Posters

Introduction People with Parkinson's disease are more likely to have osteoporosis and falls. They also have a higher risk of fractures, and their outcomes are poorer than in the general population. Despite this, only half of the patients seen in Parkinson's clinic have a bone health assessment. The aim of this project was to improve bone health assessments in the Parkinson's clinic at Mansfield Community Hospital. Method One plan - do-study-act cycle was completed with the implementation of a Parkinson's fracture risk assessment tool in the clinic. 19 clinic notes were evaluated over an 8-week

Title: Antibiotic Stewardship Audit in Gerontology wards in Princess Royal University Hospital Introduction: Misuse of antibiotics leads to the emergence of antimicrobial resistance, which is an important public health and patient safety issue. Infections caused by resistant organisms are associated with poorer clinical outcomes and undesired side effects. Aim: Assessing compliance with the antimicrobial stewardship package introduced by the UK Department of Health in 2011 and with the trust guidelines. Method: * Spot checks done across all gerontology wards between January and March 2024 to

Title: Evaluation of Frailty Assessment, Management Practices, and Patient Outcomes in GIM Patients Under 85 Years: A Two-Cycle Audit in GIM Wards at Queen Alexandra Hospital, Portsmouth Hospital University NHS trust. Introduction: Frailty significantly affects outcomes like length of stay and readmissions in elderly patients. At Queen Alexandra Hospital, inpatients under 85 are under the care of General Internal Medicine (GIM) wards and they lack regular access to frailty services. This baseline audit evaluated frailty assessment, management practices and patient outcomes, implementing staff

Introduction Residents of care homes for older people experience multi-factorial problems when being given oral medication. A systematic integrated mixed-methods review of the literature revealed that practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread internationally. There is a high prevalence of swallowing problems. Care home routines are time pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. The literature presented very little from the

Background: Anaemia, defined as insufficient haemoglobin to meet the body’s demands, is common in older adults. It is especially common in frail older adults, affecting over 50% of nursing home residents. In the elderly, anaemia is linked to increased falls, impaired cognition, reduced muscle strength, and poor quality of life. New iron deficiency anaemia (IDA) in those over 60 is a red-flag symptom that warrants urgent investigation for GI malignancy. Methods: This quality-improvement project used the Plan, Do, Study, Act (PDSA) framework in three audit cycles, including care of the elderly

Background Frailty in over 65s is common, but is not often assessed on medical admission at Barnsley Hospital. Identifying frail patients is clinically important, as it can highlight those who may benefit from a Comprehensive Geriatric Assessment –an intervention which has been shown to reduce mortality and improve independence. Introduction At Barnsley Hospital, only 13.49% of patients aged over 65 admitted to the Acute Medical Unit (AMU) were found to have a documented Rockwood Clinical Frailty Score (CFS). This project aimed to increase this to a target of 30%. Methods A survey conducted

Introduction: Opiates are suitable analgesics in acute pain. However, there is no evidence to support their use in chronic pain and NICE discourages its prescription. Opiates are commonly prescribed amongst the elderly, and long-term use is associated with immunosuppression, hyperalgesia, fractures, falls and dependence. Once opiates are prescribed for acute-on-chronic pain, we should discourage long-term use by ensuring they are reviewed and weaned in the community and that patients are counselled on their risks. We aimed to promote effective opiate weaning practices upon patient discharge

Introduction: Orthostatic Hypotension is a significant cause of falls leading to injury and morbidity in elderly population. In an online survey by Royal College of Physicians (RCP) 271 out of 316 clinicians routinely performed these measurements and there were significant variations in how lying and standing BP is performed. This could have adverse effects on detection rates and accuracy of the procedure resulting in misdiagnosis. As a result, RCP has released guidance on L/S BP2 measurements in view of standardising practice and improving accuracy. The purpose of this QIP is to improve how L

Introduction The Older Persons Assessment and Liaison team at North Manchester General Hospital (NMGH) reviews geriatric patients using a Comprehensive Geriatric Assessment (CGA), as directed by the British Geriatric Society. The Anticholinergic Burden (ACB) score is an integral part of the CGA however it is often overlooked. ACB is the cumulative effect of taking one or more drugs used to block Acetylcholine. A greater ACB score increases the risk of developing adverse drug reactions such as; falls and urinary retention. As such, it is integral that we work to reduce patient ACB scores during

Delirium is a neuropsychiatric syndrome characterised by an acute fluctuation in attention and cognition and affects approximately one quarter of older patients admitted to hospital (1) (2). Delirium results in increased length of stay, increased risk of long-term cognitive impairment, increased mortality, and results in significant patient and carer distress (3) (4) (5). Electronic patient records for adults admitted to the Frailty Acute Medical Unit (fAMU) at Huddersfield Royal Infirmary from 2022 to 2024 were reviewed to assess whether delirium was identified, and whether this was discussed

