How the risk factors for Dementia vary in the United Kingdom: Results from the Global Burden of Disease Study
Introduction: Dementia is one of the leading contributors of disability in the UK. Evidence of a downward trend in age-adjusted incidence of Dementia has highlighted the potential impact of modifiable risk-factors in reducing the disease burden of Dementia. This research will determine how risk-factors of Dementia have varied over time, between the different countries of the UK, the different regions of England and by sex in the UK. Methods: This is a descriptive time-series of risk factors of Dementia within the United Kingdom (UK) between 1990 and 2019. Data was extracted from the Global
AN OBSERVATIONAL STUDY OF URINARY INCONTINENCE AND ITS CORRELATION WITH MENTAL HEALTH AND WELL-BEING IN A PRIMARY CARE POPULATION
Background: The prevalence of urinary incontinence and frailty increases with ageing. As an adaptive mechanism patients become socially isolated resulting in worsening of mental health anxiety and depression. Aims/Objectives: We undertook a retrospective observational study of frail patients with an eFI above 0.33 to look for a correlation between eFI, GAD and phQ-9 scores. Methods: The records of 600 patients with an eFI above 0.33 ( n=600 ) were analysed for declared symptoms of incontinence using the Michigan Incontinence Score Index (MISI) to see if there was a correlation with mental
An Evaluation of a Geriatrician-Led Acute Medical Admission Unit at Morriston Hospital, Swansea
Introduction The medical intake at Morriston Hospital is accepted on two units; Rapid Assessment Unit (RAU) and Acute Medical Assessment Unit. Both were acute physician-led until July 2021 (Phase 1). From July 2021, RAU became geriatrician-led (Phase 2). This evaluation concerns the performance of RAU. Phase 1 (Acute Physician-Led Unit) Between 01/08/2020-30/06/2021, there were 3102 admissions with a median length of stay (LOS) of 2 days on RAU. 37.2% of patients were discharged directly from the unit. (SBUHB data). A detailed analysis of 496 patients consecutively assessed between November
Medically Safe For Discharge (MSFD): Reducing doctor input in MSFD patients across geriatric medicine wards at a DGH in Somerset
Introduction: Large numbers of geriatric inpatients within acute settings are deemed medically safe for discharge (MSFD) but stranded within the hospital due to a lack of community services and social care packages, leading to increasing length of patient stay and reduced hospital flow. These patients do not require inpatient care and would otherwise be discharged to their home or residential care. This project aimed to identify these patients and rationalise their medical input to mirror a community setting (without routine daily medical reviews). Methods: MSFD patient were identified by the
A Quality Improvement Project to Improve End of Life Care Documentation on a Care of the Elderly Ward
INTRODUCTION The National End of Life Care (EOLC) Strategy highlighted the need for individualised, accessible, multi-disciplinary care plans for people nearing the end of life. Proformas provide a systematic approach to recording end of life discussions. Our Trust uses an electronic patient record (Cerner), which includes an “End of life care agreement” for people in the last days of life. An initial staff survey on a Medicine for the Elderly (MFE) ward highlighted a lack of familiarity with required documentation. The aim of this project was to improve end of life care documentation. METHODS
Hypocalcemia leading to fall in a patient with Multiple Myeloma: a case report
Hypocalcemia is seldom encountered in patients with multiple myeloma. It is usually due to secondary causes. Most reported cause amongst this population is bisphosphonate therapy. We report a case of a 65-year-old gentleman with a background of multiple myeloma presenting with worsening numbness and tingling in arms and legs. These symptoms eventually led to a fall. Blood tests revealed severe hypocalcemia. He had never been on any bisphosphonates. Despite repeated calcium replacement during admission, the severe hypocalcemia persisted, and his symptoms failed to resolve. His renal function
Demographic and clinical presentation of hospitalised patients with SARS-COV-2 omicron variant
Introduction Objectives of this retrospective study were to describe clinical presentations and mortality outcome of hospitalised patients with COVID-19 omicron variant within two acute district general hospitals and to evaluate demographic factors associated with these presentations and mortality. Methods Data was obtained over a month in 2021-22 from a retrospective survey of all patients hospitalised and detected to have SARS-COV-2 omicron variant infection. The trust serves a diverse multi-ethnic inner-city population. Data included socio-demographic details, vaccination status, admitting
Retrospective survey of Differential Diagnoses in a Neurovascular Clinic
