What Are We Teaching UK Medical Students About Ageing? Results of the third BGS national curriculum survey
Introduction: The ageing population means all doctors, regardless of specialty, will need knowledge, skills, and attitudes to care for older people with complex health conditions. An essential component of preparing the medical workforce to best care for older people is by including teaching on ageing and geriatric medicine in undergraduate medical curricula. Here we present results of the British Geriatrics Society (BGS) national curriculum survey 2021-22, highlighting progress made in undergraduate teaching in geriatric medicine. Methods: All 35 UK GMC-registered medical schools at the time
Knowledge of dying in place and preferences for place of death among older adults in Hong Kong
Introduction: The preference for place of death and the concept of dying in place have been subjects of debate in numerous jurisdictions. Despite the growing prevalence of ageing populations and the increasing demand for dying in place, there is a limited body of literature exploring older adults’ knowledge of dying in place and their preferences for the place of death. In Hong Kong, there are ongoing legislative efforts to revise the policy on dying in place. This study aims to investigate the knowledge of dying in place and the preferences for the place of death among older adults in Hong
How can effective teaching about dementia be integrated into the undergraduate medical curriculum? A realist review
Introduction The prevalence of dementia is increasing and yet healthcare professionals (HCP) do not always have sufficient education and training to deliver optimal care for patients with dementia (PWD). There is an evidence base as to how to deliver effective undergraduate education about dementia but this is infrequently integrated into the medical curriculum. Methods We undertook a realist synthesis to review the barriers to integrating effective interventions on dementia into the medical curriculum. A realist synthesis differs from a traditional systematic review in terms of explaining how
The introduction of an additional meal in nursing homes may be associated with a positive impact on the BMI of residents with dementia.
The introduction of an additional meal in nursing homes may be associated with a positive impact on the BMI of residents with dementia. Abstract Background Since 2010, many nursing homes in Norway have introduced an extra meal daily, with a hot lunch, and pushing dinner to later in the day. This initiative aims to reduce the long time interval between breakfast and supper. Aim This study examines how an extra meal affects the residents' body mass index (BMI) at nursing homes in Norway. Research questions include how an extra meal affects BMI among residents in the dementia unit. Methods We
Geriatric patients in virtual wards; technology adoption style, ease of use, and adherence to remote monitoring technology
Introduction NHS England is committed to the expansion of virtual wards, necessitating patient engagement with home care technology. Literature suggests there is a technology adoption lag among older populations. We investigated if this lag was evident in geriatric virtual ward patients. Methods Data from three NHS trusts using a virtual care platform (March 2021-August 2023) were aggregated to assess differences in perceived ease of use, technology adoption style, and measures of adherence. All patients received the Telehealth Usability Questionnaire Ease of Use (EOU) subsection (higher
The prevalence of medication-related harm in people with dementia – a systematic review
Introduction Medication-related harm (MRH) is defined as any negative outcome, harm or injury caused by taking a medication (Falconer et al. Eur J Clin Pharmacol, 2018;75(2):137-145). People living with dementia (PLWD) take more medications than those without dementia, increasing their risk of MRH (Mueller et al. Exp Gerontol 2018;106:240-245). There is urgent need to explore the scale of MRH affecting PLWD. This systematic review aimed to determine the prevalence of MRH in PLWD and evaluate various outcomes to assess its impact. Methods Twelve databases were systematically searched for
Effectiveness of Horticultural Therapy on the Psychosocial and Physical Function of Older Adults with Normal Cognitive Function.
Introduction Horticultural therapy (HT) is not uncommonly used as non- pharmacological therapy for patients with dementia. However, less is known about its effects on older adults with normal cognition. This systematic review and meta-analysis synthesises available evidence to evaluate the effects of HT on psychosocial and physical function in cognitively intact older adults. Method A systematic search in 9 electronic databases for experimental and quasi- experimental studies was performed between January 1, 2001, and July 19, 2021. Studies involving participants above 60 years old with normal
Predictive factors of Delirium in Neck of Femur Fracture and Post-Operative Outcomes at Morriston Hospital
Introduction: Neck of femur fractures (NOF) remain a significant cause of mortality in the elderly, especially in those who develop delirium post operatively. The aim of our study is to identify risk factors that may contribute to developing a delirium. Method: A prospective cohort study of 717 patients presenting to Morriston Hospital who underwent operative management for a NOF fracture. Results: A total of 103 patients developed a post-operative delirium, an incidence of 14.4%. Clinical Frailty Score (CFS) and Abbreviated Mental Test Score (AMTS) proved to be significantly associated with
A Quality Improvement Project (QIP) to Improve Pain Management in Elderly Patients (65 and over) presenting with Falls to Emergency Department and being referred to the Older Persons Assessment and Liaison (OPAL) Team
Introduction: Falls account for one of the most common and serious issues contributing to a disability, especially among elderly individuals. (1) Injuries resulting from a fall range from mild to severe, but they are all usually painful. (2) According to RCEM ‘Recognition and alleviation of pain should be a priority when treating the ill and injured’. (3) The aim of this project was to improve pain management in patients with falls being referred to the OPAL team. Studies have shown that patients whose primary pain is well managed and treated in the ED have a higher overall satisfaction with
Targeted Geriatric Assessment In The Emergency Department: Does It Make A Difference?
