Polypharmacy in the elderly: Are addressing the medication burden?
INTRODUCTION Polypharmacy represents a significant challenge in the vulnerable elderly population, where concurrent use of multiple medications increases the risk of interactions and adverse reactions, often precipitating acute events and complicated hospital stays. This necessitates thorough medication reviews to mitigate these risks; a hospital admission allows for such opportunities. METHODS This project aimed to evaluate and address the medication burden among elderly patients, following WHO's Global Patient Safety Challenge: Medication Without Harm. 50 patient’s medications were reviewed
Improving Bone Health Assessment and Treatment Delivery in the Acute Frailty Service at Whittington Hospital: A Quality Improvement Project
Background: The UK National Osteoporosis Guideline Group (NOGG) guidelines 2021 recommend that all older patients presenting to geriatric clinics or wards should have a FRAX assessment guide BMD measurement and referral for DEXA or starting of drug treatment. Aims: 1) To increase the proportion of patients assessed by the acute frailty service (AFS) undergoing FRAX assessment to 85%. 2) Offer 85% of AFS patients with low-risk FRAX scores lifestyle advice. 3) Refer 85% of AFS patients with intermediate (below treatment threshold) FRAX scores for DEXA scans. 4) Refer 85% of AFS patients with
Improving Advance Care Planning Within Residential Homes
Improving Advance Care Planning Within Residential Homes Introduction: As care home residents are living with advancing frailty and multi-morbidity, it is important to initiate advance care planning as part of the comprehensive geriatric assessment and create universal care plans (UCPs). There is evidence that it can reduce inappropriate escalations of care, reduce hospital admissions, increase the proportion of residents dying in their preferred place and improve both resident and relative satisfaction. Method: Retrospective audit in June 2024 of residents within the five residential homes
An audit of the perioperative DOAC prescribing practices in the elderly with hip fractures.
The elderly population ( cut off 65 and over, for this audit) are being increasingly prescribed direct oral anticoagulants(DOAC) for prevention of stroke in atrial fibrillation/ prevention and treatment of DVT/PE.This poses significant difficulties when stopping/ restarting these medications in the peri-operative period , due to the ever changing clinical circumstances in this period. Therefore , we performed an audit( in Glangwili Hospital, Jan-July 2024) , using the Welsh Frailty Fracture Network guidelines as our standard and found out(during the first cycle) that around 40 percent of
Identify, Intervene and Have Confidence! A Quality Improvement Project Implementing a New Inpatient Delirium Bedside Bundle.
Introduction: Delirium is common in hospital inpatients, under-recognised, and associated with increased morbidity and mortality. NICE quality standards are that all at-risk adults newly admitted to hospital receive tailored interventions to prevent delirium. Aims: 1. To reduce time to diagnosis of delirium. 2. For 100% of patients with delirium to have tailored interventions, including behaviour/ bowel/ food charts, medication reviews, and family involvement. 3. To increase junior doctors’ confidence in recognising and managing delirium. Methods: Two changes were implemented and three cycles
Characterization of the local prevalence of hypertriglyceridemia in a city of northeastern Colombia during 2020-2022.
