bluuebunny/crossref_metadata_2025 huggingface dataset:
Right large deviation principle for the top eigenvalue of the sum or product of invariant random matrices
Authors: Mergny Pierre , Potters Marc
Published: June 2022

In this note we study the right large deviation of the top eigenvalue (or singular value) of the sum or product of two random matrices A and B as their dimensions goes to infinity. We consider a general framework containing the cases where A and/or B are taken from an invariant ensemble or are fixed diagonal matrices. We show that the tilting method introduced in Guionnet and Maïda (2020 Electron. J. Probab.
25 1–24) can be extended to our general setting and is equivalent to the study of a spherical spin glass model specific to the operation—sum of symmetric matrices/product of symmetric matrices/sum of rectangular matrices—we are considering.
Implementation of the school literacy movement development stage in fostering secondary school students’ mathematical literacy skills
Authors: Sopiany Hanifah Nurus , Turmudi  , Juandi Dadang , Sari Rika Mulyati Mustika
Published: June 2022

This is a further research from the previous study which describes the situation of how the school literacy movement activities at the habituation stage were implemented which was carried out by the researchers in early 2020. This research is a situation analysis on the implementation of school literacy movement activities at the development stage which becomes a part of Indonesian government program in Strengthening Character Education. The growth and development of students’ mathematical literacy is one of the final objectives of the series researches being conducted. Teachers in secondary schools around North Cimahi region were involved as research subject in this study. The data of this research were collected through questionnaires and interviews. The results presented are divided into two parts, namely: the result of general literacy development and the result of mathematical literacy development.
Quadratic Bezier Curve as the base for pot modelling
Authors: Mutimmah Dzurotul , Prayekti Novi
Published: June 2022

Pot is a place or container made of clay, earthenware, cement, or plastic to plant trees or plants. In addition to a place to plant plants, pots also function to decorate the appearance of the house, both on the outside (outdoor) or in the room (indoor). So that the selection of the right pot model can make the yard or corner of the room look more comfortable, beautiful, and attractive. Some pot models that are already on the market have a circular or rectangular base with a monotonous pot shape. Thus, the researcher conducted on the pot modelling with the initial data of regular hexagon polygons as the base of the pot and the Quadratic Bezier curve as the basis for modelling pots with the help of Maple software. This research method uses applied research methods, namely the application of the Quadratic Bezier Curve in making pot models, several pot models were produced, namely a pot with two tiers and three tiers, where each level has several potted models with twisted and symmetrical types. So that the pot models obtained are more attractive and have artistic value.
Metric dimension of vertex shackle operation result graph on wheel and star graphs
Authors: Saifudin Ilham , Umilasari Reni , Jalil Abdul
Published: June 2022

The ordered set W = (w1, w2, w3,…, wk
} of vertex set on graph G and a vertex v in G the it form k-vector ordered r(v|W) = (d(v, w1
), d(v, w2
),…, (v, wk
)) is set of metric coordinate by v to W. W can be said as resolving set of G if every coordinate of W are not same. The number of resolving set or basis of G which minimum is called metric dimension and written by dim(G). Shackle is one technique to construct a graph by attach the vertex or edge between the same graph then it make linkage vertex and edge vertex that every graph which constructed be denoted by Shack(G, v, t) and Shack(G, e, t) means a shackle graph consist of t copy with t > 2. In this study case, we determine metric dimension of vertex shackle products graphs of wheel graph Shack(Wm, v, n) for m > 3, n > 2 and vertex shackle products of star graph Shack(Sm, v, n) for m > 3 and n > 2. In addition, we also determined the implementation of metric dimension theory by finding the coordinate of drone as navigation for traffic monitoring in Jember Regency.
Alternative solution optimization quadratic form with fuzzy number parameters
Authors: Sugiyarto
Published: June 2022

