The views and the use of information communication technologies to access dementia post-diagnostic support: a systematic review
Introduction: Post-diagnostic support is key to ensuring the well-being of people with dementia and unpaid carers. The COVID-19 pandemic has caused a shift from in-person to remote service delivery, often with the use of information communication technologies (ICT) formats. This systematic review examined how ICT has been used to access remote post-diagnostic support services that address the needs people with dementia, or those of dyad, and explored care recipients’ views on accessing dementia-related support remotely. Method: Concepts relating to dementia and ICT were searched across six
Sleep deprivation induces aging like changes in antigravity muscles of young adult male wistar rats
Introduction: Poor muscle health is associated with a series of chronic and metabolic conditions that are prevalent in individuals who chronically experience poor-quality sleep. But there is no study deciphering the role of sleep deprivation on muscle ageing. Therefore, in the present study we have measured the ultrastructure, histopathology, and oxidative stressors in soleus muscle of wistar rat after sleep deprivation and recovery sleep. Material and Methods: The experiments were conducted in18 rats of three groups. Group I rats had normal sleep wake cycle, Group II rats were subjected to 24
The impact of acute healthcare utilisation on functional decline in older adults over time: A Population-Based Cohort Study
Introduction: Acute healthcare use varies by age, with older adults the highest users of most acute healthcare services. International reports have highlighted increased use of Emergency Department (ED) services by older adults . Older adults who visit the ED may be admitted to hospital or discharged home and are vulnerable to adverse outcomes including cognitive decline, falls, readmission, mortality and hospital acquired limitations in activities of daily living. Using data from The Irish Longitudinal Study on Ageing (TILDA), the aim of this study was to investigate the impact of acute
FRailty and Arterial stiffness – the role of oXidative stress and Inflammation (FRAXI study)
Introduction There is an association between frailty and arterial stiffness. However, arterial stiffness does not uniformly correlate with the spectrum of frailty states. Both oxidative stress and inflammaging contribute to vascular aging. There are no human studies exploring links between arterial stiffness, oxidative stress, inflammaging and frailty. Our objective is to investigate arterial stiffness and inflammaging as predictors of frailty states. Methods An observational longitudinal cohort study will be used to examine the association between arterial stiffness, oxidative stress, and
Improving hydration in elderly patients on outlier wards at Newham University Hospital (NUH)
Introduction: Dehydration is a major contributing factor to morbidity and mortality in elderly patients, as they are at greater risk and more vulnerable to the consequences of inadequate fluid intake. Care of the Elderly (COE) wards are set up to meet the specific care needs of elderly patients, however, these care needs are not consistently met on medical outlier wards at NUH. This project aimed to improve hydration-related patient care on outlier wards using a sustainable intervention by increasing average daily fluid intake (ADFI) by 50% and patients with drinks within an arm's reach by 50%
Frail Trauma Pathway: Encountering stumbling blocks
Introduction: The Trauma Audit and Research Network report “Major Trauma in Older People” highlighted the need to recognise falls in older patients as a mechanism leading to potentially life-threatening injuries. Reasons behind falls can be equally serious and must be addressed concurrently. A Frail Trauma Pathway was introduced in the Emergency Department (ED) of a Major Trauma Centre (MTC) and subsequent audit revealed it was underutilised. We relaunched the Frail Trauma Pathway incorporating a checklist with the aim of improving patient care. Method: Retrospective data was collected over
Perioperative geriatric review of surgical patients: compliance with NCEPOD standards at BHNFT and patient outcomes
A National Confidential Enquiry of Patient Outcome and Death (NCEPOD) report ‘An Age Old Problem’ in 2010 highlighted the failure of the NHS in providing good quality clinical care for elderly patients undergoing surgery. This report generated important guidelines aimed at improving the perioperative care of elderly patients. NCEPOD standards state 95% of elderly patients receiving a geriatric review as part of their perioperative care. A closed loop audit with two completed cycles in 2018 and 2021 and an ongoing cycle in 2022 looks at the compliance of Barnsley Hospital NHS Foundation Trust
Quality Improvement Project on Medical Discharge Letters
INTRODUCTION The aim of this quality improvement project was to assess the medical discharge letters written by medical colleagues at this trust against the guidelines set by the Royal College of Physicians. The target was to achieve at least 90% compliance across the components evaluated at the end of this project. METHOD This quality improvement project evaluated medical discharge letters from three medical wards. Following the application of filtering criteria, a sample size of approximately 20 patients was randomly selected for data collection. Sections that were evaluated in the discharge
Improving Advanced Care Planning in Severe Frailty
Introduction: NICE guidance recommends that doctors need to identify patients who are approaching their final year of life, through the utilisation of tools such as the Clinical Frailty Score (CFS). The 'Getting it right first time' (GIRFT) document recommended that all local health systems identify older people in the last phase of life and offer them Advanced Care Planning (ACP). Wigan has a large population of frail patients who would benefit from ACP discussions. Aim: Initiate a strategy for identifying patients with severe frailty and establish a process for implementing ACP. Method
'Frailty as an adjective rather than a diagnosis' - The Identification of Frailty in Primary Care: a qualitative interview study