Introduction: There is limited data on the prevalence of hypertriglyceridemia (HTG), a recognized risk factor for cardiovascular disease, in the northeastern region of Colombia. Therefore, we aimed to characterize the local prevalence of HTG and cardiovascular disease-related variables in the subsidized regime population of a city in northeastern Colombia during the period 2020-2022. Materials and Methods: We conducted a retrospective review of medical records from all health centers in Bucaramanga, Santander, Colombia. The study included patients aged 60-95 years who were part of the
Frail2Fit study: a feasibility and acceptability study of a remote multimodal intervention delivered by volunteers to improve functional outcomes in older adults with frailty after discharge from hospital
Introduction Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. We aimed to evaluate the feasibility and acceptability of training volunteers to deliver a remote intervention, comprising exercise, behaviour change, and nutrition support, to older people with frailty after a hospital stay. Methods Volunteers were trained to deliver a 3-month, multimodal intervention to frail (Clinical Frailty Status ≥5) adults ≥65 years after hospital discharge, using telephone, or online support. Feasibility was
Navigating morally challenging scenarios in advance care planning: A survey study
Introduction: There are abundant anecdotal reports of healthcare professionals undergoing strain, specifically moral distress, in advance care planning (ACP) related work. This study measured perceptions of morally challenging scenarios (MCS) faced by ACP facilitators and frontline clinicians. Method: An online survey, which is currently ongoing, was sent to the ACP community and also frontline clinicians in Singapore. Purposive and snowballing sampling approaches were employed. Result: Participants rated their opinions on 23 MCS in ACP-related work that were earlier identified from 30
Anticoagulation in Atrial Fibrillation
Introduction: A Clinical Audit was recommended by the ME following identification of potential safety signal because of possible non-compliance with guidelines on Anticoagulation in AF. The audit data collection tool was developed in discussion with the Chief Pharmacist and took account of up-to-date prescribing guidance from the Integrated Commissioning Board (ICB). Aim of the audit was to identify if, as per NICE guidelines patients had: o Risk for stroke (CHA2DS2-VASc) and bleeding (ORBIT) is assessed upon new diagnosis of AF? o Made aware of their risk assessments and involved in
EVALUATION OF PACEYCUFF AS A NOVEL TREATMENT FOR MALE STRESS URINARY INCONTINENCE: THE FIRST UK EXPERIENCE
Background: Prostate cancer and bladder outlet obstruction, often treated surgically, are increasing in the aging population, leading to more cases of stress urinary incontinence (SUI). While implantable continence devices are beneficial for many, a growing number of frail patients are unsuitable for surgery and rely on incontinence pads or penile clamps, which are limited to three-hour use to prevent tissue ischaemia. We present the first UK evaluation of the new PaceyCuff penile clamp, designed for 24-hour wear while maintaining blood flow, to assess its efficacy, safety, and impact on
CROSS-CULTURAL ADAPTATION AND PSYCHOMETRIC PROPERTIES OF THE YORUBA VERSION OF THE CLINICAL FRAILTY SCALE
Background: This cross-sectional study aimed to assess the socio-demographic, anthropometric, and patient characteristics of 94 Yoruba speakers aged 60 years and older, and to validate the Yoruba version of the Clinical Frailty Scale (CFS). Methods: This study used a cross-sectional design with a purposive sampling technique and a sample size of 94 participants. This study also made use of the World Health Organization methodologic guidelines on cultural adaptation of clinical scales. Convergent validity was assessed by evaluating the context that the Clinical frailty scale (CFS) relates to
Hospital at Home - An opportune training environment for Internal Medicine Trainees
Introduction: Hospital at home (HAH) is growing apace in the United Kingdom, offering hospital-delivered treatments at home. In parallel, increasingly structured alternative training pathways are being created to enable doctors to train outside of formal specialty training programmes. With a need to train doctors to work in community settings, a HAH rotation within a locally developed internal medicine training (IMT) programme at one large NHS Foundation Trust was evaluated. Method: A questionnaire was designed to review the alignment of HAH rotation experience with the IMT curriculum and its
Improving delirium assessments in acute senior health: A quality improvement project for care of the older person
Background: Delirium is a common and reversible neurobehavioral condition with significant morbidity and mortality ramifications for older patients. Consequentially, clear guidelines exist pertaining to its swift identification and management. However, studies suggest that adherence to these guidelines are poor. This audit aimed to evaluate compliance to the National Institute for Health and Care Excellence’s (NICE) delirium guidelines in an Acute Senior Health Unit (ASHU) and to present a single centre experience of a low-cost ward-based intervention for improving delirium guideline adherence
