bluuebunny/crossref_metadata_2025 huggingface dataset:
150 The Association Between Increasing Frailty and Greater Co-Morbidity and Surviving Cardio Pulmonary Resuscitation
Authors: Thomas E , Lloyd A , Leopold N
Published: March 2021

Introduction

Population ageing is a triumph of public health and medical advancement but it can equally lead to burdensome and futile interventions at the end of natural life. This is especially relevant when offering treatments such as cardiopulmonary resuscitation (CPR) that can carry a significant burden of harm. The aim of this study was to investigate the association between increasing frailty and greater co-morbidity and surviving CPR.

Method

A retrospective analysis of prospectively collected data from contemporaneous patient notes and electronic patient records of all patients that suffered an in-hospital cardiac arrest between 1st April 2017 and March 31st 2018 in a tertiary hospital (that includes tertiary cardiology) in South Wales was undertaken.

Results

A total of 113 patient records were assessed. Average patient age was 74. Patient frailty was assessed based on calculation of Rockwood score (RS) and co-morbidity assessment based on Charlson index (CI). We identified a strong linear correlation between increasing CI and poor survival and rates of ROSC. No patient with a Charlson index of above 6 survived one year. Similarly, patients with a RS between 1–3 had a survival to discharge, 30 day and 1 year survival rate of 45.7%. Only 10.3% of those with a RS between 5–9 survived 1 year post cardiac arrest. No patient with a RS above 6 survived one year. No association between duration of CPR and patient frailty was identified. Increasing age was also found to be linearly associated with reduced likelihood of survival. This association was much less significant than the association with increasing RS or CI.

Conclusion

It is clear from our findings that both increasing patient frailty and level of co-morbidity significantly adversely affect survival from CPR. Accurate individualised assessment of both of these factors is therefore imperative when assessing the appropriateness of undertaking CPR.
152 The Relationship Between 25(OH) Vitamin D and Bone Mineral Density (BMD) in Patients 65 Years and Older with Prior Fragility Fractures
Authors: Obiechina N , Michael A , Nandi A , Jameel I , Javed F
Published: March 2021

Introduction

25(OH) vitamin D [25(OH) D] levels are known to influence skeletal health as well as muscle function. Some studies suggest a positive association between 25(OH) D levels and BMD at various skeletal sites in men but not in women. These findings were mostly observed in younger (less than 50 year old) cohorts. Evidence for this association in older patients with prior fragility fractures is lacking. Aim: To assess the correlation of 25(OH) D levels with T-scores at the neck of femur, hip and spine in patients 65 years and older with prior fragility fractures and the effect of gender on the correlation.

Methods

A retrospective, cross-sectional analysis of patients 65 and older with previous fragility fractures in patients attending a fracture prevention service. Data was extracted from the electronic records. SPSS 26 statistical software was used for statistical analysis. Pearson correlation coefficient was used to calculate correlation and regression coefficient for gender.

Results

151 patients were included; 26 males and 126 females. Mean age was 76.2 and 74.1 years respectively. In the males there was good positive, statistically significant correlation between the 25(OH) D and T-scores at the neck of femur (r = 0.415; p < 0.05) and hip (r = 0.413; p < 0.05), but correlation with T-score of the spine was not statistically significant (r = 0.349; p = 0.103). In the females there was no statistically significant correlation between 25(OH) D and T-scores at the neck of femur, hip or spine (r = 0.163; p = 0.077), (r = 0.096; p = 0.299) and (r = 0.114; p = 0.217) respectively.

Conclusion

In males, 65 years and older, with prior fragility fracture, there is a positive significant correlation between 25(OH) D and BMD at the neck of femur and hip whereas there is no significant correlation in females.
153 Age and the Extent of Chest Radiographic Findings in Hospitalized Patients with COVID 19
Authors: Fernandez A , Michael A , Obiechina N , Nandi A , Koh J
Published: March 2021

Introduction

Since the emergence of COVID 19 in December 2019, its clinical and radiological features are still being discovered and their prognostic implications evaluated. Chest X-ray (CXR) typically shows patchy or diffuse asymmetric airspace opacities. Regardless of the different classifications of radiological findings that have been used, it is becoming clear that multi-lobar changes in the lungs are associated with poorer outcomes than single lobar involvement or minimal/no radiological abnormalities.

Aim: To assess the correlation of age with the extent of CXR findings in hospitalized COVID 19 patients.

Methods

A retrospective, cross-sectional analysis was carried out on inpatients with RT-PCR confirmed COVID 19. Chest X-ray findings were classified as minimal/no radiological changes, single lobar opacification and multi-lobar changes (involving 2 or more lobes and/or ARDS changes). SPSS 26 software was used for statistical analysis. Spearman’s correlation and linear regression were used to assess correlation.

