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Outcomes of Deprescribing for people with Life-Limiting Conditions: A Systematic Review

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Rajeev Shrestha1, Emily Shaw1, Liam Mullen2, David Sinclair3, Felicity Dewhurst3,4;, Adam Todd1
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Introduction: Polypharmacy and potentially inappropriate prescribing are common in people with life-limiting conditions. While deprescribing - a structured approach to reducing or discontinuing medications - is one approach to address this, its impact in this population is not well understood. Therefore, this systematic review aimed to synthesise evidence on outcomes of deprescribing medication in this population. Method: A systematic search of MEDLINE, Embase, Scopus, PyscINFO and CINAHL was conducted to identify original studies reporting clinical-, medication-, and system-related outcomes
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Measuring extended Activities of Daily Living (eADLs) in 2025: what do older people and multidisciplinary professionals think?

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SA Hay1; JK Burton2; TJ Quinn2
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Introduction Measuring extended Activities of Daily Living (eADLs) is an important part of functional assessment. Several eADL scales are currently used, resulting in heterogeneity and lack of standardisation. Existing scales are potentially outdated, containing activities which are no longer considered relevant by older people. We aimed to explore the perspectives of older adults and healthcare professionals on eADL assessment to inform new approaches to eADL measurement. Method Semi-structured qualitative interviews were undertaken with older adults and healthcare professionals. Perspectives

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A Review of Catheter Use and Catheter-Associated UTI Prevention in Geriatric Patients on the Stroke Unit

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A AIZAD1; M D'COSTA1; S HOLLOWS1; M MIAH2, T SRI KANDAKUMAR1; V SRI KANDAKUMAR3; A BOHORQUEZ1
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Introduction Urinary catheterisation is frequently required in older patients on the Stroke Unit. However, inappropriate use significantly increases the risk of catheter-associated urinary tract infections (CAUTIs), which are particularly harmful in frail, geriatric populations. The appropriate use of catheters is necessary and strict documentation of the indication should be noted upon insertion. Research suggests more than a third of catheters are unnecessary (Saint et al., 2000). Recognising the need for timely review and if appropriate, removal of indwelling catheters is imperative in
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Establishing the prevalence of prescriptions for pharmacogenetic testable medications in a geriatric medicine inpatient cohort.

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M Patel1,2; H Dillon1; R Moore2, C Barry1,2.
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Introduction: Genetic testing in medical practice is becoming increasingly commonplace. Particularly relevant to geriatric medicine and polypharmacy is the science of pharmacogenetics; the testing of an individual patient to check for drug-gene interactions, which can determine if a new or existing prescription is a good fit for them. We wanted to establish the prevalence of prescriptions for medicines that have a known pharmacogenetic target in a population of people admitted to a geriatric medicine department at a UK teaching hospital. Methods: We conducted a retrospective cohort analysis

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Dopaminergic Management in Dementia with Lewy Bodies: Practical Insights from a Narrative Review

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Dory Anthony Ghanem1, Giovanni Palermo2,3,4, Robert Bryce1, Siobhan Coulter1, Alison Yarnall1,3,4
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Background: Dementia with Lewy Bodies (DLB) is the second most prevalent cause of degenerative dementia, with many DLB patients eventually developing parkinsonism. Dopaminergic agents, although somewhat efficacious in relieving motor symptoms, risk exacerbating non-motor, and especially neuropsychiatric, features. There is also limited practical guidance on managing parkinsonism in acutely admitted DLB patients with impaired swallowing. Objectives: This summary narrative assumes a critical synoptic perspective of the literature concerning the use of dopaminergic agents in DLB. Here, we aim to
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Exploring facilitators and barriers to engagement with technology among older adults with and without frailty

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Tricia Tay1; Fangyue Chen1; Leila Shepherd1; Michael Fertleman2; Ara Darzi1; Kate Grailey1
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Introduction Literature reviews indicate older adults are less engaged in using digital technologies due to reasons such as fear of falling and perceived lack of time. However, there is limited literature on the facilitators and barriers to engagement in digitally enabled interventions, like remote exercise programmes with sensors, among older adults with frailty. This study aimed to explore the facilitators and barriers to engagement in digital interventions among community-dwelling older adults with and without frailty. Method Community-dwelling older adults at or above 65 years old across

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The impact of digital interventions to reverse frailty – systematic review and meta-analysis

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Tricia Tay1, Fangyue Chen1, Hamzah Amin2, Balraj Maan3, Simon Dryden1, Michael Fertleman1, Leila Shepherd1, Kate Grailey1, Ara Darzi1
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Introduction Frailty is defined as a clinically recognised state of increased vulnerability, reflecting a decline in an individual’s psychological and physical reserves. Digital interventions, such as smartwatches, are increasingly utilised to monitor and support the health of older adults. Evidence on the effectiveness of digital interventions in reducing or reversing frailty is limited. This systematic review aimed to investigate the types of digital interventions tested and the resulting outcomes. Method The following databases: Medline, CINAHL, Scopus, PsychInfo and Embase were searched

