Barriers percieved by medical students when considering a career in geriatric medicine
Introduction Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8,031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality. Method The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career
Related risk factors for the development of dysphagia in geriatric patients in a South American cohort with COVID-19 infection
Introduction: The appearance of dysphagia after intubation in COVID 19 patients is very frequent, however there are few studies carried out in this regard. Methods: Retrospective study of 306 adults infected by SARSCOV2 by antigenic or molecular test. The main objective was to evaluate the risk factors involved in the appearance of dysphagia after intubation. Results: There was a higher frequency of COVID 19 in the Male gender 78% in relation to the Female 22%, the time of mechanical ventilation greater than 14 days was a factor with a high association, as well as the appearance of pneumonia
Role of oximetry in the CURB65 in geriatric patients with pneumonia from a Latin American hospital.
Introduction: The use of pneumonia scores to stratify the prognosis is very useful in general terms, since it allows objectively evaluating the risks in these patients. Methods: mixed type open study, first cross-sectional phase Test vs. Test, second phase follow-up at 8 and 30 days. Carried out between November 2017 and April 2018. The main objective was to determine the usefulness of pulse oximetry as a substitute for urea of the CURB 65 score in the evaluation of the severity of pneumonia in geriatric patients. Results: 65 patients, gender distribution was comparable, the main age group was
Factors involved in morbidity and mortality due to hip osteoporotic fracture in a South American geriatric cohort.
Introduction: Mortality after a hip fracture increases compared to the general population. The main objective of this study is to examine the incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures. Methods: This is a retrospective cohort study from a South American hospital. Patients older than 65 years with osteoporotic hip fracture between 2015 and 2018 were identified. Demographic data and comorbidities were obtained. The incidence rate, standardized mortality rate, trend (Poisson regression), and risk (hazard ratio) were calculated. Results: A
Establishing a national network of trainee representatives in geriatric medicine higher specialty training
Introduction : This study demonstrates how a network of geriatric medicine trainee representatives was established across the UK. The intention of the network was threefold: accurately represent the interests of trainees by gathering national feedback, develop a job description of deanery trainee representatives and create a community of practice between representatives. Method: Deanery trainee representatives were identified through TPDs then contacted to participate in an online questionnaire which also consented for whatsapp group invitation. Results: Deanery representatives were identified
Risk predictors during 90 days of follow-up in geriatric patients with asthma and SARSCOV2 infection
Risk predictors during 90 days of follow-up in geriatric patients with asthma and SARSCOV2 infection
Introduction: Since the first wave of COVID-19, caused by SARS-CoV-2 virus, we have sought to identify possible short- and long-term complications, the so-called "post-discharge syndrome", especially in patients at higher risk, after prolonged hospitalization and intensive care. Objective: The aim of the study was to study the outcomes, possible adverse consequences after severe COVID-19 illness and its predictors in the 90-day post-hospitalization stage in elderly patients with asthma. Methodology and Results: We conducted a longitudinal observational study including 131 patients older than
Frailty, longevity and comorbidities as prognostic determinants of mortality in geriatric patients with COVID-19 infection
Introduction: The presence of comorbidities and longevity is associated with worse outcomes in patients with COVID-19 infection. Materials and Methods: retrospective study of 306 adults infected by SARSCOV2. The main objective was to evaluate the role of the ROX index as well as comorbidities according to the age group as predictors of respiratory failure and mortality. In the inferential statistical analysis, the odds ratios OR with their confidence intervals greater than 95% were used as association measures. Qualitative variables were evaluated using the Chi-square test or Fisher's exact
Cerebrovascular disease in a cohort of geriatrics patients with COVID-19 in a South American hospital
Introduction: The presence of ischemic cerebrovascular accident in COVID 19 patients is a complication that has stood out due to its complications, the predisposing factors are the procoagulant state derived from the infection as well as cardiovascular arrhythmic causes. Patients: Describe the frequency of cerebral ischemia and cardiac rhythm disturbances in patients admitted to the emergency room from July 2020 to January 2021 and its impact on prognosis and mortality. Methods: Retrospective study of 306 adults infected by SARS COV2 by antigenic or molecular test. The presence of these events
IV Fluid prescribing post hip fracture fixation: does this impact level of orthostatic hypotension and acute Kidney Injury
Introduction The patients most often admitted with a hip fracture are older adults, many of whom are frail. The Scottish Hip Fracture Standards recommend that all patients have fluid assessment and are mobilised by the end of day 1 post operatively. We set out to look to see which patients are most at risk of acute kidney injury (AKI) and orthostatic hypotension (OH) post operatively and whether this was linked to the prescription of iv fluids (IVF). Method All online notes of patients admitted with a hip fracture in the months of July and November 2022 were reviewed. Notes were reviewed for
Development Of Inter-Professional Simulation-Based Education in Geriatric Medicine
Background Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) can be used to provide insight into other disciplines roles. We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence. Method We organised a one-day
Reducing Decision Times By Up To 80% Upgrading Laboratory Priority Of Blood Samples For Frail Individuals