Introduction: Older people represent between 21 to 40% of Emergency Department (ED) users and proportionally use more ED services than any other age group. A Geriatric Ambulatory care service, in collaboration with Emergency Department, was initiated to achieve earlier identification and interventions for frail patients with geriatric syndromes. Methodology : Retrospective review was undertaken from 13th January 2022 until 23rd December 2022 in older patients discharged from the ED ambulatory area following a targeted geriatric assessment and recommended follow-up interventions at the
Evidence of systematic missingness in frailty data: A European Cohort Study
Introduction Emergency department (ED) frailty screening is recommended in guidelines for its potential to trigger earlier and more appropriate comprehensive evaluation and intervention for the most vulnerable patients. Post-implementation studies of the Clinical Frailty Scale (CFS) typically observe around 50% concordance with screening. Little is known regarding the characteristics of those people omitted. Methods The Frailty in European Emergency Departments (FEED) cohort study observed prevalence of frailty, administering the CFS to consecutive attenders over twenty-four hours
Incidence of Inappropriate CPR in The Emergency Department
Introduction: A BMJ study suggested that 1 in 5 sick, older patients have a ‘do not resuscitate’ document and a large proportion only had this completed in the Emergency Department (ED) (1). Current ED pressures could cause greater delay in this discussion, resulting in inappropriate cardiopulmonary resuscitation (CPR). The ReSPECT form was established to bring consistency to the communication of patients wishes, including ‘do not attempt CPR’ (DNACPR) (2). This QUIP assessed the incidence of inappropriate CPR in two ED’s by investigating the proportion of CPR performed on those with a prior
Preventing Frailty Crises: improving the care of Frail patients in an Acute Hospital Ward Setting
INTRODUCTION: Frailty is common in hospitalised older patients and hospitalisation can lead to negative outcomes. Our study aimed to provide insights into current decision-making processes on treatment, care and discharge by clinical teams. METHODS: We conducted a prospective cohort study in frail older patients ≥ 65 years old admitted to acute medical and surgical wards. Clinical Frailty Scale ≥ 5 was used to identify frail patients and process mapping was undertaken to identify common themes, trajectories and potentially modifiable factors. We followed patient journeys from admission to
THE PREVELANCE OF PRE-ADMISSION VITAMIN D LEVELS IN THE MANAGEMENT AND OUTCOMES OF PROXIMAL FEMUR FRACTURES
Introduction The aim of this study was to examine the prevalence of vitamin D deficiency in elderly patients with fragility fractures of the hip by estimating 25-hydroxyvitamin D levels, whether low levels of Vitamin D at the time of admission affects the functional outcomes and mortality at 28 day and one year. Methods A retrospective study of all the patients admitted with a fracture neck of femur from Jan 2018 to March 2021 was carried out. The data was obtained from NHFD (National Hip Fracture Database) and Medway software. A total of 1221 patients were admitted during this period. Patient
Deficits comprising multi-dimensional frailty indices based on routine data: sub-analysis of a scoping review
Introduction The frailty index (FI) is a frailty assessment tool calculated as the proportion of the number of deficits, or “things that individuals have wrong with them”, to the total number of variables in the index. Routine health and administrative databases are valuable sources of deficits to automatically calculate FIs. There is large heterogeneity in the deficits used in FIs. This sub-analysis of a scoping review on routine data-based FIs aimed to describe and map the deficits used in multi-dimensional FIs. Methods Seven databases were searched to find literature published between 2013
The interrelationship between multiple long-term conditions (MLTC) and delirium: A scoping review
Introduction Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium. Methods Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings
A scoping review of guidelines and resources to promote evidence-based prescribing for older people with sensory impairment
A Scoping Review of Guidelines and Resources to Promote Evidence-Based Prescribing for Older People with Sensory Impairment (OPwSI) BC Morrison1; E Asante2; MR Lennon2; MC Watson1 1. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow; 2. Department of Computer and Information Sciences, University of Strathclyde, Glasgow Introduction By 2030, hearing impairment is expected to affect one in four people globally (WHO, 2022) and one in five in the UK (Hearing Link, 2023). Visual impairment is projected to impact 2.7 million people in the UK by 2030 (ONS
Improving the assessment and management of osteoporosis in a district general hospital.
Introduction Over 500,000 fragility fractures occur in the UK each year (1). NICE guidelines state that all women aged ≥65 and all men aged ≥75 should be considered for a fracture risk assessment. It was recognised that locally these guidelines were not being met. The aim of this quality improvement project was to improve the number of patients being assessed for osteoporosis across two medical wards. Method This quality improvement project followed two “Plan Do Study Act” (PDSA) cycles. The first cycle involved teaching sessions for junior doctors on using the FRAX tool – a tool recommended
Impact of creation and subsequent expansion of the Acute Frailty Team at Queen Elizabeth Hospital, Gateshead on patient outcomes
Introduction An Acute Frailty Team pilot was launched in December 2022 at the QEH. The aim was to reduce unnecessary hospital admissions and length of stay (LOS) by providing interventions in the Emergency Admissions Unit (EAU), through comprehensive geriatric assessment. Following the pilot’s success additional recruitment was made to the multi-disciplinary team (MDT) and the service revaluated. The MDT consists of a Consultant Geriatrician, Specialist Frailty Practitioner, Frailty Fellow, Physiotherapist, Technical Instructor, Occupational Therapist, and Pharmacist. Method To allow
A quality improvement project to improve bone health plan in Trauma and Orthopaedic discharge summaries
Introduction In 2022, 293 hip fractures had been admitted to the Bristol Royal Infirmary. As recommended by National Osteoporosis Guideline Group ( NOGG ) intravenous zoledronate is the first line treatment option following a hip fracture. Aims We wanted to improve bone health summaries on discharge summaries for the benefit of the General practitioner ( GP ), Fracture liaison service and patient. Results We used our local National Hip Fracture database to identify the patients who had had a fractured hip in September 2023. We then introduced our changes as part of the PDSA cycle. The change