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Improving Hospital Fall Management: Findings from a Second-Cycle Quality Improvement Project

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Jasmin Maghamifar1, Goksu Ozen1, Areefa Momtaz1, Wajiha Gul1, Fatin Ilham1, Bhatti Shahzad1, Kayteck Ling1
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Introduction Falls are a significant cause of patient harm in hospitals. Effective fall management requires timely assessment, early identification of risk factors, intervention, and thorough documentation. A quality improvement project (QIP) assessed compliance with key fall management measures through audit cycles. The second audit cycle evaluated progress following interventions implemented after the first audit. Methods A retrospective audit was conducted to assess adherence to post-fall assessment protocols. Key areas examined included timeliness of assessment, documentation of vital
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Percutaneous Endoscopic Gastrostomy in atypical Parkinsonian syndromes: survival and aspiration risk in an international cohort

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Tim Ruttle1, Edward Jones2, Cindy Towns3,4
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Abstract Introduction Dysphagia frequently occurs in movement disorders, leading to malnutrition and aspiration. Percutaneous endoscopic gastrostomy (PEG) provides nutrition directly into the stomach, bypassing the dysfunctional swallow. However, PEG insertion is a complex decision, both clinically and ethically. Although PEG outcomes are reported in other neurological disorders, there is limited research in atypical Parkinsonian syndromes such as Multiple Systems Atrophy (MSA), Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration (CBD). Insertion rates remain variable
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The associations between hearing loss and dementia and the therapeutic potential of hearing aids: An extended literature review.

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Aaliyah Khan.
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Introduction Research has suggested that age-related hearing loss (ARHL) may increase the risk of dementia, an incurable and prevalent condition. Unlike dementia, ARHL is prevalent but undertreated and modifiable. In the absence of a cure and under the pressure of an ageing population, preventative strategies targeting dementia are crucial. This review therefore explores the association between ARHL and dementia in more depth and considers the evidence that hearing interventions such as hearing aids (HAs) may reduce the subsequent risk of dementia. Method A comprehensive search strategy was
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The Mind-Body Connection: Developing integrated Old Age Psychiatry and Care of the Elderly services for people with Parkinson's

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C Penman1; J Parker2; S Duroux3; J Olds3; T Prasath4; R Ward4; E Stratton4
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The Mind-Body Connection: Developing integrated Old Age Psychiatry and Care of the Elderly Medicine services for people with Parkinson’s Disease: Service Development and Evaluation Introduction With approximately 17,300 new diagnoses per annum and the ageing population we are facing the ever-growing challenge of managing complexity in Parkinson’s disease (1). It is recognised that the neuropsychiatric symptoms of Parkinson’s disease are as common and at least as disabling as the motor symptoms (2). These symptoms remain under-recognised and under-treated and evidence suggests that they are

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Associations between accelerometry-measured physical activity, sleep, and mobility improvement in hospitalised older adults

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NJT Wee1; LC Heng1; CY Chia1; WQ Mok1; JA Low1,2; CY Cheong 1; PLK Yap1
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Introduction: Mobility decline during hospitalisation is common among older adults and is associated with adverse outcomes including prolonged length of stay, institutionalisation, and mortality. While physical activity and sleep are key modifiable factors influencing recovery and mobility improvement, their relationships remain underexplored in acute geriatric settings. Methods: We conducted a prospective observational pilot study involving 15 hospitalised older adults (mean age 84.9 years) admitted to an acute geriatric ward. Participants wore wrist- and thigh-worn ActiGraph wGT3X-BT

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‘What are we going to do about the catheter?’ Our team’s way of starting the discussion.

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Emma Brew, Catherine Kidd, Ellie Wilson, Sarah Keir
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Introduction: The cornerstone of catheter-associated urinary tract infection (CAUTI) prevention is avoiding unnecessary indwelling urinary catheter (IUC) insertion [1]. As part of a long-term project to reduce the number of catheters, the most common inserted device used across MOE wards in our hospital, we recently undertook a project to improve planning (does it need to stay, can we remove it?) and the reliability of information reconciliation around their use. Methods: We designed a data collection tool, analysing key aspects of IUC care, measured our performance at least twice-yearly using

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Continuous subcutaneous infusion of furosemide for treatment of decompensated heart failure in frail older people in a Hospital at Home Service