Background Time critical intervention delays contribute to increased waiting times, length of stay, worsening morbidity, and mortality for the already frail patient. Evidence suggests some clinicians decide to admit whenever test results are not yet available; mistakenly believing this decreases patient risk. Within one day, this project reduced waiting times for decision makers by upgrading the blood sample processing priority so results are available sooner. Method Our Quality Improvement (QI) team leader spent one shift observing practices in the Emergency Department, noting ED blood
Evaluating the appropriate methods of antihypertensive prescribing in older populations
Introduction Treating hypertension in older patients (>65y) remains controversial given limited evidence around optimising blood pressure in frailty. Although studies suggest improved cardiovascular benefit, NICE guidelines emphasise the need for careful clinical decisions to balance benefits and risks. This local audit assessed the appropriateness of antihypertensive regimens prescribed for older patients against NICE guidelines and STOPP/START criteria. Secondary aims assessed admissions related to antihypertensive medication, polypharmacy reviews during inpatient stays, and management of
Quality Improvement Project on Assessment and Management of Rib Fractures at Weston General Hospital
Quality Improvement Project on Assessment and Management of Rib Fractures at Weston General Hospital
Introduction Rib fractures are very common worldwide, particularly in the elderly due to the increased risk of fragility fractures. They are associated with significant morbidity and mortality, largely due to respiratory complications secondary to pain. For each additional fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27% . It is therefore crucial that recognition and effective analgesia is done promptly. This quality improvement project aimed to assess demographics and management of patients presenting to the Emergency Department (ED) at Weston General
Audit Assessing the Effectiveness of an Intervention in Those with a Fractured Neck of Femur in Line with the NICE Guidelines
Introduction In the United Kingdom an average of 65,000 patients attend hospital with hip fractures each year, with 87% of these patients over the age of 70. Effective pain management is associated with significantly improved outcomes. Pain is known to be a significant trigger for delirium which itself greatly increases 1 year mortality and morbidity. Given the magnitude of the issue, this audit aimed to assess the effectiveness of an intervention in relation to the NICE National Standards for Neck of Femur (NOF) fractures at Weston General Hospital. Methods Data sets were collected from NOF
Frailty and immunotherapy in melanoma: NI experience
Background: Pembrolizumab is an immune checkpoint inhibitor licensed for use in patients with melanoma. Melanoma is more common with increasing age, requiring oncologists to quantify suitability for immunotherapy. Currently, patient’s fitness for treatment is determined using the Eastern Cooperative Oncology Group (ECOG) performance status (PS) scale. Recently, the G8 frailty screening tool has been developed to enhance prognostic value in the geriatric oncology population. Methods: Records of all patients treated with pembrolizumab for melanoma in the Northern Ireland Cancer Centre from
Frailty in vascular surgical patients; a retrospective audit with scope for quality improvement in a tertiary vascular centre
Background Clinicians are increasingly aware of the association of frailty syndrome and adverse outcomes. The British Geriatric Society recommends that clinical frailty scores (CFS) are assessed for all patients on admission to surgery, to optimise peri-operative care. Method For in-patients over one month (June 2023), the concordance with guidelines was recorded and any ‘missing’ scores retrospectively completed (Rockwood CFS). Clinical metrics included length of stay. Results 110 patients were admitted under vascular surgery. The median age was 67 (IQ 61-79). 73 (66%) were aged >65-years and
Prescribing of Acute Sedation in the Older Person
Introduction: Anti-psychotics and benzodiazepines are commonly prescribed for older people. They are usually indicated in the short term for delirium and agitation. There are known risks associated with these drugs in the older population including functional decline, increased falls risk and overall mortality. Moreover, chemical sedation is a form of restraint and deprives patients of their liberty. Sedative prescribing should be protocol driven and preceded by non-pharmacological intervention. However, these prescriptions are often initiated prematurely and evade review, continuing in the
Advance Care Planning in Patients with Moderate to Advanced Dementia
Introduction Advance care planning is a cornerstone of holistic care in patients with dementia. I conducted a quality improvement project (QIP) in Musgrave Park Hospital on the Orthogeriatrics Ward. The QIP focused on advance care planning in patients with moderate to advanced dementia. Method The target cohort was post-operative fracture patients with a formal diagnosis of dementia. Patients with moderate to advanced dementia were identified using the clinical frailty scale. Once a patient was identified, I ascertained whether the patient had capacity. If the patient was not deemed to have
Implementation and Effectiveness of an Integrated Virtual Frailty Ward in a Rural Setting – the first year.
Introduction: Virtual frailty wards, where patients are treated at home who otherwise would be in an acute hospital, are a model of care being promoted within the NHS in the UK, with the aim to ‘provide an alternative to admission and/or early discharge’. The evidence base for this model of care is limited and the ideal set up has not been defined. The aim is to describe the implementation and delivery of a virtual frailty ward serving a rural community. Methods: Creating a 7 day a week frailty virtual ward integrated across primary and secondary care. A multidisciplinary team (MDT) focus was
Using wearable devices to assess response to medication in de novo Parkinson’s disease.
Background: Patients not yet receiving medication provide insight to drug-naïve early physiology of Parkinson's Disease (PD). Decisions to start medication and assessment of response to its initiation can be challenging for physicians and patients alike. Aim: To identify objective, sensor-derived features of upper limb bradykinesia, postural stability, and gait that can inform decision-making in a movement disorder clinic. Methods: We used a single finger sensor to identify upper limb features and an array of six body-worn sensors to measure postural stability and gait. Patients were tested