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Continuous subcutaneous infusion of furosemide for treatment of decompensated heart failure in frail older people in a Hospital at Home Service

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IAustin1;REvans1;RDavidson2;KGaunt2
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Intro: Decompensated heart failure is a common acute presentation to hospital amongst the frail older population where treatment often involves intravenous furosemide. Whilst this is effective in inducing a diuresis, it can be associated with negative effects of hospital stay such as hospital-associated infections and deconditioning. Continuous subcutaneous infusion (CSCI) of furosemide is well-established as a palliative treatment for end-stage heart failure and there is growing evidence that CSCI Furosemide is as safe and effective as intravenous in the management of acute episodes of
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Deaf Awareness in the UK NHS: Identifying Challenges and Opportunities for Change

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H Henshaw1,2,3; B Parmar3,4,5; L Turton3,6; S Calvert1,2; S Howe3,7; AM Dickinson3,8; C Rolfe3,9; P Le Mere3; E Blondiaus-Ding3,10; R Stevenson3,11 S E Hughes3,12; E Stapleton3,13,14; Z Musker3,15
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Introduction: People with deafness or hearing loss (PDHL) face substantial communication barriers within the UK’s National Health Service (NHS), leading to reduced access to care, lower engagement with services, and poorer health outcomes. Deafness can affect anyone, but acquired hearing loss increases in prevalence and severity with age. A multidisciplinary working group comprising patients, clinicians, researchers, and charity representatives was formed to explore accessibility, communication practices, and deaf awareness across NHS services. Method: A cross-sectional survey assessed the
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Improving person-centred elderly care- A quality improvement project

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A Barden1; N Sharma1; H Alexander 2
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Effective communication is essential in delivering quality, patient-centred care, yet older inpatients frequently encounter barriers arising from sensory impairment, cognitive decline, and complex co-morbidities1. Evidence suggests inadequate communication contributes to reduced patient satisfaction, delayed discharges and avoidable readmissions2,3. Within local elderly care wards, observations indicated patients often lacked understanding of their diagnoses and were not engaged in decision-making. This project sought to evaluate existing communication practices during ward rounds and
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Improving Documentation and Communication with Care Homes when Discharging Older Adults from ED.

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Dr Isabel Copley1, Dr Chibuike Nwachukwu2, Dr Owen Morgan3
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Introduction: This quality improvement project (QIP) was conducted in a busy Emergency Department (ED) in South Wales (Grange University Hospital (GUH)), as part of efforts to improve safety for older patients. Our ultimate goal is to reduce unnecessary re-admissions, as hospital stays can cause rapid deconditioning in older patients. Patients aged over 65 account for 25% of ED attendances (Emergency Care Data Set, 2024). It is well documented for this subset of patients that good handover is crucial to improving overall standards of care, and continuity of care into the community. Standard
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Improving Discussions About Resuscitation With Frail Older Adults: Clinicians’ Perspectives

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F Kirkham 2; P Xenofontos 1; S Jamil 1; R Techache 1; L Tomkow 1
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Background Frailty is a poor prognostic indicator following cardiopulmonary resuscitation (CPR). Discussions about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are often contentious. While existing research focuses on patients’ and relatives’ perspectives, there is a lack of in-depth studies exploring clinicians' experiences of DNACPR discussions. This study aims to explore how clinicians' personal and professional beliefs and experiences influence their approach to DNACPR conversations with frail, older adults. Methods Ninety clinicians from primary and secondary care

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Ageing with Confidence; A Quality Improvement Project on Urinary Incontinence Assessment

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S Kannan1; RM Jacob1
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Title: Ageing with Confidence; A QI project on Urinary Incontinence Assessment Introduction: UI is a common yet underdiagnosed geriatric problem with a UK prevalence of >20% in individuals aged over 65. Despite its high prevalence, UI often remains untreated negatively impacting the quality of life. Objectives: This project aimed to raise awareness and improve patient outcomes by introducing a standardised urinary incontinence (UI) assessment proforma to aid early recognition and management of UI among elderly patients admitted to the COTE ward in a district general hospital. Methods: A
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Factors impacting retention in rehab RCTs with community dwelling older people with frailty: systematic review and meta analysis

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M Prescott1; JA Adamson2; CE Hewitt2.
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Introduction: The UK and global life expectancy is increasing, but life years lived in ill health is also increasing. Disease burden, and health and social care service use is highest in older age. Prevention, treatment and management of conditions of older age (e.g. frailty and multi-morbidity) is a research priority. Efficient trials need to better recruit and retain older participants to produce robust and generalisable evidence for our aging population. Synthesised qualitative and quantitative evidence regarding trial retention does not generally include the oldest and frail in society
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The Case for Space:  Does a dedicated Frailty Same Day Emergency Care (F-SDEC) unit improve the impact of an acute frailty team? 

