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Piloting an anticipatory care intervention for people living in a residential care home

Authors' names
Elizabeth Graham; Peter O'Halloran ; Julie Foster; Emma Mackle
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Unlike nursing homes, which have a qualified nurse on duty 24 hours, residential homes offer a social care model and are managed by a senior care assistant. This may increase the risk of admission to the emergency department (ED). The 45 bedded residential care home and associated GP medical practice in this pilot reported poorly communicated, inappropriate, and duplicate referrals to the practice, with nearly half of admissions to the emergency department occurring without professional assessment of any kind. The pilot aimed to enable care home staff to improve identification of residents at

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Adherence to the intra-cerebral bleeding bundle of care and treatment pathway.

Authors' names
A Mohamed 1; T Akinola 1; K Ajiboye 1; G Wallace 1.
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Introduction: Intracerebral haemorrhage (ICH) accounts for 10-20% of strokes worldwide. Mortality is high at 40% and survivors might suffer from severe disabilities that massively impact quality of life and independence. Diagnosis and treatment are straight forward. A non-contrast CT head scan is diagnostic. Treatment is focused on prompt anticoagulation reversal and blood pressure control, with consideration of surgery in appropriate cases and admission to an acute stroke unit or an intensive care unit. Methods: Two PDSA cycles of 28 and 29 patients were completed in the acute stroke Unit

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Developing a Frailty Model for Causeway Hospital: facilitating enhanced short stay care and early supported discharge

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Stephen Collins, Carrie Coulter, Audrey Kelly, Michael McAteer, Emily McIntosh
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Introduction Causeway Hospital’s frailty service consists of an Acute Elder Medicine/Stroke unit of 30 inpatient beds and a Frailty Direct Assessment Unit (DAU) for GP referrals and EmergenIntroductioncy Department (ED) patients suitable for same-day turnaround with comprehensive geriatric assessment (CGA) from our multidisciplinary team. We have devised a new Frailty Model to enhance our service, maximise integration between primary and secondary care services and facilitate more effective short-stay care and early supported discharge. Method To initiate this model, we plan to: 1. Strengthen

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Medicines Optimisation In An Acute Frailty Unit (AFU) - A Multidisciplinary Team Approach

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J Magee; J Grier; A McLoughlin; S Turkington; H Sedek; M Betts
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Introduction AFU aims to provide Comprehensive Geriatric Assessment to frail, older service users. A key component is Medication Review. Patients living with frailty are more susceptible to medication side-effects and are often on Falls Risk Increasing Drugs (FRIDs 1) and medications with Anticholinergic Burden (ACB 2) effects, which can cause falls/confusion/delirium/hallucinations. Aiming to reduce inappropriate polypharmacy, ACB and FRIDs scores, and optimise bone health is therefore essential. Data highlighted only 17% of patients received Medication Review by a Pharmacist, which needed

Benefits of Comprehensive Geriatric Assessment on an Emergency Surgical Unit

Authors' names
S Leung1; M Magee1; L Reid2
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Introduction; Patients living with frailty admitted under Emergency Surgery are vulnerable to complications, longer lengths of stay and readmission. Perioperative Care of the Older Person in Surgery (POPS) services are well evidenced and recommended by many national reports. Whilst they are well established in the other home nations, our POPS pilot in Craigavon Area Hospital is the first in N.Ireland. Method; Our POPS Pilot in the Emergency Surgical Unit aimed to identify all patients over 65 living with frailty and deliver high quality comprehensive geriatric assessment (CGA). This consists

A Descriptive Analysis of an Out-Patient Service Provided by a Hospital Based Frailty Intervention Team, 2021 - 2022.

Authors' names
H Cooney1; K Donlon1; S Burke1; F Finneran1.
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Introduction: The Frailty Intervention Team (FIT) is a multidisciplinary team that provides a service to community based frail adults. This particular service is novel in the sense that it is a hospital based out-patient service as opposed to frailty at the front door or a community based service and has access to rapid diagnostic and intervention services. Aims: The aim of this research is to share and describe the model of this relatively new and novel service for the benefit of other service providers. Method: A prospective database review was performed to provide descriptive data on the

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An observational study of the effectiveness of FIT test as a risk stratification tool in frail patients presenting with anaemia

Authors' names
Mosammath Monira Khatun1; Shafali Khanom2; Reshma Rasheed3
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Introduction: Faecal-immunochemical test is employed as a screening tool for colorectal cancer. Our observational study examined the FIT in primary care as a risk stratification tool in frail patients. Method: The records of 217 frail patients over a 24-month period were analysed. Patients with haematological indices of anaemia were offered FIT to detect GI haemorrhage as part of assessment for selection for lower GI investigations. Patients were risk stratified based on FIT results based on the presence or absence of red flags. Patients who were FIT positive were referred for urgent lower GI

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The association between the presence of medical care and resident outcomes: A retrospective cross-sectional analysis.

