The CGA Board Round – Improving documentation and communication for older adult inpatients, University Hospital Hairmyres
Background Acutely unwell hospitalised older people have better outcomes including mortality and functional status when CGA (Comprehensive Geriatric Assessment) is performed. A previous complaint, escalated to the Scottish Public Services Ombudsman, highlighted issues with CGA documentation and recording MDT discussion. This pilot project’s aim was to create a method for documenting CGA MDT plans and to embed this as routine practice for all inpatients on a Geriatrics ward. Method Following consultation with staff on this ward, a sticker was developed detailing status of medical and therapy
Evaluating a new delirium follow up clinic service
Background: Delirium is common and experienced by 20% of all admissions to hospital1. Studies have shown a link between delirium and development of dementia2 but there are not many services to follow such patients up post-discharge. A new service has been developed at New Cross Hospital run by Care of the Elderly Consultants with an interest in Cognition. Methods: A delirium follow up clinic was designed to assess these patients after 6 to 8 weeks from discharge following hospital admission or reviews in Frailty. We set up a referral criteria for prolonged or recurrent delirium follow up
Promoting Activity, Independence and Stability in Early Dementia and MCI: the PrAISED Randomised Controlled Trial
Introduction People living with dementia and MCI progressively lose abilities, through increasing cognitive impairment, co-morbidities, inactivity, acute illnesses and injuries. Rehabilitation therapy may reduce disability and falls and increase resilience. Methods We co-produced a therapy intervention, comprising strength, balance and dual-task exercises, functional activity training and promoting community access, providing up to 50 therapy sessions, delivered over 12 months and underpinned by a behaviour change strategy. We evaluated the intervention in a 5-site multi-centred Randomised
What patient-reported outcome measures are used in research involving older adults with frailty? A rapid review
Introduction: The need to develop and evaluate frailty-related interventions is becoming more pertinent as life expectancy increases. Patient-reported outcome measures (PROMs) are arguably essential in this field of research, and can be defined as “ any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else” (FDA 2009). Numerous validated questionnaires can be classed as PROMs, but seem inconsistently used, and of uncertain relevance to/for those living with frailty. This rapid
Improving the Multidisciplinary Team Meeting in a Community Hospital
Introduction Whitehills Health and Community Care Centre (WHCCC) is a 31-bed community hospital. Weekly multidisciplinary team (MDT) meetings occur to co-ordinate care and discharge planning. The format prior to this quality improvement project was meetings twice per week using Microsoft Teams. Errors were noted such as incorrect discharge dates and missed referrals. Aims: improving information transfer during MDT meetings, reducing errors in communication, reducing meeting duration and improving staff satisfaction. Methods Data was collected in the format of surveys distributed to members of
Reducing hypoglycaemia on the Care of the Elderly wards: A multidisciplinary team focused quality improvement project
Introduction Older adults with diabetes are at increased risk of hypoglycaemia during inpatient hospital stays. It was noted that a large proportion of diabetic patients on the care of the elderly wards at North Middlesex University Hospital were experiencing hypoglycaemia so a quality improvement project was devised to address this issue and improve patient safety. Method Baseline data was collected in October 2021 by monitoring the glucose levels of 21 diabetic inpatients across three care of the elderly wards over a 72-hour period. The project consisted of 3 interventions introduced on one
Delivery of resistance exercise for older people with probable sarcopenia or frailty - the Benchmarking Exercise Programmes for Older People (BEPOP) project
Introduction Resistance exercise is an effective intervention for older people at risk of, or living with, sarcopenia and frailty. Surveys of current UK practice in exercise prescription for these conditions found that resistance exercise was offered in only 9% of departments and was often not optimised for sarcopenia and frailty. The Benchmarking Exercise Programmes for Older People (BEPOP) project is a joint British Geriatrics Society and AGILE initiative to promote best practice in the prescription of resistance exercise for older people. Methods Using an online data collection tool, 10
Video-Recording Patients for Direct Care Purposes A Systematic Review Sub-Group Analysis on the Older Patient
INTRODUCTION Video-recordings of patients may offer advantages over text-based documentation to supplement assessment and decision-making – particularly for older patients with complex needs. Our systematic review aimed to evaluate the application, acceptability, and impact of video-based records; here we highlight current evidence on using video-recordings to support direct care delivery for older patients. METHODS Five electronic databases (Medline/Embase/PsycInfo/Cochrane/HMIC) were searched from 2012-2022. Studies involving videorecording patients aged ≥ 18 years for diagnosis, care, or
Delirium in hip fracture patients admitted from home is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation and readmission to acute services: The IMPACT Delirium study
Delirium in hip fracture patients admitted from home is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation and readmission to acute services: The IMPACT Delirium study RS Penfold1,2, AJ Hall2,3,4, A Anand5, ND Clement2,4, AD Duckworth4,6, AMJ MacLullich1,2 1. Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK 2. Scottish Hip Fracture Audit, Edinburgh, UK 3. Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK 4. Edinburgh Orthopaedics, Royal
Using Patient and Public Involvement (PPI), Data and Design to Communicate about Frailty to the General Public
Introduction Despite the high prevalence of frailty among older people, the clinical definitions and implications of frailty are not well understood by the public. Existing communication material is predominantly technical in nature and aimed at healthcare professionals. This project integrated expertise in geriatric medicine, data science, user design and patient and public involvement (PPI) to develop an accessible visual communication resource on frailty that linked data stories, clinical perspectives and public views of frailty in later life. Methods We recruited three public contributors
Can an Advanced Clinical Practitioner (ACP) lead the development of a POPS service?