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Catrin Kunemund-Hughes1, Emily Tridimas2, Grace Walker3
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Background: National and local standards in acute frailty recommend a seven-day service, with front-door assessment and a dedicated frailty area. Many acute frailty teams struggle to maintain a dedicated space as they are vulnerable to becoming inpatient areas when bed pressures increase. The Acute Older Persons Unit (AOPU) at Guys and St Thomas' has faced similar challenges and is based on the Acute Admissions Ward and the Emergency Department. This project assessed whether a dedicated Acute Frailty SDEC (F-SDEC) space increased the number of patients seen and the number of same-day

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Intersectional Risks and Adverse Drug Events in Older Adults: A Scoping Review

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Fatima Sabir1,2; Alishba Z. Hussain2,6; Jenni Murray2; Oliver Todd5,6; Muhammad Faisal2,3,4; David P. Alldred1,2
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Introduction Adverse drug events (ADEs) in older adults contribute to preventable harm, hospitalisation, and health inequalities. While age-related physiological changes affecting drug safety are recognised, less attention is given to how sociodemographic and structural factors such as ethnicity and deprivation jointly shape vulnerability to ADEs. This limits the development of equitable medication safety strategies. This review examines how intersectional risks are conceptualised and analysed in ADE research to inform more inclusive approaches to medication safety. Method A scoping review was

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Digital CGA: Innovation, Implementation, and Audit-Driven Evaluation

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Emma Hibbs
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Introduction The Comprehensive Geriatric Assessment (CGA) is the gold standard for managing frailty in older adults, with strong support in the literature. However, gaps remain in the evaluation of electronic CGA's (eCGA's) and standardised implementation. The Frailty Intervention Team at Sandwell and West Birmingham delivers multidisciplinary care via CGA, but prior to intervention, assessments were often incomplete, with baseline compliance at just 23%. This was largely due to the absence of a user-friendly, embedded electronic solution. Method A root cause analysis identified key barriers

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Preventing future fractures; Increasing compliance to National Osteoporosis Guidelines in a Surrey General Practice

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Amy Forrest1 Narmina Chamedova2
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Introduction Osteoporosis is systematic skeletal disorder causing low bone mass, which increases pre-disposition to fractures. In older adults, fragility fractures are usually the first presentation of this. National Osteoporosis Guidelines Group (NOGG) have published evidenced-based guidelines for identifying and managing bone health in the over 50’s, however compliance can be variable. Methods An EMIS search was conducted of patients at the Surrey practice which identified 46 patients over 50 years old (25 of which were over 70 years old) who had been coded as having had a fragility fracture
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Building better bones, a quality improvement project to enhance bone health in the older person’s unit

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A Sweeney1; A Sowah1; A Arora1; S Rehman1,2; M NiLochlainn1,3;
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Introduction: Fragility fractures can have a profound impact on older adults’ quality of life. Optimising bone health by checking vitamin D level, FRAX score, and actioning outcomes provides a cost-effective strategy for reducing the incidence of these fractures. Our aim therefore is to promote awareness and undertaking of bone health assessments in the Older Persons Unit (OPU) Methods: This was a pre-post cross-sectional study. Data was collected from 212 patient records over two separate days, one month apart. Patients admitted to the OPU at St Thomas’ Hospital were included and data was
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Understanding patient experience on the Older Person's Acute Medical Unit (OPAMU) and the acute frailty pathway at UHW.

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T Parkin1; S Lewis2
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Introduction: The older population are more likely to suffer from chronic diseases, requiring more frequent hospital admissions, therefore, in University Hospital of Wales there is a dedicated Older Persons Acute Medical Unit (OPAMU). The OPAMU, opened in 2023, admits frail patients directly from the Emergency (ED) and Acute Medicine (AM) Departments for comprehensive geriatric assessment before discharge or onward hospital stay. Main objective: To understand how our patients felt throughout different steps of their journey to the OPAMU. Secondary objective: To assess how the patient

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Improving the Weekend Handover Process on Older Adults Medicine Wards at Leeds Teaching Hospitals

