Posters

Introduction Delirium remains under-recognised. We wished to improve recognition of delirium on our assessment wards. Methods Data was collected prospectively on two admissions wards between 18/10/21 and 30/01/23 initially weekly, and then periodically to assess for the presence of a 4AT assessment by post take ward round. PDSA 1 -Departmental meeting to raise awareness and creating of an improvement team including doctors and ward managers. PDSA 2 -Teaching ward nurses “How to” do a 4AT and education sessions for nurses on delirium. Online guide on 4AT PDSA 3 -Adding 4AT to the admissions

Background North Central London Integrated Care System has invested in a pre-hospital programme where geriatricians and emergency physicians support London Ambulance Service via a telephone ‘Silver Triage’ in their clinical decision making on whether to convey an older person living with frailty to hospital. The results of the scheme are described elsewhere. Methods 452 cases were discussed with Silver Triage between November 2021 and January 2023. Paramedics using the service were sent a survey including a free text question on how the scheme could be improved which was analysed using

Introduction: In the current European guidelines, sarcopenia is diagnosed on the basis of low muscle strength, with low muscle mass used to confirm diagnosis. The added value of measuring muscle mass is unclear. We performed a systematic review to assess whether muscle mass was independently associated with adverse outcomes in patients with hip fracture. Method: The systematic review protocol was registered on the PROSPERO database (CRD42021274981). Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Clinicaltrials.gov) were searched for observational studies of patients with hip fracture

Introduction There is relatively little known about physical health of older people who are unpaid carers. The English Longitudinal Study of Ageing (ELSA) Wave 9 (2019) was used to examine the relationship between unpaid caring and health. This study contains information on frailty, caring, comorbidities and Instrumental Activities of Daily Living (IADL) from 8,736 participants 50 years and over. Methods We included participants who received a nurse visit in Wave 9 (n=3,047), 21 were excluded due to missing data. Frailty was calculated using the ELSA-Frailty Index (FI). Carers were those in

Introduction: NICE guidelines state that assessment of osteoporosis risk is a part of multifactorial fall assessment in older people who present with a fall (NICE clinical guidelines: fall in older people, June 2013). This audit was conducted to examine and improve our practice in assessing osteoporosis risk in patients admitted with fall to Care of Elderly department. Method: FRAX or QFracture are the recommended tools to evaluate the risk of osteoporosis and future fragility fracture. We have checked if any of these assessment tools has been used in patients who were admitted with a

INTRODUCTION: Frailty assessment in stroke is not commonly integrated into clinical practice, despite current clinical recommendations. Pre-stroke frailty is associated with longer-term mortality, length of admission, and disability. Similarly, anticholinergic burden (ACB) is not routinely reviewed, even though it is associated with cognitive and physical impairment, increased hospital admissions, and higher mortality in older people. Healthcare Improvement Scotland-Frailty (HIS-Frailty) is a novel tool for the evaluation of frailty in older people. Our aim was to compare and correlate the

Introduction Small vessel disease (SVD) lesions may cause symptoms apart from stroke. We aimed to determine whether white matter hyperintensity (WMH) progression and incident infarcts associate with gait, mood, and cognitive symptoms. Method We recruited patients with non-disabling stroke (modified Rankin Scale The baseline visit occurred 3months post-stroke. We repeated MRI and symptoms assessments every 3-6 months for 12 months, assessing WMH change and incident infarcts (i.e. new since previous scan) on DWI or FLAIR. We analysed WMH using cubed root normalised for intracranial volume. We

Background Dietary nitrate (inorganic nitrate) supplementation has been proposed as an intervention to improve muscle function via increased nitric oxide (NO) availability. Although some studies show benefit in younger adults, the effectsin older people are unclear. This systematic review evaluated the effects of dietary nitrate supplementation on physical performance and muscle strength measures in older people. Method The review was conducted according to a prespecified protocol by two reviewers. We included interventional studies using dietary nitrate supplementation, mean participant age

Introduction Substantial variations remain in hip fracture care delivery across the UK despite established standards and guidelines. We aimed to predict adverse patient outcomes following hip fracture from modifiable hospital-level organisational factors and develop implementation tools to improve national service delivery. Method We used a national record-linkage cohort of 178,757 patients (≥60 years) with a hip fracture in England and Wales (2016–19). We linked patient-level hospital admissions, National Hip Fracture Database and mortality data with 231 metrics from 18 hospital-level

Introduction: Older patients are vulnerable to falls after discharge as hospitalization could induce declines in physical function, mobility, and muscle strength. Falls may cause readmissions and subsequent healthcare burden. However, such incidence rates and costs have not been studied. This study aimed to investigate the incidence and costs of fall-related readmissions in older patients. Method: A population-based retrospective cohort study was conducted among patients aged 65 or over and discharged from public hospitals in Hong Kong from 2007 to 2017. The administrative data for inpatient