Authors' names
K Bali1; A Wagg1; R Murphy2; A Gruneir3
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Introduction: There is a high level of clinical need among residents but little is known about the role of physicians or nurse practitioners (NP) in the nursing home (NH) setting. Our objective was to test for associations between physician and nurse practitioner (NP) presence on care units and outcomes among nursing home (NH) residents. A retrospective cross sectional analysis of secondary data collected in the Translating Research in Elder Care (TREC) study during 2019-20. The sample consisted of 10,888 residents across 320 care units in 92 facilities. Methods: We used TREC Survey data

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Analysis of Level 3 Medication Reviews for Patients Reviewed by the Acute Frailty Team.

Authors' names
A McCulloch1; K Lowdon1.
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Introduction: The Acute Frailty Team (AFT) review all acute admissions referred to Medicine for the Elderly within our organisation. Our team is comprised of a consultant, AHPs and a specialist clinical pharmacist. The Clinical Frailty Scale Score (CFS) was used to quantify frailty within our patient population. Recognising that older patients are at increased risk of medicine related harm, medication reviews are undertaken as part of the comprehensive geriatric assessment. The aim of this project was to determine the number of documented Level 3 medication reviews on discharge including

Analgesia prescription in elderly presenting with acute pain – QI Project

Authors' names
K Karunakaran1; T O'Hare2; L Fielden3.
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Introduction: Acute pain is a common presentation of elderly and tends to be under-recognised and under-treated. Consequently, delayed and inadequate treatment of acute pain is known to lengthen in-hospital stay whilst reducing quality of life. Using local hospital guidelines for acute pain management in adults as gold standard, anecdotally we felt patients were not received medication as per guidance. A quality improvement project was undertaken with an aim to increase the number of patients >65 years old that received appropriate analgesia within the first 24-48 hours of presenting to the

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Is concerns about falling a risk factor for future falls? A systematic review of prospective studies

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Toby Jack Ellmers (Imperial College London), Jodi Ventre (University of Manchester), Ellen Freiberger (Friedrich-Alexander-University Erlangen-Nürnberg), Klaus Hauer (AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg), David B Hogan (University of Calgary), Lisa McGarrigle (University of Manchester), Samuel Nyman (University of Winchester), Mae Ling Lim (Neuroscience Research Australia), Chris Todd (University of Manchester), Kim Delbaere (Neuroscience Research Australia), The World Falls Guidelines Working Group on Concerns About Falling Background

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“The Patient is The Expert of Their Experience”

Authors' names
K Donlon1; F Morrissey2 ; H Cooney3 ; S Burke4 ; F Finneran5 ; V Gilleran6; Dr G O’Mara7.
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Rationale: The Frailty Intervention Team (FIT) is a multidisciplinary team that provides a service to community based frail adults. This particular service is novel in the sense that it is a hospital based out-patient service as opposed to a frailty at the front door or a community based service, and has access to rapid diagnostic and intervention services. As this is a novel service a qualitative study was undertaken to assess patient satisfaction and guide the direction and development of future quality improvements initiatives. Objective: To evaluate the satisfaction of service users with

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The 7 R's - Improving the safety of Residents with Swallowing difficulties

Authors' names
Daniel Oliveira
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Between 2016 and 2021, HSC Trust reported 1,383 choking-related adverse incidents, highlighting a pressing concern for patient safety. This Quality Improvement (QI) Initiative was developed within a Nursing Home specializing in caring for residents with learning disabilities who faced an elevated risk of eating and drinking difficulties. The primary objective was to enhance safety during meal times by integrating a structured safety pause, aligned with the "7 Rights" framework. The initiative leveraged various QI tools, including process mapping, PDSA (Plan-Do-Study-Act) cycles, structured

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PROGNOSTIC ROLE OF FRAILITY DERIVED FROM COMORBIDITIES AND LONGER-LIVING AGE GROUPS IN PATIENTS INFECTED WITH SARSCOV2