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E Brew1, R Ambar1, J Burnham1, K Russell1, A Hussain1, F Bennett1, E Ball1, P Khan1, S Ninan1
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Introduction Clinicians covering six older people’s medicine wards reported feeling burdened by requests for weekend review of patients without clear indications, reducing time for patient care. We aimed to standardise the process to streamline reviews, freeing up clinicians to deliver optimal care. Methods We developed a new electronic weekend handover process using existing capabilities within our electronic patient record. The COM-B behaviour change method was used with a focus group of clinicians including PAs, residents and consultants to identify targets to change behaviour. Fifteen

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Satisfaction with Shared Decision Making and Decision Regret in Older Adults Undergoing Elective Colorectal Cancer Surgery

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Dr C Whitear 1, Dr M Sun Wai 1, Dr M Kaneshamoorthy 1, Dr J Jegard 1
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Introduction: Involvement of Geriatricians in peri-operative assessment acknowledges the altered physiology of frail patients and helps to evaluate realistic outcomes as part of patient-centred shared decision making. This is with the aim of addressing modifiable risk factors, preventing complications, preparing for a realistic recovery and ensuring that treatment options are aligned to what is important to the patient. There is data suggesting improved survival following geriatric peri-operative assessment but little analysis from the patient’s perspective; their thoughts about the shared

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Setting the Research Agenda for Co-existing Dementia and Hearing Conditions: A James Lind Alliance Priority Setting Partnership

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Eithne Heffernan1,2,3; Sian Calvert2,3; Tom Dening3; Emma Broome2,3; Ruth V Spriggs2,3; Nahid Ahmad4; Natalie Lerigo-Smith2,3; Helen Henshaw2,3
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Introduction: Dementia and hearing conditions are both major public health concerns. Most people living with dementia also live with hearing conditions (e.g., hearing loss, vestibular disorders, hyperacusis). Furthermore, evidence suggests that hearing loss is a risk factor for the development of dementia. There is a critical need for research to explain the association between dementia and hearing conditions and to optimise assessments and interventions for this co-morbidity. This James Lind Alliance Priority Setting Partnership (JLA PSP) aimed to identify unanswered research questions about
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Standing Up to Deconditioning: A Multidisciplinary Approach to Enhancing Patient Mobilization

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MOE MOE SAN1; SHWE ZIN MYAT SAN2; SIDAK HANSPAL3; HIND ABDELRAHMAN4
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Introduction: Deconditioning, the progressive loss of physical and functional capacity during hospital admission, is a well-recognized but often under-addressed risk factor for poor patient outcomes. It can lead to increased dependency, delayed discharge, and higher rates of hospital-associated complications. Despite its importance, barriers such as invasive lines, limited staff awareness, and entrenched ward routines often prevent patients from engaging in early mobilization. Objective: Our quality improvement project sought to evaluate whether small and simple, multidisciplinary
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Improving outcomes in fragility fractures: integrating bone health into the acute medical unit

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H Donnelly1; S McDonald1; C Henderson1; A Joseph1; F O'Kane1
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Introduction Fragility fractures are a frequent presentation to the acute medical take. Defined as a fracture following a fall from standing height or less[1], they represent up to 10% of acute admissions. Despite this, we identified no standardised protocol for commencing bone protection in our unit. Our project aimed to improve the management of bone health in this cohort. Methods Data was collected across an 18-week audit cycle, with 6 weeks of baseline data collected prior to any interventions. Patients with radiologically proven fractures sustained from standing height or less were
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Implementing Frax based Osteoporosis Risk stratification across Geriatric wards in St Cross Hospital Rugby

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J Odia1 ; M Siddiqui1; J Boylan1; S Gurijala1 ;H Unnikrishnan1
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Introduction: Osteoporosis affects approximately 3.5 million individuals in the UK, with prevalence increasing with age—particularly among women over 75. Hip fractures carry a one-year mortality rate of nearly 33%, underscoring the importance of primary prevention over reactive treatment. However, many elderly patients do not proactively engage with their GP regarding bone health. Objective: This audit aimed to Identify elderly inpatients at elevated risk of osteoporotic fragility fractures using the FRAX tool Communicate these findings to their GPs to support early intervention. Methodology
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Enhancing Delirium Documentation at the Hospital-Community Interface

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C Wong1; H Freeman1; S Rizwan1; S Reddy1
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Introduction Delirium is common in older inpatients and associated with cognitive decline, underlying dementia, and mortality. NICE recommends that current or resolved delirium diagnosis is communicated to general practitioners (GPs) upon discharge. A 2021–22 quality improvement project at Lister Hospital improved the delirium assessments consistently to over 95% across the Trust. However, this study found that only 25% of delirium cases were documented in discharge letters. This gap poses significant risks to patient safety, as unresolved delirium may be overlooked, and underlying dementia

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