Introduction Diagnosis of Transient Ischaemic Attack [TIA] is important to minimise risk of future strokes. This retrospective descriptive study aimed to describe frequency of alternative diagnoses in a busy inner-city neurovascular clinic and evaluate processes of assessment and investigations of ‘true’ TIA patients. Methods Data was obtained over a 2-year period [2019-2020] for all new patients assessed in a busy consultant-provided daily week-day neurovascular service that serves a million multi-ethnic, population. Data collected included socio-demographic details, final clinical diagnoses
Socio-demographic and risk factor differences between TIA and TIA mimics
Introduction Diagnosis of Transient Ischaemic Attack [TIA] is important to minimise risk of future strokes. This retrospective descriptive study aimed to evaluate sociodemographic and risk factor differences between TIA and TIA ‘mimics’ in patients presenting to an inner-city neurovascular clinic. Methods Data was obtained over a 2-year period [2019-2020] for all new patients assessed in a consultant-provided daily week-day neurovascular service that serves a million multi-ethnic, population. Data collected included socio-demographic details, clinical risk factors, source of referral and final
Persistent Post-COVID-19 Symptoms and Functional Status after 12-14 weeks of recovery, Tamil Nadu, India, 2021
Introduction Most of the patients completely recovered after COVID-19 infection. However, a substantial proportion of patients infected with COVID-19 continue to have symptoms long past the time they recovered from the initial disease. Understanding the burden of post-COVID-19 symptoms is vital in planning Post COVID care. We assessed the burden of persistent post-COVID-19 symptoms and functional status after 12-14 weeks among those who recovered from COVID-19. Method We obtained the list of COVID-19-positive cases between February 25 and March 09, 2021, from the COVID-19 surveillance unit in
Fluorine-18-Fluorodeoxyglucose PET CT (18F-FDG PET CT) proven Valvular Endocarditis in a native valve Patient: A case report
Introduction Infective Endocarditis (IE) is an uncommon disease that can lead to serious complications and mortality. It is diagnosed based on modified duke criteria, with relevant findings on clinical examination, echocardiography, microbiological studies, and imaging, and the sensitivity of the same can be improved by new imaging techniques as per the European Society of Cardiology (ESC) 2015, if echocardiography/Microbiological studies are inconclusive, particularly to diagnose Prosthetic Valve Endocarditis (PVE). Case report A 79-year-old female presented with confusion and high-grade
Proactive IT-assisted CGA (i-CGA) in care homes improves adherence to preferred place of care & death, hospitalisation & mortality rates
Introduction: Primary care-based frailty identification and proactive comprehensive geriatric assessment (CGA) remains challenging. Our Devon-based Primary Care Network has developed and introduced an innovative, community-based IT-assisted CGA (i-CGA) process, which includes advance care planning (ACP). We wished to see if this process could improve effectiveness of ACP in residential care home (CH) residents. Methods/Intervention: 1) GPs clinically assessed all CH residents for frailty. 2) Proactive i-CGAs completed using our IT-assisted CGA tool, which prompts to review/consider/address
The Value of a Multidisciplinary Team (MDT) for patients with complex or unexplained syncope
Introduction: Syncope is a common clinical problem with a lifetime prevalence of 20%. 1 Syncope shares clinical features with other disorders including seizures, metabolic disturbances and sleep disorders. 2 The assessment and management of syncope can be challenging. The syncope service at the QEUH is run by geriatricians and cardiologists with an interest in syncope. Although MDTs are recognised key components in contemporary patient care in areas such as heart failure and cancer management, there is no guidance on MDT working in syncope management. 3/4 In November 2017, a syncope MDT was
Towards an understanding of the biological mechanisms of delirium using functional MRI: Pilot Study
Introduction Delirium is a common condition in older hospitalised patients causing high morbidity and mortality. The neurobiological basis for delirium is uncertain and, for numerous reasons, research in this area has been limited. Several recent studies have demonstrated that functional neuroimaging in delirium is achievable and has suggested that a brain region termed the default mode network (DMN), may play a cardinal role in delirium pathogenesis. We set out to develop a pilot study to demonstrate that it is feasible to undertake functional magnetic resonance imaging (fMRI) scans in older
The use of diagnostics in a Frailty Hospital at Home Service and the affect on patient-centred management.