The fuzzy number is one of the alternatives to maximize solving a quadratic model programming problem. Based on that statement, this paper provides one of the methods to solve the quadratic model programming problem. It started with a general discussion on quadratic model programming and continued by transposing a basic form into a fuzzy quadratic programming equation and giving a reference to solve that problem. Finally, a few examples are provided to analyse how accurate this method works.
Finite element/holomorphic operator function method for the transmission eigenvalue problem
Authors: Gong Bo , Sun Jiguang , Turner Tiara , Zheng Chunxiong
Published: June 2022

The transmission eigenvalue problem arises from the inverse scattering theory for inhomogeneous media. It plays a key role in the unique determination of inhomogeneous media. Furthermore, transmission eigenvalues can be reconstructed from the scattering data and used to estimate the material properties of the unknown object. The problem is posted as a system of two second order partial differential equations and is nonlinear and non-selfadjoint. It is challenging to develop effective numerical methods. In this paper, we formulate the transmission eigenvalue problem as the eigenvalue problem of a holomorphic operator function. The Lagrange finite elements are used for the discretization and the convergence is proved using the abstract approximation theory for holomorphic Fredholm operator functions. The spectral indicator method is employed to compute the eigenvalues. Numerical examples are presented to validate the proposed method.
Density questions on arithmetic equivalence
Authors: Mantilla-Soler Guillermo
Published: June 2022

It is a classic result that two number fields have equal Dedekind zeta functions if and only if the arithmetic type of a prime

p
p

is the same in both fields for almost all prime

p
p

. Here, almost all means with the possible exception of a set of Dirichlet density zero. One of the results of this paper shows that the condition density zero can be improved to a specific positive density that depends solely on the degree of the fields. More specifically, for every positive

n
n

we exhibit a positive constant

c

n

c_{n}

such that any two degree

n
n

number fields

K
K

and

L
L

are arithmetically equivalent if and only if the set of primes

p
p

such that the arithmetic type of

p
p

in

K
K

and

L
L

is not the same has Dirichlet density at most

c
n

c_n

. We in fact show that

c
n

=

1

4

n
2

\displaystyle c_n=\frac {1}{4n^2}

works and give a heuristic evidence that points to the fact that this value might be improved to

2

n
2

\displaystyle \frac {2}{n^2}

. We also show that to check whether or not two number fields are arithmetically equivalent it is enough to check equality between finitely many coefficients of their zeta functions, and we give an upper bound for such number.
1071 INCIDENCE OF RECORDED OSTEOPOROSIS, OSTEOPENIA AND FRAGILITY FRACTURE IN OLDER PEOPLE: ANALYSIS OF UK PRIMARY CARE DATA
Authors: Avgerinou C , Petersen I , Clegg A , West R M , Osborn D , Walters K
Published: June 2022

Introduction

Osteoporosis is common in later life, leading to fragility fractures associated with increased mortality, disability, and costs. There is a surprising lack of data regarding the incidence of osteoporosis. We aimed to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in older people, explore time trends in diagnosis, and differences by age, sex, and social deprivation.

Method

We used de-identified patient data provided as part of routine primary care (IQVIA Medical Research Database (IMRD). All patients aged 50-99y registered with THIN (The Health Improvement Network) participating practices between 1/1/2000–31/12/2018 were included. Crude incidence rates (IR) were estimated per 10,000 person-years (PY). We used Poisson regression to calculate adjusted Incidence Rate Ratios (IRR) accounting for sex, age, calendar year and deprivation.

Results

The IR of osteoporosis was significantly higher in women, 84.32 (95%CI 83.81–84.83) vs. 16.66 (95%CI 16.43–16.90) in men per 10,000PY. In women, recorded IR of osteoporosis reached a peak in 2009. In the adjusted model, older men in most deprived areas had a higher IRR of osteoporosis [1.67 (95% 1.59–1.74)] compared to those in least deprived areas. Women were more likely to be diagnosed with osteopenia compared to men, at any age. Incidence of osteopenia diagnosis increased over time. In the adjusted model, men in most deprived areas had a higher IRR of osteopenia [1.44 (95%CI 1.35–1.53)] compared to least deprived areas. The IR of fragility fracture was higher in women, 84.97 (95%CI 84.45–85.48) vs. 31.15 (95%CI 30.83–31.48) in men per 10,000PY. In the adjusted model, men in most deprived areas had an increased IRR of fragility fracture [1.53 (95%CI 1.48–1.59)] compared to least deprived areas.

