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Systematic review of the effectiveness of social prescribing for older adults living with frailty or multimorbidity

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N J Bracewell1,2, J K Taylor3,4, K G E Kala5, A Weatherburn1
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Introduction Social prescribing is a widely implemented tool used to support unmet non-medical needs in the community. This systematic review aimed to summarise the impact of social prescribing on a population of older adults living with frailty and/or multimorbidity. Methods This review was conducted in line with PRISMA guidelines for systematic review. Searches were completed across MEDLINE, EMBASE and PsychInfo. Social prescribing was defined as co-ordinated multi-component individualised community-based referrals via a link worker. Studies of adults age 65+ or predominantly older adults

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Deprescribing in Frailty (DiF) project; Phase 1 – Scoping the issue

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Kyaw Soe Tun1; Lelly Oboh2; Sarah Swabey1; Grace Walker1
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Introduction Deprescribing in older people living with frailty is an evidence-based, structured, patient-centred process aimed at reducing or stopping medications where potential harms outweigh benefits. Evidence suggests that deprescribing is safe and feasible, reduces number of potentially inappropriate medications (PIMs) in older people, without increasing adverse outcomes and leads to modest clinically meaningful benefits. Identifying PIMs is a critical step in deprescribing and Phase1 of this project aims to proactively identify and understand the size of inappropriate polypharmacy in

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Patient Perspectives on Medicines and Their Impact on Frailty and Falls: A Qualitative Study

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L Black1; J Crawford2; J Lock1; E Thompson2; J Stirton2; P Forsyth3; C Smyth2; G McCafferty2; A Harkins2; C McDonald2; L Halcrow4; L Dorrian5
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Introduction Frailty and falls are significant concerns for older adults, leading to reduced independence and increased healthcare needs. Medicines, particularly polypharmacy, can contribute to frailty and falls yet patient awareness of these risks remains unclear. Patient engagement is essential to inform strategies that improve knowledge and reduce the risk of medicines related harm. Methods Participants were identified by the local NHS patient engagement team and invited to participate in focus groups. Semi-structured interview templates were designed by the study team. Sessions were

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Evaluation of Computed Tomography Head scan reporting on Brain Frailty Markers in an Acute Medical Cohort

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A Yu1; J Gan2; S T Pendlebury2,3
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Introduction Computed tomography head (CTH) scans are commonly used in the acute medical setting to detect acute intracranial pathology. CTH scan information on cerebrovascular burden and atrophy, key markers of brain frailty, could also be used to identify patients at risk of cognitive decline. In an observational study, we assessed reporting brain frailty markers in routinely acquired scans. Method Anonymised reports of CTH scans performed during or <1-year of index admission were retrieved on consecutive acute medicine patients aged >65 years admitted over six 8-week periods (2010-2018)
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Integrating CGA principles and acute clinical assessment into pharmacist-led care home service: A Feasibility Study

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L Black1; Dr R Lowrie1; J Crawford2.
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Introduction Falls, hospital admissions, and reduced quality of life (QoL) are common among care home residents with dementia. Polypharmacy increases these risks, particularly in those with frailty. Current models of care often lack structured medication review and pharmacist-led reviews rarely include clinical assessment. We assessed the feasibility of a prescribing pharmacist with advanced clinical skills delivering holistic structured medication review alongside acute clinical care in a care home setting. Methods Single-group before-and-after feasibility study in a Glasgow care home

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Does the drive to a net-zero NHS affect General Practice access for our vulnerable patients? A systematised narrative review

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Sanah Hussain1, Georgia Paddington1
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Introduction The National Health Service (NHS) aims to achieve net-zero emissions by 2045. Telehealth is a potential low-carbon alternative within general practice which might help to achieve this. Despite environmental benefits, concerns remain regarding the impact on vulnerable groups who may face digital exclusion. This systematised narrative review examines how telehealth, as part of decarbonisation efforts, influences access to general practice among vulnerable populations. Methods A systematic search of Medline, Embase and Scopus was conducted using PRISMA guidelines. Eligibility

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Metabolic Bone Treatment Service Overhaul: A Quality Improvement Approach

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A Alcock1; C Gibson1; S Halliwell2; G Noblet1; M Sheridan1; M Wright1
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Introduction The Assessment and Rehabilitation Day Unit (ARDU) at Aintree Hospital is responsible for the safe and timely administration of treatments for osteoporosis. In the last 5 years patient numbers have increased significantly, leading to an overwhelmed service resulting in long overdue waiting lists and a burnt-out team. A Quality Improvement (QI) project was initiated to stabilise the service and reduce the overdue waiting list by 50% by October 2025. Method Using a clinical microsystem approach, the team developed a driver diagram and measurement strategy to identify priority areas

