction Frailty is a major predictor of adverse postoperative outcomes, yet routine identification within elective surgical pathways remains inconsistent. National perioperative guidance recommends early frailty identification to facilitate optimisation and shared decision-making, but sustainable implementation at scale has proved challenging. Swansea Bay University Health Board developed and evaluated a digital patient self-assessment pathway using a modified patient-reported Clinical Frailty Scale (CFS). Following a successful pilot in elective general surgery, the pathway was adopted

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Improving delivery and safety of Fascia Iliaca Blocks in patients with Neck of Femur fractures in Tunbridge Wells Hospital

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Hugh Jones1, Zeeshan Kisat1
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Introduction Fascia Iliaca (FI) nerve blocks are recommended for patients presenting with neck of femur fractures to provide effective analgesia and reduce opioid requirements. We conducted a quality improvement project (QIP) in a busy district general hospital to increase the proportion of patients receiving FI blocks and improve compliance with post-procedural safety precautions, in line with Royal College of Anaesthetists (RCoA) guidance. Methods Data were collected retrospectively from the local orthopaedic trauma database and electronic patient records over two separate two-week periods
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Improving Referrals to an Older Adults' Inpatient Surgical Liaison service – A QI project and retrospective service review

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R Page 1; G Donnelly 2; A Khan 2.
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Introduction Frailty is associated with increased rates of postoperative complications, a quarter of adults undergoing emergency laparotomy are living with frailty. The "Care of the Elderly Surgical Liaison service" aims to provide a comprehensive geriatric assessment for surgical patients aged over 65 years old and living with frailty. The aim was to conduct a general review of the Surgical Liaison service at Royal Bolton Hospital and improve the referral process. Method The project was a retrospective study across a period of 3 years, from January 2023 to December 2025. A total of 730

Optimising Guideline-Based Laxative Prescribing in Older Adult Inpatients: A Quality Improvement Project

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M Babikir, S Sheokand, M Yousif, A Burgess
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Title: Optimising Guideline-Based Laxative Prescribing in Older Adult Inpatients: A Quality Improvement Project Introduction: Constipation is common in older adult inpatients and is associated with delirium, urinary retention, abdominal discomfort, prolonged hospital stay and increased polypharmacy. Despite national guidance, laxatives are frequently prescribed without adequate assessment of reversible causes or documentation of the indication. We aimed to improve guideline-based, individualised laxative prescribing on two geriatric wards, targeting 85% appropriate management within 8–12 weeks

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Frailty, Anticoagulation Use and Clinical Outcomes in Older Adults With Atrial Fibrillation: A Prospective Observational Study

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Tabish Jamal Bari12; Saarim Bari3; Simon Payne1; Shahid A Khan2
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INTRODUCTION Frailty is common among older adults with atrial fibrillation (AF) and may influence anticoagulation prescribing despite not being incorporated into conventional stroke and bleeding risk assessment tools. Concerns regarding falls, bleeding risk and multimorbidity may contribute to therapeutic uncertainty. This study evaluated the association between frailty, anticoagulation use and clinical outcomes in older adults admitted with AF. METHODS A prospective observational study was conducted across four elderly care wards in a UK district general hospital. Consecutive inpatients aged
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Improving Multidisciplinary Delirium Assessment and Documentation Using the 4AT on an Acute Geriatric Ward

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Assya Dimia1, Nadia Afsheen1, DimpleShamnani2, Sarah Dimia2, Wania Shami2
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Background: Delirium is a common complication of hospitalisation in older adults and is associated with increased mortality, prolonged hospital stay and functional decline. Although routine screening using the 4AT is recommended, delirium assessment and documentation remain inconsistent. Baseline auditing identified poor ward-based 4AT completion, with assessments predominantly undertaken by medical staff despite the multidisciplinary nature of geriatric care. Aim: To improve multidisciplinary recognition, assessment and documentation of delirium by increasing staff knowledge, confidence and
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Discrepancy in Clinical Frailty Score documentation in Vascular Surgical inpatients

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E Varghese1; F Ahmad1; R Shome1; S Gupta1
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Introduction An accurate Clinical Frailty Score (CFS) is a good predictor of surgical outcomes and should be documented correctly for all surgical patients. However, this is not always followed in practice. This project aims to identify discrepancies in CFS documentation between Emergency Department (ED) triage and the POPS (Perioperative care for Older People undergoing Surgery) team and explore adherence to POPS recommendations. Method This was conducted by the POPS team in a district general hospital in England. The CFS done preoperatively on vascular inpatients separately by ED triage

Improving insulin medicines reconciliation and glycaemic safety in frail hospitalised older adults: quality improvement project

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Mohammed Azam Ali1; Michaela Watt1; Adeola Adebayo1; Eileen Capek1; Elizabeth Oommen1; Mairi Blair1; Rahat Maitland1
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Improving insulin medicines reconciliation and glycaemic safety in frail hospitalised older adults: a quality improvement project Background Insulin is a high-risk medication, and prescribing errors are a recognised cause of inpatient harm. Accurate medicines reconciliation of pre-admission insulin regimens is essential for safe glycaemic management and continuity of care, particularly in frail older adults with multimorbidity, cognitive impairment and acute illness. This quality improvement project evaluated insulin medicines reconciliation and glycaemic safety practices on geriatric wards

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Streamlining Newcastle Upon-Tyne's Acute Frailty Team

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S Bennett; K Treherne; C Barnes; A Kilsby; C Patchett
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Key words: acute frailty, triple assessment, comprehensive geriatric assessment, integrated discharge team (IDT) Introduction: The expansion of acute frailty services is essential to meet the needs of our ageing population. According to the UK Office for National Statistics 2021 census, over one-sixth of the population (18.6%, or 11.1 million people) were aged 65 and over, with this proportion expected to rise to 25% within the next 20 years. Acute Frailty Team (AFT) was introduced in Newcastle in December 2024, aiming to create a streamlined pathway to avoid unnecessary admission and

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Embedding the Clinical Frailty Scale into Acute Elderly Care: Improving Documentation to Support Safer Decision-Making

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K Earnshaw; S Lynch; K Guthrie
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Introduction Frailty is a recognised clinical syndrome associated with increased vulnerability to adverse outcomes, including higher morbidity, prolonged hospital stays, and increased mortality. 1,2 Assessment of frailty, utilising Clinical Frailty Scale (CFS), rather than using chronological age and social history, supports individualised clinical decision-making by guiding treatment goals. 3,4 CFS provides a standardised, reproducible, and evidence-based measure of physiological reserve. 4 Despite its importance, frailty assessment is not consistently documented during hospital admissions
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