Results

211 patients were included in the analysis; 124 males and 87 females. Mean age of the patients was 72.4 years; SD +/−16.15. There was significant positive correlation between age and degree and extent of radiological changes in all patients (r = 0.367; p < 0.01). This correlation persisted even when broken down by gender (r = 0.448; p < 0.01) for males and (r = 0.322; p < 0.01) for females. Discussion: Older age has been repeatedly reported as a risk factor for poor prognosis in COVID 19. The main findings of COVID-19 on CXR are those of atypical or organizing pneumonia. Older people tend to have more extensive involvement of the lungs. There could be many explanations for the CXR correlation with age including the diminished cardiovascular reserve with ageing, the accumulation of comorbidities and decreased or abnormal immune response.

Conclusion

Age significantly correlate with the extent of chest radiographic findings in inpatients with COVID 19.
155 Establishing A Community Frailty Unit During the COVID19 Pandemic
Authors: Wilson H
Published: March 2021

Introduction

In response to the Covid19 pandemic a community Hospital was transformed in to a Community Frailty Unit (CFU). The aims were to meet the needs of patients living with frailty including medical instability and end of life care outside the acute setting, to improve patient flow and to improve integration of acute and community frailty services.

Method

Existing community teams were integrated with an acute based multidisciplinary team including a frailty practitioner and pharmacist. Supported by programme managers they rapidly transformed (within 3 weeks) processes to align these with the acute site including paperwork, assessments, use of a flow board, board rounds and discharge to assess. Technology was used to organise transfers via the NHS Digital approved App Pando. Point of care testing and oxygen concentrators were put in place.

Results

Median and mean length of stay (LOS) in the acute site reduced by 59% (14.5 to 6 days) and 56% (18 to 8 days) respectively. Median and mean LOS in the community site reduced by 38% (16 to 10 days) and 39% (18 to 11 days) respectively. Readmissions fell from 10% to 2%. 85% of staff rated the following better or much better: the capability of the service to manage every aspect of the patient’s care; integration; co-ordination of transfers. 83% of staff rated patient experience better or much better and 79% rated discharge co-ordination better or much better. At 85% bed occupancy at a cost of £67 k/bed/year this released 5,525 bed days and 16.9 beds with a return on investment of £1,132,300.

Conclusion

It is possible to rapidly integrate community and acute services and to establish acute frailty unit care in a community setting. A CFU can lead to improved integration, patient flow, patient and staff experience at reduced system wide cost.
156 Potentially Inappropriate Cardiovascular Medications in Czech Older Adults in Acute Care: Inomed and Euroageism H2020 Project
Authors: Kummer I , Lukačišinová A , Gajdošová P , Bhagavathula A S , Brkic J , Fialová D
Published: March 2021

Introduction

Cardiovascular disorders (CVS) belong to the most frequent causes of deaths and cardiovascular medications among the most common drugs. Older patients are vulnerable to drug risks due to presence of pharmacological changes, polymorbidity, polypharmacy and geriatric syndromes. Thus, the effort to reduce prescribing of potentially inappropriate medications (PIMs) represents a substantial prevention strategy in this population.

Methods

This was a prospective, cross-sectional study conducted in 288 patients (65+) admitted to acute care geriatric wards in the Czech Republic from Aug 2018 to Jan 2019. We aimed to investigate prevalence of CVS PIMs using relevant parts of STOPP/START 2015 criteria, the EU(7) PIM 2015 list and the Beers criteria 2019. Only patients with stable health conditions were included in our study. Results: Overall prevalence of CVS PIMs was 77.6%. Undertreatment of CVS problems, identified by START criteria, was found in 63.2% patients. Prevalence of CVS PIMs according to different criteria was 16.1%, 23.6% and 30.9%, using the Beers criteria 2012, STOPP criteria and the EU (7)-PIM list; respectively. The most prevalent problem of undertreatment was the absence of statins with documented history of coronary, cerebral and peripheral vascular disease (excluding patients at the end-of-life or at the age of >85 years) (27.3%). According to the EU (7)-PIM list, the most common CVS PIMs were the use of amiodarone in maintenance doses of >200 mg/48 hours and use of spironolactone in doses of >25 mg/day (9.0% and 5.6%; respectively).

Conclusions

This study confirmed high prevalence of CVS PIMs in older adults admitted to acute care hospitals in the Czech Republic. Detecting and identifying CVS PIMs is of high importance in order to prevent serious adverse drug events, higher mortality and increased frailty in vulnerable older population. Grant support: InoMed project (reg. No: CZ.02.1.01/0.0/0.0/18_069/0010046, 2019–2022), H2020-MCSF-ITN-764632, PROGRESS Q42 FoP, Charles University, SVV 260417.
157 Prevalence and Patterns of Drug-Disease Interactions in Long-Term Residents in Nursing Home Facilities in the Czech Republic
Authors: Lukačišinová A , Kummer I , Příhodová V , Bandari D K , Brkic J , Fialová D
Published: March 2021

Introduction

Prescription of potentially inappropriate medications, non-geriatric doses and drug-disease interactions contribute to high prevalence of adverse drug events, geriatric syndromes and symptoms, and increased frailty in older adults. Despite serious health and socio-economic consequences, a very few studies have been published on phenomenon of prescribing of drug-disease interactions (DDI) in older patients in Central and Eastern Europe.

