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Improving recognition and management of acute delirium in older adults: A quality improvement project

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Sowmiya Gunabalasingam1, Ayida Khan1, Tun Moe1, Shumaila Manzoor1, Khalid Haque1
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Introduction Delirium in older adults is associated with increased morbidity, functional decline and mortality. NICE recommends the use of the 4AT within 24 hours of admission in adults aged ≥ 65 years. However, completion rates in clinical practice remain suboptimal. This quality improvement project aimed to improve recognition of acute delirium on a geriatric ward in Queen’s Hospital, by increasing the proportion of new ward admissions with a documented diagnosis of delirium and corresponding management plan by 20% through improved use of the 4AT. Methods Baseline data were collected over
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Comparison of polypharmacy and ACB in a cohort of older adults living with frailty at a DGH in Southwest Wales between 2023-2025

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Talia Bartley1, James Flynn2, Zena Marney3
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Introduction Polypharmacy is defined as use of 5+ medications. An anticholinergic burden score (ACB) 3+ increases risk of adverse outcomes in frail patients including falls, cognitive decline, and mortality. Optimising older adults’ medication regimen is a critical element of Comprehensive Geriatric Assessment (CGA). Method In December 2025 a frailty census was completed at Prince Philip Hospital (PPH). Criteria for inclusion were age ≥65 years. Data was collected for a range of metrics including Clinical Frailty Scale score (CFS), polypharmacy, anti-cholinergic burden, and whether admitted

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Evaluation of a Training Package for Clinical Frailty Scale Scoring in Urgent and Emergency Care.

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J Lai1; S Lewis2
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Objective: The Welsh Acute Frailty Service guidelines require Clinical Frailty Scale (CFS) completion within 60 minutes of arrival into urgent care outlining a clear need for staff to be confident using the CFS in these settings. This study evaluates use of a training package to educate healthcare staff on using the CFS in an acute setting. Method: Patient interviews were recorded in the emergency and acute medical units from which videos were created to explain how each patient’s CFS had been calculated. Patient stories and photographs were also used in an educational poster to support the
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Closing the Loop After Discharge: An IMT-Led Telephone Results Clinic in Geriatric Medicine

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Dr C Guy1, Dr D Paxton1
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Introduction Investigations requested as an inpatient were not reliably followed up in our hospital. Poor coordination of post-discharge follow-up can lead to delayed results review, threatening patient safety. This uncertainty contributes to increased length of stay, a risk factor for deconditioning and delirium. In older adults, results must be reviewed in the context of a Comprehensive Geriatric Assessment, allowing robust advanced care planning and ensuring onward investigations are tailored to the individual. We implemented a consultant-supervised, Internal Medicine Trainee (IMT)-led

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The Burden of Behavioural and Psychological Symptoms in Dementia (BPSD) in Post-Diagnostic Memory Services

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Abigail Campbell1, Lowri Elias1, Dr Cherry Shute2, Dr Biju Mohamed 2
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Introduction: BPSD significantly impact patient wellbeing and caregiver burden [1]. The Cardiff and Vale Memory Service provides integrated assessment, diagnosis and post-diagnostic care to around 5000 community-dwelling people with dementia (PwD) across South Wales. BPSD frequently prompt escalation to the multidisciplinary team (MDT). This project aimed to evaluate the burden of BPSD within the service. Method: Over 5 weeks, surveys were completed for patients discussed at the MDT with BPSD concerns. The survey captured number and type of BPSD features, demographics and routine clinical

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Delirium in Older Adults Admitted With Acute Stroke: Prevalence, Risk Factors, and In-Hospital Outcomes

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CMA Angulugaha Gamage 1; F H D Shehan Silva 2; Rajaratnam K 2.
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Introduction Delirium is a common, but frequently under-recognised complication in older adults admitted with acute stroke and is associated with adverse clinical outcomes. Data describing the prevalence, clinical profile, and impact of delirium in older adults with acute stroke in Sri Lanka are limited. Methods This descriptive cross-sectional study included 90 adults aged ≥60 years admitted with acute ischaemic stroke (including transient ischaemic attack) or haemorrhagic stroke to Professorial Medical Unit at Colombo South Teaching Hospital, Sri Lanka. Delirium was assessed using the

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Quality Improvement Project: Improving Multidisciplinary Meeting Documentation on Older Person Wards with an EPIC SmartPhrase