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Isobel Austin1; MinHee Kim1; Rhys Evans1; Katie Gaunt1; Rachel Davidson​1
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Decompensated heart failure is a common acute presentation to hospital amongst the frail older population (1). Treatment often involves intravenous furosemide, which is effective in inducing potent diuresis.​ However, this treatment can be associated with negative effects of hospital stay, such as hospital-associated infections, delirium and deconditioning. These risks are particularly significant for patients living with frailty, for whom admission can increase dependency, increase likelihood of readmission, and contribute to higher mortality. For many individuals with frailty, personal
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Pre-emptive holding of antihypertensives in the first three days after neck of femur fracture surgery: a study in an orthogeriatric ward

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Adam Turna1, Emma Lines2
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Introduction: Elderly patients undergoing surgery for neck of femur (NOF) fractures are at high risk of post-operative hypotension due to reduced physiological reserve. Hypotension in this context is associated with an increased risk of cardiovascular events and impaired recovery. Therefore, senior clinicians often pre-emptively hold angiotensin-converting enzyme inhibitors (ACE-Is) and calcium channel blockers (CCBs) for 48 hours post-operatively, but this practice is inconsistently followed by resident doctors. We audited the prevalence and impact of this practice, and introduced an

From Broad-Spectrum to Broad Thinking: Frailty-Based Antibiotic Stewardship in Action

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Dr Pharveen Jaspal1, Dr Shalini Rajcoomar2, Dr John Blair2, Kameron Shah3, Rachel Kay3, Dr Thekli Gee4
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Introduction Since COVID-19, Clostridioides difficile infection (CDI) rates have increased nationally, including at South Warwickshire Hospital Foundation Trust (SWFT) during 2022–2023. A Quality Improvement Project (QIP), in collaboration with the Antimicrobial Stewardship (AMS) team, identified older adults with frailty as high-risk for receiving broad-spectrum antibiotics, which were linked to higher CDI rates and poorer outcomes. To address this, a frailty-specific antimicrobial guideline was introduced to reduce inappropriate broad-spectrum antibiotic use, particularly co-amoxiclav, and
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An audit of inpatient falls - are we adequately addressing bone health?

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Ayesha Ahmed1, Kerri Ramsay1
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An audit of inpatient falls - are we adequately addressing bone health? Background: Falls in older adults frequently result in osteoporotic fractures, leading to longer stays, greater dependency, and long-term morbidity. Fragility fractures are estimated to cost the UK around £4.5 billion annually. Despite these serious implications, tools like FRAX, and routine assessments such as calcium and vitamin D levels, are still underused in the inpatient setting, especially following a fall. The National Osteoporosis Guideline Group (NOGG) recommends using the FRAX tool to estimate 10-year fracture
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A Project on Inpatient Falls: Are We Adequately Addressing Bone Health?

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Ayesha Ahmed1, Kerri Ramsay1
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Introduction Inpatient falls in older adults frequently lead to fragility fractures, with femoral fractures occurring in up to 82% of cases (RCP, NAIF 2023). These injuries significantly impact long-term morbidity and cost the NHS £4.4 billion annually (ROS, 2022). Despite tools like FRAX and national guidance (NOGG, 2021; NICE, 2022), bone health assessments remain inconsistently performed after a fall. Objectives To evaluate whether inpatients who fell received appropriate fracture risk assessment and bone protection in line with NICE and NOGG recommendations. Methods We conducted a
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A QIP Presentation: Reducing Deconditioning: Sit Up,Get Dressed, Keep Moving


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Kwei Eng Tan 1; Husam Eddie Mohamed 1; Azrai Iskandar Murhiz 1; Philip Mathew 1

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Introduction: Deconditioning remains a significant challenge for hospital inpatients, particularly the older patients. National campaigns such as “End PJ Paralysis” and “Sit Up, Get Dressed, Keep Moving” endorsed by the British Geriatrics Society, highlight the importance of maintaining mobility during hospital stays. We designed a QIP to raise awareness of deconditioning among nursing staff and resident doctors and to identify barriers preventing mobilization. Method: We conducted a QIP on a geriatric ward at Lincoln County Hospital, collecting quantitative data on the frequency of patients

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“All Hands On FSDEC”: Implementation of an MDT Delivered Same Day Emergency Care Unit for Older Patients Living with Frailty

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Binita Bhakta, Sabrina Walker, Emily Laithwaite, Chris Miller
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Introduction Older adults living with frailty are at high risk of harm in traditional emergency care settings whilst frailty prevalence is rising. The Frailty Same Day Emergency Care (FSDEC) service at University Hospitals of Leicester (UHL) was launched in January 2025 to provide rapid, specialist-led, multidisciplinary care outside the Emergency Department (ED) footprint. The aim: to assess, treat, and discharge patients on the same day, avoiding unnecessary and unwanted admissions and aligning with the NHS Long Term Plan. Method FSDEC operated as a three-month pilot within the medical SDEC

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