Methods

This study aimed to investigate the prevalence of DDI and differences across nursing home (NH) facilities applying relevant parts of Beers 2012 criteria, Czech national consensus 2012 (CNC), and STOPP/START criteria vers.1. This is a retrospective cross-sectional study that analysed semi-implicitly InterRAI-LTC assessment protocols of 490 NH residents from 10 Czech NH facilities (N = 490, 65+) participating in the EU SHELTER project. Retrospective analyses were conducted in 2019 year.

Results

Prevalence of potentially inappropriate DDI ranged from 44.5% to 62.3% identified by STOPP criteria and CNC, respectively. The most common DDIs were long-term use of benzodiazepines in depressive residents (7.8%) and use of opioids in residents with chronic constipation without osmotic laxative treatment (7.4%). The prevalence of undertreatment identified by START criteria was 52.9%, mainly due to absence of statins in NH residents with diabetes mellitus and cardiovascular risk factors (9.8%) and the absence of anticoagulation therapy in patients with atrial fibrillation (7.1%).

Conclusions

Potentially inappropriate DDI were highly prevalent in Czech long-term NH residents with significant differences across NH facilities. Using method of semi-implicit medication reviews, we cannot judge the real quality of drug treatment, but there is a necessity to reduce the high prevalence of DDI in NHs in order to prevent potential adverse drug events. Grant support: InoMed project (reg. No: CZ.02.1.01/0.0/0.0/18_069/0010046, 2019–2022), H2020-MCSF-ITN-764632, PROGRESS Q42 FoP, Charles University, FP7-HEALTH-F4–2008-201,917, SVV 260417.
160 The Effect of Frailty and COVID-19 Infection on Clinical Outcomes in Older Adults—A Single Centre Retrospective Study
Authors: Okuwoga O , Mufti S
Published: March 2021

Introduction

It was anticipated that the COVID-19 pandemic would put a strain on our healthcare system, disproportionately affecting older people. NICE guidance recommended using frailty scoring to support decision making around escalation of care. This study aimed to assess frailty, demographics and COVID-19 infection and to investigate how these related to outcomes of patients aged over 65 years admitted to hospital.

Methods

A single centre retrospective cohort study was carried out by reviewing the electronic health records of all admissions over 65 years. Data points collected included length of stay (LOS), frailty score using the Rockwood Clinical Frailty Scale (CFS) and mortality. Patients were stratified into COVID and non-COVID based on health records and into non-frail (CFS 1–4) and frail (CFS 5–9).

Results

A total of 257 patients admitted between 30th March and 30th April 2020 were included in the study (mean age 79 years, 43% female). 141 (54.9%) of patients were diagnosed with COVID-19 infection. 120 patients had CFS 1–4 and 136 has CFS 5–9. 1 patient did not have a frailty score due to insufficient information. 68 (26.8%) of all patients died during the admission. The relative risk (RR) of mortality of patients with coronavirus was 6.3 (95% CI 3.1–12.6, p < 0.0001). The RR of mortality for frail patients compared to the non-frail was 2.1 (95% CI 1.3–3.2, p = 0.002). The median LOS for patients with COVID-19 was 5 days, compared to 4 days for patients who did not have coronavirus. Frailty did not predict longer admission, with median LOS of 5 days for both non-frail and frail patients.

Conclusion

The results demonstrated in this study show that COVID-19 infection and frailty were significantly associated with increased mortality in older patients. This validates the continued use of frailty scoring of older patients on admission to support care planning.
162 Relationship Between NT Pro BNP Levels and Heart Failure in Patients >85 Years of Age
Authors: Sabharwal A , Okoli U , Smithard D
Published: March 2021

Introduction

Around 920,000 people in the UK have been Diagnosed with Heart Failure with a median age of diagnosis been 77 years. The most commonly used test used to diagnose and measure prognosis in HF is BNP levels.

B—Type Natriuretic Peptide is a hormone which is released in response to pressure changes in the ventricles. It causes Natriuresis which means removing sodium (salt) and water from the body thereby reducing the strain on the heart. It has a high negative predictive value to exclude heart failure with the following cut-off values.

High levels—NTproBNP >2000 pg/ml.

Raised levels—NTproBNP 400–2000 pg/ml.

Normal levels—NTproBNP <400 pg/ml.