Introduction In 2017 NHS England introduced proactive identification of frailty into the General Practitioners (GPs) Contract. There is currently little information as to how this policy has been operationalised by front-line clinicians, their working understanding of frailty, or perceptions of impact on patient care. Evidence from international settings suggests primary care clinicians may have mixed interpretations of frailty, with important implications for their willingness to support different frailty interventions. We aimed to explore the conceptualisation of frailty, and how community
Review of outcomes of patients admitted to an Enhanced Assessment Bed at an Intermediate Care Unit
Introduction The Norman Power Centre (NPC) is an Intermediate Care Unit, in Birmingham, UK, providing enhanced assessment beds (EAB) where patients undergo functional assessment after an acute admission. There is little published data regarding the outcomes for patients admitted to EAB, so we set out to analyse outcomes in our unit. Method Data was collected from 50 patients who were discharged from EAB between September 2021 and March 2022. Results The mean length of stay was 36 days, median was 29 days. Of the 50 patients: 4 went home with no services, 9 went home with Early Intervention
The ‘Consultation Communication’ Proforma: enhancing effective communication between Outpatients and Intermediate Care
Introduction The Norman Power Centre (NPC) is a 32 bedded Intermediate Care Unit, run by an acute hospital trust in Birmingham, UK, for patients who require ongoing 24 hour care, rehabilitation or further assessment, but do not need to be in an acute hospital setting. These frail patients attend numerous outpatient hospital appointments, but rarely do staff receive communication back from these outpatient reviews. This can lead to delays in implementing specialist management plans, with potential for adverse outcomes for patients and increased staff workload in seeking out the required
Can P1NP levels influence management planning for patients with a fragility hip fracture receiving anti-resorptive medications?
Introduction: Procollagen-N-terminal-peptide(P1NP) is a bone formation marker. Bisphosphonates lead to a reduction in P1NP levels and levels are significantly elevated shortly after fracture. In older patients taking bisphosphonates who have had a further osteoporotic fracture there is a lack of evidence to guide ongoing osteoporotic management. Objectives: To assess if measuring P1NP in patients receiving Bisphosphonates treatment who develop neck of femur fractures helps guide further management in regards to long term bone protection treatment. Methodology: Retrospective descriptive cohort
A cross-sectional study exploring the treatment burden in people with Parkinson's and their caregivers
Introduction Treatment burden is the workload of healthcare and its impact on patient well-being and functioning. High treatment burden in other long-term conditions is associated with poor health outcomes. This study aimed to determine the extent and levels of treatment burden among people with Parkinson’s (PwP) and their caregivers, and explore modifiable factors. Methods A cross-sectional survey using the Multimorbidity Treatment Burden Questionnaire (MTBQ) to measure treatment burden was conducted among adults (age >18 years) diagnosed with Parkinson’s or self-identified caregivers of
Using the Supportive and Palliative Care Indicators Tool (SPICT) to prioritise frail inpatients for Anticipatory Care Planning
Introduction Patients with frailty who have emergency admissions are at risk of mortality and may benefit from Anticipatory Care Planning (ACP). Appropriate identification, to target limited resource in an in-patient environment can be challenging. We conducted a prospective study on a cohort of frail in-patients with a hospital admission of ≥ 72 hours duration. We aimed to evaluate the effectiveness of the SPICT tool alongside Clinical Frailty Score (CFS) as a predictor of mortality to improve our targeting of patients for ACP. Method. On a single day a SPICT form was completed prospectively
Virtual Frailty Ward - Post Discharge Frailty Support (PDFS)
Background: In response to the COVID pandemic when new robust discharge criteria were introduced to facilitate early discharge to optimise hospital capacity, Post Discharge Frailty Support (PDFS) was established. PDFS provides nurse-led telephone follow-up for patients discharged primarily from the Emergency Department (ED) and the Acute Frailty Assessment Unit (AFAU). Objectives: We aim to provide continuity of care by following up frail elderly patients at home, reviewing their medical, functional and social progress post discharge and ensuring they received adequate support to avoid
Palliative Care Movement Disorders Multidisciplinary Meeting
Introduction It is well recognised that patients with Parkinson’s disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting. Method In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson’s
Postural hypotension Quality Improvement Project– How good we are in measuring it?
Introduction: A large proportion of Morriston Hospital’s acute medical take consists of elderly patients admitted with falls. Postural hypotension is a cause of syncope and fall which contributes to morbidity, disability and death in cases of injury in the frail and elderly population 1. Hence, diagnosing and treating postural hypotension is crucial. It is important that the measurement of lying-standing blood pressure (LSBP) is consistent to ensure reliability of results as this would affect patients’ management. The aim of this project is to assess how postural hypotension is diagnosed in
Do Not Attempt Conversations Pre Rehearsal: Teaching Medical Students to Have DNACPR Conversations.
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel
Frailty, loneliness and social isolation in the UK Biobank cohort
Background : Three challenges for ageing populations are frailty (a state of reduced physiological reserve), social isolation (objective lack of social connections), and loneliness (subjective experience of feeling alone). These are associated with adverse outcomes. This study aims to examine how frailty in combination with loneliness or social isolation is associated with all-cause mortality and hospitalisation rate using data from UK Biobank, a large population-based research cohort. Methods: 502,456 UK Biobank participants were recruited 2006-2010. Baseline data assessed frailty (via two