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Dulcey L1; Theran J2; Caltagirone R3; Gomez J1; Ciliberti M1; Blanco C1; Martinez J1; Mayorca J1; Parales R1; Cabrera V1; Cala M1; L Gutierrez1; C Herran1.
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Introduction: The use of the ROX index in COVID-19 patients allows evaluating those with a high risk of ventilatory failure, however, it has not been openly validated in patients who use a mask with a Hudson-type reservoir. Materials and Methods: retrospective study of 306 adults infected with SARSCOV2 by antigenic or molecular test. The main objective was to evaluate the role of the ROX index as a predictor of respiratory failure and mortality. In the inferential statistical analysis, the odds ratios OR with their confidence intervals greater than 95% will be used as association measures

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Epidemiological study on the relationship of Frank's sign with cardiovascular disease in geriatric patients from Latin America

Authors' names
- Dulcey L1; Theran J2; Esteban L2; Caltagirone R3; Gomez J1; Amaya M1; Ciliberti M1; Blanco C1; Martinez J1; Mayorca J1; Parales R1; Cabrera V1; Cala M1; Laura Gutierrez1; Catalina Herran1; Lizcano A1; Gutierrez E1.
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Introduction: The sign of Frank or sign of the cleft lobe has been associated with the existence of a disorganization of the elastic fibers and a thickening of the arterioles that causes a vascular sclerosis and a chronic local ischemia of the lobe of the ear. Objectives: To determine the relationship of the split lobe sign with cardiovascular diseases in geriatrics patients of the Internal Medicine service of a Southamerican hospital 2017 to July-2018. Methodology: A descriptive and cross-sectional observational study of cases and controls to establish a relationship between the sign of the

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Older adults' frailty, falls and balance predict onset of activity restriction due to concerns about falling at 1 year follow-up

Authors' names
T. Ellmers 1, K Delbaere 2, E. Kal 3
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Introduction. Concerns about falling are common among older adults. Many older adults with concerns about falling will restrict their activities. This can trigger a vicious cycle of physical deconditioning, falls, social isolation, reduced confidence, and a loss of one’s sense of self. However, not every older adult with concerns about falling will restrict their activities. In this prospective cohort study we therefore investigated the factors that predict the development of activity restriction due to concerns about falling in older people aged ≥75 years. Methods. Data were collected as part

Lived Experiences of Falls during the COVID-19 Pandemic in Middle-aged and Older Adults

Authors' names
JP Ventre1,2; T Hall3,2; PS Holmes2; CE Craig2
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Background and Aim: Falls are a significant public health concern, with literature primarily concentrating on older adults due to their perceived higher fall risk. However, recent studies indicate similar prevalence rates of fall-related injuries between older adults (>65 years) and middle-aged adults. Despite this, there is a scarcity of literature examining the differences in experiences of falls and concerns about falling between middle-aged adults and older adults who have experienced falls. The COVID-19 pandemic and the resulting lockdown measures created an unprecedented setting to

A Prospective Database Review: A Descriptive Analysis of an Out-Patient Service Provided by a Hospital Based Frailty Intervention Team, 2021 – 2022.

Authors' names
H Cooney1; K Donlon1; S Burke1; F Finneran1.
Abstract content

Introduction: The Frailty Intervention Team (FIT) is a multidisciplinary team that provides a service to community based frail adults. This particular service is novel in the sense that it is a hospital based out-patient service as opposed to community based service and has access to rapid diagnostic and intervention services. Aims: The aim of this research is to share and describe the model of this relatively new and novel service for the benefit of other service providers. Method: A prospective database review was performed to provide descriptive data on the service between 2021 & 2022

Stepping forward: A quality improvement project to improve post-falls assessment and management on old age psychiatric wards.

Authors' names
B Pandiyan1; A Adeyemi1; I Richards1; A Vos1
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Introduction: Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by underlying mental health conditions and associated treatments. NICE recommends that people who fall should undergo multifactorial assessment including a post-fall protocol with assessment for injury before being safely moved, a timely medical examination (within a maximum of 12 hours or 30 minutes if fast-tracked), neurological observations (if there is suspicion of head injury or unwitnessed fall) and a medication review. Aim: We aimed to assess the quality of post

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Perioperative intravenous fluids in elderly hip fracture patients

Authors' names
B Prabhu1; P Patel2; N Singh2
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Background Hip fracture in the elderly is associated with significant morbidity and mortality. These patients often have serious co-morbidities, including cardiac conditions, and are at risk of developing perioperative decompensation. Heart failure represents a common and serious perioperative condition in hip fracture patients1. We conducted a quality improvement project to identify incidence of perioperative pulmonary oedema and the possible risk factors. Method Retrospective analysis of patients aged 60 years and older admitted with hip fracture over a one month period. Perioperative period