The Aim of the study was to see if the cut off values of NT pro BNP Levels, which is the non-active pro hormone released from the same molecule that produces BNP are accurate in the elderly to diagnose Heart Failure.

Method

A retrospective study was carried out using 50 patients, age > 85 years with a diagnosis of heart failure. A comparison was made to look at NT pro BNP values and Ejection fraction (EF) [1] of these patients. A cut off of 50% EF was taken as diagnosing Heart Failure.

Results

Out of 50 patients, only 39 were suitable for the study as the rest did not have either a BNP value or an TransThoracic ECHO to assess Ejection Fraction. Age group taken was 85–97 years.

22.5% patients with a NT pro BNP level > 400 had an ejection fraction >50%.

Conclusion

Although we could only involve 39 patients, the data above shows that in patients aged >85 years with NT pro BNP values >400 around 25% have a normal ejection fraction. This suggest that increasing the cut off values for NT pro BNP to 750 in the elderly should be considered to diagnose Heart Failure, hence reducing cost and getting a high positive predictive value. Although more work is needed on the same.

Reference

1. EF - in simple terms is amount of blood the heart is pumping into the body.
164 Standardised Anticipatory Care Planning in Care Homes Reduces Unscheduled Hospital Admissions
Authors: Munang L A , Rimer J H W , Ralston K , Kirby L , Robertson K , Box S
Published: March 2021

Background

Anticipatory care planning (ACP) is a proactive person-centred approach for “thinking ahead”, exploring and recording a person’s goals and preferred actions when their health deteriorates. As a key part of Comprehensive Geriatric Assessment of frail patients, care home (CH) residents would benefit from ACP.

Introduction

West Lothian has 16 care homes with 853 residents. Between Oct—Dec 2017, 5.21% of CH residents were admitted to hospital each month. Some of these admissions could have been avoided had there been robust ACP in place.

Methods

In 2017 West Lothian Health and Social Care Partnership appointed a GP lead for Care Homes. Through standardising ACP for CH residents, the goal was to improve the pathway for managing medical emergencies and reduce unnecessary unscheduled care calls and admissions. In 2019 this role was taken over by a team of 2WTE Advanced Nurse Practitioners and 1WTE Staff Nurse. Outcome measures include hospital admission rates, number of ACPs in place and uptake of ACP training amongst CH staff.

Interventions

In collaboration with the Medicine of the Elderly Department at St John’s Hospital, a standardised ACP Summary document was developed for use in all CHs. A medical advice and emergency flowchart was created to reduce unnecessary hospital admissions. An continuous education programme was delivered across all CH staff to facilitate and implement this.

Results

Medical admission rates from CHs have decreased by 60% from 6 to 2.2 admissions per week. The largest reduction is in CHs with full ACP use.

Conclusions

Standardised ACP significantly reduces the number of medical admissions. Continuous education and training is crucial in maintaining its implementation, and ensuring its routine use throughout CHs in West Lothian.
54 No One Told Me I Couldn’t Drive with Delirium
Authors: Watson H , Ralston L
Published: March 2021

Introduction

Delirium is a common cause and complication of hospital admissions. DVLA1, and Consensus guidelines2 exist for driving with dementia or mild cognitive impairment, but there are no specific guidelines pertaining to delirium. This audit set out to find the prevalence of delirium in a district general hospital prior to implementation of a standard screening tool. It was noteworthy that a significant number of patients with delirium were drivers.

Methods

The notes of 114 patients under the care of nine specialties, both medical and surgical were prospectively reviewed. Of those with risk factors for delirium, data was collected on the number of patients who had a diagnosis of delirium made during their admission. For patients at risk with no documented screening already completed a Confusion Assessment Method (CAM) screening test was performed by the lead author. In patients identified with delirium it was also established if they were current drivers via clerking documentation or by discussion with the patient/family. Drivers with delirium were highlighted in the medical notes and where possible discussions were had with the patient and their families regarding driving advice until the delirium had resolved.

Results

The prevalence of delirium in this group was 23% (n = 26/114). 20 patients had documented evidence of delirium and a further 6 patients were diagnosed as a result of this project. 15.4% (n = 4/26) of patients with delirium were current drivers. For this group there was no documented evidence that driving advice had been given to the patient or family.

Conclusion

This baseline audit has identified that delirium is not consistently screened for and identified. In patients with delirium, driving history is not being sought and consequently the opportunity for driving advice is being missed. Clear guidance from the DVLA on driving for patients with a resolving delirium is needed.

References

1. DVLA, 2018.

2. RCPsych, 2019.
56 Ageism in Myelodysplastic Syndrome
Authors: Hogan P , Enright H , Ryan D , O'Neill D
Published: March 2021

Background

Myelodysplastic Syndromes (MDS) are a group of haematological disorders which are common in older people and can be amenable to treatment. Ageism has previously been identified in studies of treatment for conditions affecting older people.