Background: Geriatrician assessment is associated with improved clinical outcomes for seriously injured older adults. In 2021, the Queen Elizabeth University Hospital opened a dedicated Major Trauma (MT) ward for adults with significant polytrauma. Four Geriatrician sessions were introduced per week, establishing the ‘Frail-T' service. Our aim was to provide specialist review to frail trauma patients within 72 hours of admission. Methods: All patients reviewed were prospectively added to a secure database. Patients >65 years on the MT ward were screened for frailty and reviewed if Clinical

Introduction: The Enhanced Health in Care Homes Framework recognises personalised advance care planning (ACP) as a key component of optimal healthcare for care home residents. We established a multi-disciplinary care home team providing comprehensive geriatric assessment (CGA), structured medication review (SMR) and advance care planning (ACP) to a pilot cohort of frail residents in 17 care homes. We aimed to explore the acceptability and perceptions of proactive ACP alongside CGA from the perspective of resident’s next-of-kin (NOK), primary care staff and care home managers (CHMs). Methods

Introduction The Scottish Care of Older People (SCoOP) collaborative regularly reports outcomes of acute geriatric medicine admissions across Scottish hospitals. The covid pandemic caused major and highly variable restructuring of acute services across the country. Their impact on activity and outcomes is unknown. Methods We collated all SMR01/SMR01E hospital episodes from Public Health Scotland from 1 st April 2017 to 31 st March 2022 where over 50% of the total episode was spent under acute geriatric medicine (code AB) and the diagnosis was not stroke. Activity and outcomes in 19 major

Introduction: Pharmacogenomics is using a patient’s genetic information to predict their likely response to a medicine. There is evidence that patients who receive pharmacogenomic-guided care benefit from a reduction in clinically significant adverse drug reactions. Therefore, pharmacogenomic testing can be used as a medicines optimisation tool to prevent adverse drug reactions in older people and reduce associated hospital admissions. This qualitative study aimed to identify the facilitators and barriers to implementing pharmacogenomic-guided prescribing in acute care for older patients by

An Acute Frailty Unit with focused MDT input decreases inpatient length of stay for older persons presenting with frailty syndrome(s). A Warner Introduction Older persons experiencing frailty are at risk of prolonged hospital stay causing adverse outcomes including mental and physical deconditioning, infections and falls (1). Tackling length of stay by ensuring patients return to their usual place of residence promptly, improves patient’s health and hospital flow (2) An Acute frailty unit (AFU) consisting of 3 male, and 3 female beds was established on the older persons ward (OPW) providing

Introduction Predicting outcomes after hip fracture is important for identifying high-risk patients who may benefit from additional care and rehabilitation. Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture surgery. Methods We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility

Introduction Alcohol use disorder (AUD) in older adults is increasingly common, under-recognised and under-treated within acute hospitals. Methods Consecutive patients seen by the Alcohol Care Team (ACT) at an acute NHS trust between January-April 2021 were invited to take part in a service evaluation. Baseline demographic and clinical data was collected in addition to community alcohol service referrals for all patients. For older adults (>64years), Older People’s Mental Health (OPMH) referral and hospital use data (ED attendances and admissions) in the 12 months prior/post index admission

Introduction The British Geriatrics Society and NHS England recommend that patients aged 65 and over should be screened for frailty when presenting to healthcare services to facilitate early comprehensive geriatric assessment (CGA). Recognition of frailty frequently relies on assessment by FY1s. We sought to assess a) how confident FY1s are in recognising and managing frailty, b) their understanding of CGA, and c) how these change during the year. Methods Questionnaires (quantitative and qualitative data) were given to FY1s at induction, 6 months, and 12 months. Teaching sessions on frailty

Introduction: The Enhanced Health in Care Homes Framework recognises personalised advance care planning (ACP) as a key component of optimal healthcare for care home residents ​(1)​. Documented ACP discussions guide decision-making in acute situations and may facilitate avoidance of inappropriate hospital admissions. Methods: We established a multidisciplinary care home service which aimed to provide comprehensive geriatric assessment (CGA) based ACP to all residents within three pilot care homes. We evaluated the effect of proactive, systematic CGA and ACP. Ambulance call-out and conveyance

Intro Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic method of recognising physical, psychosocial, and functional abilities & limitations of an elderly person. Assessment of the skin is an essential element of the physical domain of CGA as aging skin is more susceptible to loss of skin integrity. Common conditions including pressure sores, purpura from long term anticoagulation and steroid use, and venous stasis eczema put patients at high risk for developing infections. Therefore, it is essential to be cognizant of the condition of the elderly patients’ skin. We