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Georgina Lindsay, Arianna Risoli, James Maguire
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Background A quality improvement project was undertaken on inpatient wards in the Ageing and Health department of Guy’s and St Thomas’ NHS Foundation Trust. The patient group comprised older adults predominantly living with frailty and multimorbidity. Care is delivered by a multidisciplinary team (MDT) including resident doctors, consultants, nurses, physiotherapists, occupational therapists, speech and language therapists (SALT), dieticians, and discharge coordinators. Introduction Reliable documentation of multidisciplinary meetings (MDMs) contributes to safe, coordinated and patient-centred
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Formation of a Frailty Assessment Unit - From Pilot to Reality

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E Mwendwa; A Falconer; H Morgan; B Adler; I Hynd; M Gallagher; E Burnett
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Background According to Healthcare Improvement Scotland, all hospitals should have an established frailty assessment area with access to a specialist frailty team within 4 hours of admission (or within 12 hours when out of hours). Timely CGA on admission is linked to improved patient outcomes. Last year at University Hospital Wishaw (UHW), a Rapid Access Frailty team (RAFT) with dedicated frailty beds was introduced over a 10-day period. They found an improvement with length of admission and discharge rates as well as positive feedback from staff. Following this pilot, a new Frailty Assessment

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Prediction of thirty day mortality using clinical risk scores in patients over sixty-five receiving systemic anticancer cancer therapy

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N Lander1, P Jenkins2
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Introduction: One third of cancers are diagnosed in patients over the age of 65 (1), given we have an ageing population this is going to increase. Tools have been developed to identify older patients at risk of increased morbidity when receiving SACT such as Geriatric 8 (G8) and Cancer and Ageing Research Group chemotherapy toxicity tool (CARG-TT). This project aimed to assess the ability of these and other frailty assessment tools to predict 30 day mortality amongst older oncology patients. Method: Morbidity and Mortality data from a regional oncology department was reviewed to identify

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Accuracy of doctors' decision of fast-track discharges: a prospective audit

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C Hayes1, R Shah1, A Summerbell1, M Tarek1, F Hendry2, A Abdelhafiz1
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Introduction: With an ageing population, more people are living with terminal illness, giving opportunities to identify those with predictable shortened life expectancy. The fast-track pathway was developed to speed up funding of care for people expected to die within 12 weeks. Our aim was to investigate the accuracy of doctors’ prediction of death for patients admitted to hospital and referred to the fast-track pathway. Methods: A prospective audit of hospitalised patients who were referred to the fast-track discharge pathway with an expected death within 12 weeks from the date of discharge

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CGA: Improving communication at discharge

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C Gribbon1; A Ucheoma2; K Maxwell2; E Nelson2; B McCann3
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Introduction: The most recent national frailty benchmarking audit showed that many discharge letters from our Frailty Ward did not document a clinical frailty score (CFS), advanced care planning (ACP) or functional status. This project aimed to improve documentation of the comprehensive geriatric assessment (CGA) for patients seen by the Frailty Intervention Team (FIT) in Craigavon Area Hospital. Methods A baseline audit of 20 discharge letters from the FIT team was performed, assessing whether core aspects of the CGA were documented. Aspects of the CGA included were: CFS, ACP, cognitive

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Are Older Adults with Chronic Kidney Disease Receiving the Correct Gabapentinoid Dose Based on Creatinine Clearance?

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Janaki Chaountharagnanan1,2; Rachael Fosuah1,2; Conor Symington1,2
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Introduction: Chronic Kidney Disease (CKD) affects around 10% of the Scottish population and is particularly prevalent among older adults. As renal function declines with age, drug clearance decreases, increasing the risk of systemic toxicity. Gabapentin and pregabalin, commonly used for neuropathic pain in older adults, are renally excreted and can accumulate, leading to sedation, confusion, and falls. Appropriate dose adjustment according to creatinine clearance (CrCl) is therefore essential. Despite national guidance from NICE, BNF, and SIGN, dosing errors in renal impairment remain a

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Biochemical mechanisms driving the clinical features of frailty

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Ethan Clifford1, John Burthem2
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Introduction Frailty is a common syndrome characterised by reduced physiological reserve and increased vulnerability to stressors presenting with hallmark features of sarcopenia, fatigue, neurodegeneration and immune dysregulation. This may result in adverse outcomes such as falls, disability and hospitalisation. Although frailty is routinely identified phenotypically, the biological mechanisms underpinning its clinical features are not always integrated into clinical understanding. This poster aims to explore the roles of these pathways in the development of frailty and to illustrate how

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From Fall to Follow-Up: Improving Post-Fall Assessment Timeliness and Documentation with NICE and NAIF Standards