Objectives

To assess for the presence of ageism in studies of treatment for MDS.

Design

A review of the Cochrane Library of Systematic Reviews.

Setting

Desk-based.

Methods

Systematic reviews were analysed to determine: use of age as an exclusion criteria in randomized-control trials (RCTs); the comparison of ages of patients in RCTs to that of the median age of patients with MDS; exclusion of patients from RCTs on the basis of dementia or other conditions associated with ageing.

Results

17 reviews were identified, 2 of which were suitable for analysis. The two remaining systematic reviews reported data on 13 RCTs—of which 2 did not report age. The median age of all patients was 68. Three RCTs used a maximum age limit for therapy—one of which was lower than the median age of diagnosis of MDS. More recent studies tended to include older patients. No studies excluded patients on the basis of cognitive status.

Conclusion

There was some evidence of ageism identified in studies of treatment for MDS. There was limited data available in the Cochrane database of Systematic Reviews, which may itself be suggestive of ageism in such reviews.
57 Physical Activity Improvement in Elderly Hospitalised Patients at the Royal London: Exercise as Part of A Multimodal Intervention
Authors: Sayer K , Whiteaway K , Dawson J O , Simpson J , Chu W
Published: March 2021

Introduction

Approximately 65% of elderly patients admitted to hospital experience some level of deconditioning during their stay. This can lead to longer length of stays, premature admissions to care homes and loss of function whilst in hospital (British Geriatrics Society). There is evidence that exercise can be safe and effective in reversing functional decline in this population. However, there is limited evidence into the effectiveness and feasibility of running a multi modal exercise intervention (eg. Dance and Exercise) on a busy elderly care ward in the UK.

Method

An 8-week inpatient programme consisting of a 60-minute exercise classes once a week and/or 60-minute dance class once a week started on the Older Person’s Wards at the Royal London. Primary outcome measures included: 5 x Sit To Stands (5xSTS) and Falls Efficacy Scale International (FES-I). Secondary measures; Rockwood score, Barthel Index, Elderly Mobility Score (EMS), Mood, 4AT and handgrip strength. Patient satisfaction scores were also recorded.

Results

23 patients were included in the analysis, 3 patients attended the dance class, 14 attended the exercise class and 5 attended both. In total 37 sessions were completed. The average score for all outcome measures improved except one after 8 weeks. The 5xSTS times improved by an average of 7.7 seconds and the FES-I score dropped by 3.9. The Barthel score increased by 5 points. Handgrip strength increased by 2.3 kg and 57% improved on their EMS. Mood improved from 5.4/10 to 6.0/10 and 4AT from 2.7 to 1.7. Overall, 70% of participants reported enjoying the classes and 90% said they would re-attend.

Conclusion

A multifactorial intervention including seated dance and exercise sessions showed significant improvements in mobility, fear of falling, cognition and functional tasks. Further work will look into the impact on length of stay and readmissions inpatient to hospital.
67 The Evolution of A Frailty Service
Authors: Abbott C , Bishop K , Hill F , Finlow C , Maraj R
Published: March 2021

Introduction

In September 2017 our frailty service was started within our medium sized DGH in North Wales. Working with our management team we secured a significant clinical resource including:

We describe how resources, setting and staffing develop over a 2 year period in order to create a service which meets the needs of the local population.

Method

The service has been in a constant state of development since it has been in operation, utilising a PDSA model with regular meetings of clinical and managerial staff to analyse performance.

Results

With each new PDSA cycle the amount of patients reviewed has increased. With the move to AMU we increased the monthly number of patients reviewed from 29 to 172 patients reviewed, 97 of which were discharged directly from the unit.

Conclusion

Using QI methodology our Frailty Service has improved dramatically since its inception. We will continue to analyse how we work to improve patient outcomes and cost effectiveness.
68 A Full Audit Cycle: Documentation of Discharge Summaries and Functional Status in Electronic Discharge Letters
Authors: Mir A , Damany S , Tay H S
Published: March 2021

Introduction

Electronic discharge letter is the most effective way to handover to General Practitioners for the continuity of care by providing the information about what happened during hospitalisation and what needs to happen after discharge. Well written discharge letters prevent miscommunication, missing information and medications errors as well as reduction of hospital workload. It also provides timely follow up to decrease the risk of re-hospitalisation.

The aim of this project is to analyse the documentation of discharge summaries and functional status after hospital admission in discharge letters. Discharge summary template was introduced and made compulsory in all Geriatric wards following first cycle of audit. We then compared data after introduction of discharge summary template.

Methods

Electronic discharge letters were reviewed for all patients discharged from Geriatric Department in July 2019 and results were compared with data from January 2019.