A platform presentation to allow evaluation of diagnostics used in a Frailty Hospital at Home . An analysis of the data and a chance to explore the affect of diagnostics on subsequent hospital admissions or number of community team visits. Affect of diagnostics on management plans developed and whether they align with a person's documented goals. Data collected as part of an audit looking at the number of diagnostic tests taken by the Frailty Hospital at Home team. Subsequent outcomes including the number of hospital admissions, treatments started at home, subsequent number of community team
A Retrospective Service Evaluation of a Community Hospital Reablement Unit.
Introduction Gorseinon Hospital (GH) is a community rehabilitation facility which offers reablement following an acute admission to hospital. Patients are accepted from both medical and surgical specialty wards. Between 2015-2019 GH had median length of stay (LOS) 32 days. In 2018, 81% of patients returned to their own homes. Methodology A retrospective review of all admissions to GH from January to December 2021 (n= 256) to identify opportunities for service improvement. Results Median GH LOS was 53 days. Patients transferred from acute frailty and stroke services who received early
To Take Away: Quality Improvement Project assessing prescribing of fluid thickeners on discharge prescriptions
Introduction Dysphagia affects a large proportion of patients in hospitals and the community. Poor management of dysphagia results in aspiration pneumonia, malnutrition, and poor quality of life. Management, as recommended by Speech and Language Therapists (SALT), with the strongest evidence base for reducing aspiration pneumonias, is diet modification such as thickened fluids (Rosenvinge S, Starke I. Age and Ageing. 2005;34(6):587-593). Safe management of dysphagia is important discharge, as such this study focused on patients being discharged with fluid thickeners. Method We assessed current
Quality Improvement Project (QIP): Improving Delirium Assessment and Management in Geriatric Wards
1. Introduction Delirium is a very common and treatable condition, and approximately 20-30% of older patients in medical wards in hospitals presented with delirium. Hence it is important to do timely assessment and correct management of delirium. This QIP was carried out to improve adherence to the trust’s clinical guideline for delirium and to improve the communication with patients, relatives, and primary care doctors. 2. Method 40 patients’ notes were randomly reviewed in the geriatric wards of the Addenbrooke’s hospital as baseline, then 20 patients’ notes were reviewed again after PDSA
Putting patients first: improving timely reinstatement of existing DNACPR decisions in geriatric patients at Colchester hospital
Background: Delays in documenting a valid DNACPR (Do not attempt cardiopulmonary resuscitation) form in medical notes, for patients with advanced decisions, presses the cardiac arrest team to make difficult decisions about resuscitation, with little time to establish the patient’s wishes. This removes the right, for some patients, to die with dignity and peacefully. Local policy states patients with DNACPR forms should have this reviewed by the senior clinician in charge of their care as soon as is possible. Aim: To reduce the percentage of geriatric patients in Colchester hospital (with
Impact of isolation of Covid-positive patients presenting cognitive disorders in acute Geriatric units.
Introduction As we face a 7th wave of Covid in our geriatric wards, we as caregivers are exhausted and find it increasingly difficult to repeat these isolation measures again and again. We are aware of the importance of avoiding clusters but it is mostly the elderly who are positive for Sars-Cov-2 and hospitalised. Fortunately the virus no longer kills, but nevertheless has enormous deleterious consequences on the mental health of our elderly. Methods To expose the practical consequences of clinical cases experienced during these successive waves of Sars-Cov-2 and make a review of the