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H Anderson1; D Campen1; C McCleary1; J Tsang1
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This project aimed to educate foundation (FY) doctors regarding post-fall assessments and develop a proforma to enhance documentation, within an acute hospital trust. NICE Quality Standard QS86 for adults aged 65 and over in a care setting states that a fast-track examination (under 30 minutes) should occur for highly vulnerable patients, or those showing signs of serious injury. The National Audit of Inpatient Falls (NAIF) Report 2024 found that 65% of patients who had a fall-related inpatient femoral fracture (IFF) received a fast-track medical review. In our hospital this was only 30%. The
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Treating Vitamin D Deficiency Empirically

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Ayah Assadi Shekrobat1, Adam El Khouja2, Simon Langridge2, Habib Rehman3
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This quality improvement project evaluated the clinical utility of routine vitamin D testing in frail elderly patients admitted to the Acute Surgical Unit. Baseline data demonstrated that the majority of patients had suboptimal vitamin D levels, with significant variability in repeat testing and frequent prescribing errors, particularly confusion between loading and maintenance regimens. Testing rarely altered management, as patients with sufficient levels were typically already on supplementation. In response, an empirical supplementation pathway was developed, removing vitamin D testing from

How can we Improve Multi-factorial Falls Assessments in Patients at Risk using Health Pathways and Other Measures?

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Laura Rozier
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How can we Improve Multi-factorial Falls Assessments in Patients at Risk using Health Pathways and Other Measures? Background All admitted patients require completion of a multifactorial falls risk assessment (MFRA) within 6 hours; in order to identify at risk patients and implement a care plan to aim to reduce the risk of falling. Hospital Health Pathways have a ‘Falls prevention and risk assessment’ pathway which can be used to perform a multifactorial falls assessment. Objective We planned to evaluate how effectively we perform multifactorial falls assessments on the Older Persons Acute

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Opioids in the frailer adult: Are we prescribing them safely?

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Yee Ton Shek1, Sarah Keir2
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Introduction: Chronic pain is common and increases with age. It is challenging to treat and opioids are frequently used. However, these come with potentially dangerous side effects. We sought to review the prevalence of these drugs across our Medicine of the Elderly department, our prescribing practice and our communication with primary care regarding them. Method: Between the months of April and May 2025, we reviewed all patient records across the MoE footprint (142 patients) recording presence of opioid, type, whether present on admission, started ourselves, frequency of review, plan and
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Barriers and facilitators in care home training implementation: A rapid review to inform rollout of a mealtime care intervention

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Jakarin Ali 1, James Faraday 1 2, Annette Hand 2 3
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Introduction Care homes face growing pressures in delivering high-quality, person-centred care. Effective and sustainable training can enable staff to develop the knowledge, skills, and confidence required to provide this care. This rapid review aimed to identify the barriers and facilitators in implementation of training programmes in care home settings. The findings will inform rollout of a training intervention to improve mealtime care for people living with dementia. Method Methods were informed by Cochrane Rapid Reviews Methods Group guidance. A structured literature search was undertaken
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ISiTO - Improving Sight Therapy for Older-people - A Quality Improvement Project (QIP) at a Tertiary Hospital

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C Claydon 1; S Mansoor 1; I La Chapelle 1; P Fletcher 1; S Azigiri 1; Z Pruszowska 1; T Daubeney 1; J Ingham 1; W Tai 1; R Claassen 1
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Introduction Reduced visual acuity is a frequent contributing factor to admission to an acute hospital for older people yet there is little attention paid to its importance. Vision assessment is meant to be offered to all adults at risk of falling as per Montero-Odasso et al 2022(1). The NHS funds vision assessments in the community for all adults >65 years of age. Aims This project aims to assess current understanding and uptake of vision assessment in the community for patients admitted to a tertiary hospital, and whether targeted information giving can improve uptake of primary care

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Grip strength testing to identify sarcopenia in lower limb amputee outpatients: a quality improvement project.

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Joshua Turnbull, Charlotte Buckland, Sarah Tate, Katie Bell
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Introduction: The demand for lower limb amputation is growing due to factors including rising rates of diabetes and vascular disease as well as an ageing population. Sarcopenia, the loss of muscle mass and strength associated with ageing, can exacerbate the risk of unfavourable health outcomes and mortality. Consequently, early detection and management of sarcopenia is important in the rehabilitation of older people who have had lower limb amputation. Clinical practice guidelines recommend using grip strength testing to identify probable sarcopenia in high-risk patients during routine care and

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