Exploring Stakeholders’ Experiences Implementing a Navigation Program for People Living with Dementia and their Carers
Introduction: Navigating dementia care is challenging, but patient navigation (PN) offers valuable support for this population. The "Navigating Dementia NB / Naviguer la démence NB" program piloted a PN program in New Brunswick, Canada, targeting people living with dementia (PLWD) and their carers. The program aimed to assist participants in navigating health and social care systems, matching their needs with available services. Methods: Navigating Dementia NB was co-developed by researchers, patient partners, and clinicians. This pilot program embedded six PNs in primary care clinics/centers
A Description of a Patient Navigator Program for Persons Living with Dementia in Canada
Introduction: Receiving a dementia diagnosis can be overwhelming for persons living with dementia (PLWD) and their carers. Accessing information and home supports can be challenging. Having access to a Patient Navigation (PN) program is one way that may assist PLWD and their carers. Methods: This study used a mixed methods design and involved the implementation of a Patient Navigation (PN) program in 6 primary care settings in New Brunswick, Canada, between July 2022-July 2023. PLWD/carers living in their own homes were eligible to enroll. Results: There were 150 PLWD with a mean age of 76.77
Lying/Standing BP adherence to RCP guidelines
Introduction: Orthostatic Hypotension is a significant cause of falls leading to injury and morbidity in elderly population. In an online survey by Royal College of Physicians (RCP) 271 out of 316 clinicians routinely performed these measurements and there were significant variations in how lying and standing BP is performed. This could have adverse effects on detection rates and accuracy of the procedure resulting in misdiagnosis. As a result, RCP has released guidance on L/S BP2 measurements in view of standardising practice and improving accuracy. The purpose of this QIP is to improve how L
One-year outcomes in older people following discharge post-rehabilitation from a community hospital
1. Introduction Both increased frailty and multi-morbidity are independently associated with high mortality and increased risk for nursing home placement. There is limited data on the best ways of assessing frailty and complex comorbidities to guide patient selection for rehabilitation. It is important we do not deprive an individual of the chance of inpatient rehabilitation, but this needs to be balanced with potential poor outcomes at one year due to frailty and comorbidities. 2. Method Data was collated retrospectively on all discharged patients over a 90-day period from May to July 2023. A
Development of Geriatric Care with a focus on frailty in a Community Hospital
In 2022 we had a unique opportunity to develop a Geriatric service in Totnes Community Hospital after a long-standing GP led service provision ended. Given the fact that the majority of patients in the Community Hospitals were over the age of 65 and many had multiple co-morbidities or presented with a frailty syndrome, it was felt that the Geriatric department was the most suitable specialty to take over the service provision. Method Over a period of 12 months, we have gradually introduced key aspects from the Comprehensive Geriatric Assessment (CGA) to the care of our patients. Every new
A qualitative exploration of existential loss in men with osteoporosis: 'in your dreams you can run and jump'
Background Osteoporosis is a global health concern that is likely to increase with a rapidly ageing world population. It affects one in three women and one in five men over the age of 50. Although there is a large body of qualitative research exploring the experience of living with osteoporosis, far fewer studies have focused on men. We aim to explore the meaning making processes of men with osteoporosis. Methods We interviewed 13 White British men aged 63 to 94 with an osteoporotic vertebral fracture We used the six stages of reflexive thematic analysis: familiarisation with the data; coding
Abstract title - Evaluation of Frailty Assessment, Management Practices, and Patient Outcomes in GIM Patients Under 85 Years: A Two-Cycle Audit
Introduction: Frailty significantly affects outcomes like length of stay and readmissions in elderly patients. At Queen Alexandra Hospital, inpatients under 85 are under the care of General Internal Medicine (GIM) wards and they lack regular access to frailty services. This baseline audit evaluated frailty assessment, management practices and patient outcomes, implementing staff education, ward posters, and a frailty Multidisciplinary Team (MDT) between cycles. Methods: Data were retrospectively collected from three GIM wards over two cycles—January and August 2024. Eligibility criteria