Results

162 patients were discharged in the second cycle of audit. Among these, 18 patients were deceased, and 4 patients had no discharge letters available. Therefore, total number of discharge letters analysed was 140. Please see Table 1 for comparative results on documentation of discharge summaries in discharge letters.

Conclusions

Introduction of the discharge summary template improved the documentation of summaries in discharge letters. Well-written discharge letter ensures the smooth transition for when patients leave the hospital. Therefore, it should be accurate, precise and relevant.
73 Using the Gold Standards Framework to Identify Opportunities for Advance Care Planning
Authors: Harwood R , Enguell H , Sakuda K , Lunt E , Ali A
Published: March 2021

Introduction

Departmental discharge data (January 2017–January 2018) suggested a high number of “Day 1 Deaths” i.e. an individual who was readmitted 24 hours after discharge, and subsequently died during their readmission. We wondered if this was due to a lack of Advance Care Planning (ACP).

Methods

We undertook a retrospective case note audit of 50 cases from the “readmissions who died” (total 176/7421) subgroup, to understand whether or not they were predictably within the last days, weeks or months of life and whether there was ACP in place. We reviewed all Day 1 Deaths (16/50), and a random selection of cases across the Day 2–30 (34/50) data set.

We used the Gold Standards Framework (GSF) as a prognostic tool, by use of the intuitive “surprise question” (“would you be surprised if this person died within the next days, weeks, months?”) and the disease-specific Prognostic Indictors (PI).

Results

Using the GSF we (retrospectively) predicted death in 94% of the Day 1 deaths and 63% of the Day 2–30 deaths.

There was evidence of ACP in 32/50 patients (64%), predominantly in the form of a DNAR CPR (61%). There was very little evidence of other forms of ACP.

Readmissions were justified on the basis of a medical condition in 100% of cases; this was infective in 60% (30/50).

There were few interactions with secondary care in the 12 months prior to death (mode was 2 admissions in the month prior to death, 4 in the 12 months prior to death).

Conclusions

We must consider our discharge processes and medical decision making at the front door.

A Prognostic indicator Tool would be useful to focus medical decision making.

We must recognise infections as end stage disease in advanced ill health, including advanced frailty.

We need to consider how we facilitate meaningful involvement of older people in their medical care towards the end of life.
74 Improving Handover Between Doctors and Nurses on An Elderly Care Ward
Authors: Suseeharan K , Vedutla T
Published: March 2021

Background

The Royal College of Physician guidelines (2011) identified handover as a “high risk step” in patient care, especially in recent times within the NHS where shift patterns lead to more disjointed care with a high reliance on effective handover by all staff members.

Introduction

At Cannock Chase hospital, Fairoak ward is an elderly care rehabilitation ward where there is a large multi-disciplinary team. While working on the ward as doctors we noticed that handover between the MDT was poor. Anecdotal evidence from both doctors and nurses felt that this was a high risk area in need of improvement.

Aim

to improve handover between doctors and nurses on this elderly care ward.

Method

To measure the quality of current handover practice we did a questionnaire. A total of 12 questionnaires were completed which showed that 92% of staff felt that handover on the ward was very poor and 50% preferred both written and verbal handover.

We measured the number of tasks verbally handed over between doctors and nurses over 3 days. On average 65% of the tasks were completed.

We then made the below interventions and re-audited to see if there was any improvement.

Interventions over 3 week period:

Results

Questionnaire:

Measuring task completion after interventions;

Conclusion

This project has made a positive change qualitatively and quantitatively to the ward handover practice. Staff satisfaction regarding handover has improved and the number of “handed over” tasks completed daily has significantly improved. The written handover sheet had poor utilisation by staff but in 4 months we are going to re-audit and trial the handover sheet again to further improve service delivery. We hope this improvement will have a positive impact on patient care on this elderly care ward.
76 This is (Probably) Not the Frailty Solution You are Looking For: Utilisation of A Novel Stand-Alone Community-Based Ambulatory Care Unit
Authors: Dykes L , Jones C
Published: March 2021

Introduction/Aim

Our organisation wished to expand its “Care Closer To Home” capability, especially for older and/or frail patients. Our novel Ambulatory Care Unit (ACU) in a community hospital, staffed by GPs & nurses, opened a year ago. The ACU has some Point of Care (POCT) diagnostics, access to plain-film radiography and OT/physio. During the planning of the unit,” acute frailty” was anticipated to be core business. We wished to determine whether this turned out to be the case.

Method

Interrogation of the ACU patient log (spreadsheet collated from Data Collection Forms) Dec 2018-Nov 2019.

Results

Conclusion/Discussion

Recording of CFS by ACU staff was poor, limiting the validity of our results. Nevertheless, it is obvious that most patients seen in our ACU are not frail, and do not require therapies input. Those that are frail, however, have an acceptable conversion-to-admission rate of 8.6%, comfortably below the national target (20%).