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Improving Oral Care Delivery and Staff Confidence on Geriatric Medicine Wards: A Quality Improvement Project

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Ff Evans1*; J Keast1,2*; T Hughes1; D Allen1; M Upcott1
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Introduction Poor oral health is associated with increased rates of hospital-acquired infections and prolonged hospital stays (1), with aspiration a major contributor of preventable morbidity and mortality (2). Recent evidence suggests that 60-80% of older inpatients have unmet oral care needs, whilst only 38% of nursing staff have had formal oral care training. An audit conducted by the SALT team at the University Hospital of Wales identified widespread poor oral hygiene and a need to upskill staff in this area. This QIP aimed to improve patient oral care, and staff confidence in oral care
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Can a Self‑Assessment Tool Identify Unmet Therapy and Pharmacy Needs in Older Adults With Frailty on an Ambulatory Unit?

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H Symcox1; R Li1; B Greensitt1; M Fry1; N Noble1; M A Williams1,2
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Introduction Unmet needs of those living with frailty significantly contribute to hospital admissions. The Ambulatory Assessment Unit (AAU) is a high-turnover, same-day emergency care unit with 40% of patients aged ≥65. Aligned with the 10 Year Health Plan shift from sickness to prevention, this Quality Improvement (QI) project aimed to better identify patients in AAU with unmet therapy and pharmacy needs using the Edmonton Frail Scale Acute Care (EFS-AC). Methods The project received Trust governance approval (ULYSSES No.9934). Existing practice of referring to physiotherapy/pharmacy
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Lying Standing Blood Pressure Measurement following Hip Fracture

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K Howick 1; A Kenda 1;M White 1
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Background: Frail patients are at risk of post-operative orthostatic hypotension. Measuring lying and standing blood pressure (LSBP) is a key part of comprehensive post-operative geriatric assessment. Method: Three cycles of data were collected from the National Hip Fracture Database on patients with neck of femur fractures at Leeds General Infirmary. Each cycle was discussed at local governance meetings, followed by implementation of novel interventions. First, information on LSBP was added to online induction resources. Then, a poster was distributed, and finally, an email template was

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Using the Self Assessment for Frailty in the Emergency Department Tool (SAFE-T) in urgent and emergency care

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Dr B Arun1; J Pasley2; S Williams2; Dr S Wells1; Dr S Lewis1
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Abstract The Self-Assessment of Frailty in the Emergency Department Tool (SAFE-T), in keeping with the clinical frailly scale (CFS), has been developed as a self-assessment questionnaire. The tool is designed for completion by patients and/or their carers on arrival to urgent care, enabling more efficient and consistent CFS assessment by clinical staff. This is version 3 of the tool, developed via PDSA cycles and co-produced with patients and the MDT. Method SAFE-T questionnaires were distributed among a convenience sample of patients over 65 years of age in the ED and acute medicine unit
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Leveraging the Electronic Health Record to Deliver High Fidelity Comprehensive Geriatric Assessment in the Emergency Setting

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Garry Mallett1, Faida Al-Maiyah1, Clover Donohue1, Imogen Jury1, Rohan Sharma1, James Maguire1, Grace Walker1
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Introduction Comprehensive Geriatric Assessment (CGA) in the emergency department can reduce length-of-stay and prevent functional decline in older adults. However, CGA is a complex intervention requiring multi-disciplinary input and appropriate resource investment, making it challenging to deliver for ‘front-door’ frailty services. We hypothesised that improved utilisation of existing functionality within the electronic health record (EHR) could enhance delivery of high fidelity CGA in the emergency setting. Methods Quality improvement methodology was employed to evaluate a standardised

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Comparing paramedic and geriatrician Clinical Frailty Scale scores: a baseline evaluation to improve frailty pathway allocation

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Amy Noble1 Alexandra Burgess1
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Introduction Accurate prehospital frailty scoring allows direct admission to older persons' assessment units (OPAU), enabling early comprehensive geriatric assessment (CGA) and reducing unnecessary hospital admissions. The Welsh Ambulance Service Trust (WAST) uses the Clinical Frailty Scale (CFS) to guide pathway decisions, and patients scoring ≥5 may be eligible for direct OPAU admission. We compared paramedic CFS scores with those derived from in-hospital CGA, and surveyed paramedics about their training needs. Method We undertook a single-point data collection across OPAU and acute

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Inadequate Footwear in Older Medical Inpatients: An Overlooked Target for Falls Prevention and Mobility Promotion