Introduction: Discharge summaries (DS) for older patients can be more complex due to an increasing life-expectancy and multiple co-morbidities. However, this is not always reflected in the quality of DS produced. It is generally agreed that good quality DS should reduce readmission and improve patient care after discharge. Aims: Identify areas of weakness in Discharge summary V4 a on an elderly care ward at Salford Royal Hospital (SRFT) using a pre-established assessment and scoring tool. Secondary aims were to use interventions an educational session, poster (S.M.I.L.E) and acronym expansions

Introduction: Advance care planning is a process that allows individuals to make decisions about their future healthcare, including end-of-life care, by discussing and documenting their preferences, values, and goals with healthcare providers and loved ones.These are especially critical for patients with serious, life-limiting conditions or for frail older adults who may face unexpected health crises.It is a commonly recognised barrier to care planning however that senior doctors often do not have the time to complete it for all patient’s who require them and that junior doctors lack

Introduction Geriatric medicine is inherently complex and requires multidisciplinary integration. Simulation-based training is recognised as a method to enhance learning and improve patient outcomes. This project aimed to develop a multi-professional simulation programme within care of the elderly to mimic the multi-professional practice of geriatrics. Methods Ten half-day simulation sessions were run across two sites over two years. The scenarios cover frailty, orthogeriatrics, acute delirium, Parkinson’s disease, thrombolysis and palliative care. There were 57 participants, including 24

Direct Oral Anticoagulants (DOACs) have revolutionized the management of stroke prevention in non-valvular atrial fibrillation (AF), particularly in patients >65 years old who are at higher risk of thromboembolic events and bleeding complications. DOACs offer efficacy comparable to warfarin with a better safety profile and fewer dietary interactions making them suitable for elderly patients. However, challenges remain in patients with renal impairment, polypharmacy, poor nutrition or elevated bleeding risk. An audit at Derriford Hospital, Plymouth, evaluated DOAC prescriptions for stroke and

Introduction: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision and plan for escalation of care are essential components of holistic care for frail and elderly patients. Inappropriate resuscitation attempts in those populations lead to distress and harm. Improving communication about end-of-life care plan between healthcare professionals and patients/ families is key to delivering dignified care and reducing emergency “inappropriate crash calls”. Aim: The aim of this project was to assess and improve the completion rate of DNACPR forms and care escalation plans for patients

Background: The Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary tool, designed to promote holistic care of elderly patients and provide a framework for intervention. There is evidence that the CGA reduces mortality and slows progression of frailty. Performing such interventions in the acute setting can be complex and time-consuming. Introduction: The Older Person’s Assessment Unit (OPAU) at Weston General Hospital allows early identification of frailty and prompt intervention. We aimed to promote elements of the CGA by providing a tool for utilisation

A lighter load: Tackling ACB (Anticholinergic burden) in geriatric wards: Background: Exposure to high levels of anticholinergic and sedative medications significantly increases the risk of fall-related hospitalizations, delirium, and mortality in the elderly. While the dangers of traditional anticholinergic medications are well-documented, the cumulative effects of drugs with mild to moderate anticholinergic properties often go unrecognized in everyday clinical practice. Objectives: To identify the primary contributors to anticholinergic burden (ACB) in geriatric wards and propose practical

INTRODUCTION Polypharmacy represents a significant challenge in the vulnerable elderly population, where concurrent use of multiple medications increases the risk of interactions and adverse reactions, often precipitating acute events and complicated hospital stays. This necessitates thorough medication reviews to mitigate these risks; a hospital admission allows for such opportunities. METHODS This project aimed to evaluate and address the medication burden among elderly patients, following WHO's Global Patient Safety Challenge: Medication Without Harm. 50 patient’s medications were reviewed

Background: The UK National Osteoporosis Guideline Group (NOGG) guidelines 2021 recommend that all older patients presenting to geriatric clinics or wards should have a FRAX assessment guide BMD measurement and referral for DEXA or starting of drug treatment. Aims: 1) To increase the proportion of patients assessed by the acute frailty service (AFS) undergoing FRAX assessment to 85%. 2) Offer 85% of AFS patients with low-risk FRAX scores lifestyle advice. 3) Refer 85% of AFS patients with intermediate (below treatment threshold) FRAX scores for DEXA scans. 4) Refer 85% of AFS patients with

Improving Advance Care Planning Within Residential Homes Introduction: As care home residents are living with advancing frailty and multi-morbidity, it is important to initiate advance care planning as part of the comprehensive geriatric assessment and create universal care plans (UCPs). There is evidence that it can reduce inappropriate escalations of care, reduce hospital admissions, increase the proportion of residents dying in their preferred place and improve both resident and relative satisfaction. Method: Retrospective audit in June 2024 of residents within the five residential homes