Barriers to greater utilisation of our service for frail patients may include lack of urgent but non-emergency transport options for the less mobile, lack of access to certain commonly-used tests (e.g. CT, troponin) and referrer anticipation of difficulty discharging the frail patient in crisis without a new or boosted care package and/or access to respite beds. These aspects of service planning need to be addressed if the potential utility of community-based units like ours for frail patients is to be maximised.
83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study
Authors: Yang C , Hui Z , Zhu S , Wang X , Tang G , Lee D T F
Published: March 2021

Introduction

Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity.

Method

This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations.

Results

Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up.

Conclusions

The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.
90 Socio-Demographic and Medical Factors in A Multi-Ethnic Cohort of COVID Deaths
Authors: Patel M , Umasankar U , McCall B
Published: March 2021

Introduction

Whilst most patients during the COVID pandemic made an uneventful recovery,there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to examine and evaluate risk factors for those patients who died of COVID and to identify any markers for improvement in the management of such patients during future COVID surges.

Methods

Medical records of all patients who died within a multi-ethnic, inner city acute district general hospital over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for these patients.

Results

Of 275 deaths,204 were related to COVID. Compared to non-COVID deaths(n = 71), there were no age differences. There were significantly more deaths in males (58%vs39%,P < 0.001)) and in Black African and South Asian groups. 18% of COVID deaths were those who were not frail (Frailty Rockwood Scale 1–3) whereas there were no non-COVID deaths in this group(P < 0.001). 69% of COVID deaths occurred in general medical wards whereas 19% in critical care units (90% and 7% for non-COVID deaths,p < 0.001). COVID patients died more quickly compared to non-COVID patients (length of stay mean, 11vs21,p < 0.001). Medical factors prevalent in >20% of COVID deaths included Diabetes, Hypertension, Chronic Heart Disease, Chronic Kidney Disease,and Dementia. Multivariable analyses showed males (OR 1.9), age > 70(OR 2.0), frailty (OR 2.3) were independent risk factors for COVID deaths.

Discussion

Compared to non-COVID deaths,COVID deaths were more common in previously well individuals,males,Black African and South Asian ethnicity, but multivariable analyses showed males, age > 70 and frailty were independent risk factors for COVID deaths. This survey indicates that greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths.
93 Does Spinal Bone Mineral Density Predict An Absolute 10 Year Probability of Sustaining A Major Osteoporotic Fracture
Authors: Nandi A , Obiechina N , Timperley A , Al-Khalidi F
Published: March 2021

Introduction

Spine and hip bone mineral density (BMD) have previously been shown to predict the risk of sustaining future fractures. Although these have been shown in population studies, there is a paucity of trials looking at the relationship between BMD and 10 year probability of major osteoporotic fractures (Using FRAX UK without BMD) in patients with previous fragility fractures.

Aims

To evaluate the correlation between spinal T-score and an absolute 10 year probability of sustaining a major osteoporotic fracture (using FRAX without BMD) in patients with prior fragility fractures.

Methods

A retrospective cross-sectional analysis of 202 patients (29 males and 173 females) with prior fragility fractures attending a fracture prevention clinic between January and August 2019 was performed. Patients with pathological and high impact traumatic fractures were excluded. The BMD at the spine was determined using the lowest T-score of the vertebrae from L1 to L4. Using the FRAX (UK) without BMD, the absolute 10 year probability of sustaining a major osteoporotic fracture was calculated for each patient. Statistical analysis was performed using SPSS 26 software.

Results

The mean T-score at the spine was −1.15 (SD +/− 1.90) for all patients, −0.68 (SD +/− 0.45) for males and − 1.23 (SD +/− 0.14) for females. The mean FRAX score without BMD for major osteoporotic fracture was 18.5% (SD +/− 8.84) for all patients, 11.41% (SD +/−0.62) and 19.7% (SD +/−0.68) for males and females respectively. Pearson correlation coefficient showed a statistically significant, slightly negative correlation between spinal T- score and the FRAX (UK) without BMD (r = −0.157; p < 0.05). Correlation was not statistically significant when males (r = 0.109; p = 0.59) and females (r = 0.148; p = 0.053) were considered independently.

Conclusion

In patients with prior fragility fracture spinal BMD has a statistically significant negative correlation with an absolute 10 year probability of sustaining a major osteoporotic fracture.
96 Impact of COVID19 Restrictions on Older Patients Attending An Outpatient Service
Authors: Daunt R , Keena A , Kelliher S , Brewer L
Published: March 2021

Introduction

During the Covid19 pandemic older adults (>70 years) in Ireland were advised to stay at home and avoid unnecessary physical contact—termed “cocooning”. During this time hospital outpatient appointments were conducted virtually (via telephone). This project aimed to assess patients experience of Covid19 cocooning and the virtual outpatient service.