Introduction: Perioperative medicine for the Older Patient undergoing Surgery (POPS) is an established, evidence based medically led service across many Trusts. However, with consultant workforce constraints, the aim was to determine if an alternative ACP led model of care, with consultant geriatrician oversight, delivered the same benefits. Method: • A senior nurse, with POPS expertise, was seconded for one year to oversee the project. NHS Elect network supported, from February to October 2022, with monthly meetings, data analysis and facilitated shared learning from other sites • An ACP from
Mediation effect of childhood health status, life adversities, financial condition, and network satisfaction on suicidal ideation
Introduction: The study is to explore how childhood health status ( X), early life adversities ( M1), financial condition ( M2), and satisfaction with social networks ( M3) are associated with the development of suicidal ideation ( Y) over time among older adults in 13 European countries. Respondents were drawn from the Survey of Health, Ageing, Retirement in Europe (SHARE) conducted in 2013 (Wave 5), 2015 (Wave 6), 2016 (Wave 7), and 2020 (Wave 8). 56.8% (n=10043) of respondents were female, and 43.2% (n=7642) were male. The mean age at Wave 8 was 72.35 (range 60-103). Method: The conditional
The taste and acceptability of a high protein, fortified ice cream compared with hospital milkshake nutritional supplement
Introduction: Oral nutritional supplement (ONS) prescription is commonly recommend for malnourished patients in hospital. However, compliance to ONS is often low. Ice cream may be a promising nutritional intervention. We undertook a study designed to compare the acceptability of high protein, fortified, ice cream called Nottingham-Ice Cream (N-ICE CREAM) with routinely prescribed milkshake ONS. Methods: Fifty older (≥ 65 years) inpatients with hip or spine fractures were recruited from Queens Medical Centre, Nottingham. Patients were randomised into two groups, receiving two days of N-ICE
Delayed Discharges in Care of the Elderly ward
Introduction : The delayed discharge is defined as patient is deemed medically fit to leave hospital but is unable to do so for non-medical reasons. Delayed discharges are associated with mortality, infection, depression, reduction in patients' mobility and their daily activities. Aim and Objectives: 1.Recognition of different causes of discharge delays will allow health professionals, hospital administrators to propose potential strategies for minimising delays. 2.To identify causes of prolong delays in discharge among elderly patients.3. To propose strategies for eliminating advisable delays
A Green Quality Improvement Project: Sustainable Waste Disposal in a Geriatric Admissions Unit
Introduction: Following COP26, the NHS pledged a ‘Net Zero’ health service by 2040. Incineration of clinical waste has a negative impact on the environment whilst also being extremely costly. NHS Grampian spends over £1m annually on disposal of clinical waste, whilst 20% of the waste incinerated is unsuitable for that waste stream. An excess of clean plastic packaging from visors, used when managing respiratory viruses, was a particular contributor in our unit. To improve sustainability, the aim of this quality improvement project was to reduce unnecessary disposal of plastic packaging in
Next of Kin Communication Quality Improvement Project
Background Effective communication is a vital attribute in the healthcare profession. Ineffective communication between healthcare professionals and patients can impede patient safety. The three most common complaints received by GMC were related to medical treatment, communication problems and perceived lack of respect for the patient 1. In a study undertaken across three NHS trusts in England between May 2013 and September 2014, 22% of the incidents reported were associated with communication 2. Inefficient record-keeping related to communication was the issue. Methods To evaluate the
Summarising Rehabilitation for COVID-19 Patients: A Literature Review and Synthesis of COCHRANE REH-COVER
Background: The role of rehabilitation medicine in treating post-acute COVID-19 survivors is currently ill-defined. Recently developed evidence-based initiatives, such as Cochrane REH-COVER, aim to describe the management of COVID-19 patients, but the variance and overlap in intervention types result in clinical uncertainty. Objective: To provide a summary of delivered rehabilitation services for COVID-19 patients during the pandemic. Methods: We collected evidence from the full set of REH-COVER Rapid living Systematic Reviews between March 2020 and February 2022 using the supplementary tables
Empowering Frail Older Adults to Make Healthcare Choices
Introduction: Frailty is a state of increased vulnerability to physiological stressors, which is associated with increased risk of adverse outcomes such as falls and delirium in older adults. For this patient group, healthcare decisions (as in whether to undergo elective surgery or continue a burdensome outpatient treatment) often have far-reaching consequences. Despite broad consensus that healthcare decision making should be a collaborative process, studies have shown frail older adults struggle to make healthcare choices and often do not feel fully involved in the decision-making process
The burden of multimorbidity amongst older hospitalised adults in northern Tanzania: A multi-centre study
Background: Populations in sub-Saharan Africa are ageing rapidly and Tanzania is one country experiencing this acute demographic shift. Multimorbidity (the presence of two or more chronic conditions (1)) is common in the community and associated with greater risk of hospitalisation. To-date, the prevalence amongst older hospital inpatients is unknown. Objective: To establish the prevalence of multimorbidity amongst older hospitalised adults in northern Tanzania. Methods: For 6-months, adults aged ≥60 admitted to medical wards in four hospitals were invited to participate. A standardised
Clinical outcomes of older hospitalised adults living with frailty in northern Tanzania: A prospective multicentre study
Background: As global populations age, healthcare systems are facing challenges posed by multimorbidity, disability and geriatric syndromes. In high-income countries, frailty is a strong predictor of poor hospital outcomes. Comprehensive Geriatric Assessment is effective but resource-intensive and unavailable in sub-Saharan Africa where specialist geriatric training and allied health infrastructure are limited. Objective: To establish clinical outcomes of older adults with frailty admitted to hospital in northern Tanzania.= Methods: All adults aged ≥60 years admitted to medical wards at four