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V Matuschka1; S Casey2; R Hutton2; M Rashid2; C Mason2; D Fitzpatrick3
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Introduction Inpatient falls are among the most common and preventable adverse events in acute hospitals. Appropriate footwear is a simple, low-cost intervention that may reduce falls and deconditioning. This study evaluated footwear worn by older medical inpatients and explored associations between footwear adequacy, falls, mobility and cognition. Methods We conducted a cross-sectional review of a sample of patients aged ≥65 yrs on general medical wards, excluding those in critical care, clinically unstable or end of life. Demographics, reason for admission, mobility, cognitive impairment
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Transforming Weekend Flow: The Impact of a 7-Day Acute Frailty Service on Older Patients

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A Urquhart1; J Acharya1; A Manzoor2; A Lingeswaran2; A Aranda-Martinez2; K Yeong2; P Enwere2; C Chikusu2; R Williams2; R Lisk1
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Introduction The UK population is ageing, resulting in increasing numbers of older patients being admitted to hospital. At St Peter’s Hospital, Summary Acute Medicine Indicator Table (SAMIT) data show that frail patients aged over 75 have an average length of stay of 10.5 days. This group is particularly vulnerable to hospital-acquired harms, including infection, falls, and delirium, making early assessment and discharge a key priority. Method This quality improvement project utilised Plan–Do–Study–Act (PDSA) cycles to assess discharge rates for patients aged over 75 admitted via the acute
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Music based interventions to reduce agitation in nursing home residents diagnosed with dementia- a systematic review

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H Clay
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Background: Agitation is a distressing symptom of dementia. Some research suggests that engaging in music can reduce this symptom. This review synthesises recent evidence on this. Methods: A search was conducted of Pubmed articles in the last 10 years. A two-stage screening of the titles and abstracts was conducted. A narrative synthesis was performed due to heterogeneity of methods. Results: The search yielded 24 papers of which 15 were excluded. These studies were either randomised controlled trials or before-after studies. They all had an objective scale used to assess agitation as an
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I’m A Medically Fit Patient...Get Me Out Of Here!

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E Godden1; R Cooper 1
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Introduction The GMC requires medical graduates to “recognise and show respect for the roles and expertise of other health and social care professionals”. Despite this, we identified a gap in final-year medical students’ understanding of the roles of multidisciplinary team (MDT) members in older patients’ discharge (OPD). Method As Clinical Fellows at Mid Yorkshire Teaching NHS Trust, we provide near-peer teaching for undergraduate medical students at the University of Leeds. We surveyed final-year medical students’ knowledge of MDT members’ roles in facilitating safe OPD, specifically
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Evaluating the Impact of a Pharmacist Independent Prescriber Service to the Older Person’s Acute Medical Unit

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Ruth Jones 1, Laura Rozier 1
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Introduction The pharmacist’s role has been shown to be beneficial in the care of older people, and literature advocates for their inclusion within multidisciplinary teams due to particular features of this patient group (including prevalence of polypharmacy, and changing pharmacokinetics and pharmacodynamics of ageing.) This work aims to evaluate the impact of a service change - namely the provision of a pharmacist independent prescriber (PIP) service (with a scope of practice and specialist interest in geriatrics), to the Older Person’s Acute Medical Unit (OPAMU). Method Data collection

Audit to Improve Discharge Summaries as per RCP Checklist

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M Bin Sabir; K Aziz; B Barrell; AJ Burgess.
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Introduction: A discharge summary is the primary and most important way of communication between primary and secondary care. Patients when discharged should have a good discharge summary as it works as handover between hospital doctors and the community medical services. The Royal College of Physicians (RCP) has a checklist for discharge summaries which shows the amount of information that should be added in the discharge summary. Method: 40 patient Data was collected retrospectively for patients who were discharged from Older Persons Assessment Unit (OPAU)- Morriston Hospital in August 2025

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Testing a novel Clinical Assessment Tool to identify Hospital-Acquired Deconditioning

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Elinor MacFarlane1; Siobhan Lewis2; Rachel Taylor3; Kathleen Withers1
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Introduction: Previous work identified eleven domains related to Hospital-Acquired Deconditioning (HAD), and a clinical assessment tool (CAT) was subsequently developed to measure changes in patient condition during a hospital stay. As the CAT aimed to identify and monitor HAD in hospital in-patients, testing was required to ensure the tool was appropriate for use. This project was funded by NHS Wales Six Goals Programme/Value Transformation and led by CEDAR. Methods: Two rounds of pilot testing were undertaken, involving staff members in two health boards. Iterative development continued
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