Methods

Patients attending an outpatient geriatric medicine service were invited to participate in this project following their routine virtual assessment. A proforma questionnaire was administered to participants contacted virtually within one week of consent. Data was anonymised, imported into excel and analysed using SPSS (chi-squared test).

Results

31 patients were included, median age was 83 years. 52% were male, 25% lived alone and 52% had cognitive impairment. 77% had heard of “cocooning”, of which 79% correctly understood the term. Three-quarters stated that cocooning had negatively impacted their quality of life (QoL); anxiety, loneliness and depression were reported in 49%, 36% and 29% respectively. 39% strongly feared getting Covid19. Cognition and living status did not correlate significantly with the psychological impact of Covid19. 61% did not use modern social media, its use did not impact QoL scores (p = 0.075). 45% experienced a reduction in support services. 87% found the OPD telephone service useful and 77% reported their needs were addressed. Three-quarters favoured future virtual assessments.

Conclusion

One third of patients poorly understood “cocooning”. Necessary Covid19 restrictions impacted negatively psychologically on this older cohort. Novel virtual clinics proved a positive experience and a useful future outpatient resource even amongst our oldest patients with dementia.
107 Improving Frailty Screening and Accuracy in the Emergency Department (Ed) of A Busy District General Hospital
Authors: Dowell H , Mallinson R , Cartmell D , Mellstrom K , Pettigrew G , Spice C
Published: March 2021

Background

Over 20,000 75+ years attendances annually in ED with frailty screening in introduced in ED in 2016. Early recognition of frailty is recommended. Accurate estimation of frailty level is important as it contributes to clinical pathway and management.

Introduction

Screening rates had fallen and there were concerns about the accuracy.. Our aim was increased frequency and accuracy of screening at triage. Method Frailty screening rates for patients aged 75+ years attending the ED (routine measure) reviewed with ED Frailty Lead. Stakeholder engagement with ED staff and Frailty and Interface Team (FIT). Frailty screening tool revised. Data review March 2020 focused on CFS accuracy (CFS at triage v CFS by FIT in routine assessment). Sampling approach to CFS accuracy during June 2020.

Interventions

Small group sessions with ED nursing staff (Jan 2020). Revised electronic screening tool introduced (February 2020). Education sessions (x2) for ED nursing staff (June 2020) focused on CFS. Results Frailty screening increased significantly following revised screening tool introduction from 60% to >80%. In March 2020 agreement of CFS at triage and FIT review in 22% (76/341). The CFS reliability for 10 consecutive patients per day was measured in June 2020 before and following 2 education sessions held on CFS. The reliability of CFS was 0.23 prior to teaching in June and rose to an average of 0.31 following the teaching intervention.

Conclusions

Frailty screening frequency and the reliability of the CFS improved following teaching interventions but remains low. Work is continuing to focus on improving this further. Although CFS has been found to be reliable between raters in other hospitals we have found this difficult to replicate. It is not known if this is due to local factors or to more common challenges that others may face in CFS estimation by ED staff.
117 Hospital @Home and the Amber Care Bundle: Introducing the Concept of Uncertainty of Survival to Improve Advance Care Planning
Authors: MacDougall A , Costa S , Seymour E , Yielding R , Schiff R
Published: March 2021

Introduction

GSTT@home is a hospital@home providing multi-disciplinary acute care in peoples’ homes throughout Lambeth and Southwark. AMBER is an internationally recognised care bundle to improve care for hospital inpatients where survival is uncertain. The bundle prompts recognition of survival uncertainty, communication and advance care planning (ACP)- principles relevant to many hospital@home patients. This quality improvement project aimed to embed these principles into GSTT@home by adapting AMBER to this community setting.

Methods

Cycle 1 Plan- Determine whether @home patients might benefit from principles of AMBER. Do and Study- Audit patients >80 years that died within a 3-month period after @home admission (January–June 2018); one in 10 patients died (10.9%), median age 82 and median CFS 8. Act- Inpatient AMBER bundle adapted for @home setting to systemically identify and prompt ACP. Cycle 2 Plan and Do- AMBER@Home bundle formally introduced and piloted with @home, education using posters and lanyard cards.

Study

Audit use of AMBER@Home for patients >80 years who died within three months of discharge from @home (August–October 2019). Act- AMBER@Home incorporated into daily handover document. Cycle 3 Plan and Do- Further education embedded AMBER@Home, increased consultant and GP support. Study- Use of AMBER@Home re-audited as above for November 2019–January 2020.

Conclusions

Using AMBER@Home appears to have changed practice without the AMBER bundle being formally used. Throughout 3 audit cycles there was a steady increase in ACP. Future planned interventions include appointing a frailty nurse to @home team to further embed AMBER@Home, distributing lanyard cards more often and using “Coordinate My Care” to improve accessibility to ACP decisions including PEACE.