Conclusion

Community bone health interventions might be targeted at populations at higher risk of fragility fractures, including older men living in socially deprived areas.
1027 DEVELOPING A MINIMUM COMMON DATASET FOR HIP FRACTURE AUDIT
Authors: Poacher A , Ojeda-Thies C , Hall A , Ahern E , Brent L , Costa M , Johansen A
Published: June 2022

Introduction

National hip fracture audits share a common heritage in the work of Rikshöft and the Standardised Audit of Hip Fracture in Europe. However, as more countries develop audit programmes and these evolve to address local needs, divergence in the data they collect compromises their scope for learning from clinical, audit and quality improvement work in other nations.

Method

In 2021 we compared all ten established national hip fracture audits: England/Wales/Northern Ireland; Scotland; Australia/New Zealand; Ireland; Germany; the Netherlands; Sweden; Norway; Denmark; Spain. We tabulated all questions included in each, and cross-referenced them against the 32 questions of the minimum common dataset (MCD) defined by the global Fragility Fracture Network (FFN) in 2014. We identified those consistently used in most national audits, and additional fields that might need to form part of a revised MCD. Any MCD must meet the needs of both developed and developing countries. We presented these findings at the Asia-Pacific FFN meeting, and used an online questionnaire to capture feedback from different countries. A draft revision was presented at the Global FFN conference in September 2021, with feedback again used to finalise this revised MCD.

Results

We tabulated a total of 215 possible questions. Only 72 (34%) were used in >1 national audit, and only 32 (15%) by more than half of audits. Adherence to the 2014 MCD was disappointing; all 32 fields were used by at least one audit, but 5/32 only by one audit. Only 21/32 (65%) were used in the majority, and only three (anaesthetic grade, operation and date/time of surgery) by all ten established audits.

Discussion

This revised MCD will help aspirant nations establish new audit programmes, facilitate the integration of novel analytic techniques and greater multinational collaboration, and serve as an internationally-accepted standard for monitoring and improving hip fracture services.
942 THE POST-OPERATIVE RISKS OF STOMA FORMATION IN THE COGNITIVELY IMPAIRED
Authors: Jarratt-Barnham I
Published: June 2022

Introduction

Over 20,000 stomas are formed in the UK annually, many for geriatric patients. However, formation both requires significant surgical intervention and leaves patients with the substantial post-operative burden of stoma care. Such is this care’s complexity, 70% of all stoma patients experience complication. Patients with cognitive impairment may be at particular risk of poor outcomes following stoma formation. However, the impact of cognitive impairment on patient suitability for stoma formation is under-discussed in the literature. We conducted a preliminary literature review to identify factors for to be considered when proposing stoma formation in this patient group.

Method

A preliminary literature review searching several databases (PubMed, Cochrane and Embase) was conducted using pre-devised search terms. A further manual search was then performed reviewing the references of identified papers of interest. Arguments relevant to stoma formation in elderly patients with cognitive impairment were extracted.

Results

Little quantitative evidence surrounding stoma formation in the cognitively impaired was found. However, four key risks for these patients were identified: 1) Patients with cognitive impairment, particularly dementia, experience higher rates of perioperative complication following surgery. 2) Cognitively impaired patients are at increased risk of post-operative stoma complications, precipitated by poor stoma care. These complications are also more likely to be uncommonly advanced on presentation due to poor patient surveillance. 3) The need for regular stoma care can necessitate unwanted nursing home admission. 4) Cognitively impaired patients are particularly vulnerable to psychological distress following stoma formation due to reduced ability to adapt to and participate in their stoma’s care.

Conclusion

This preliminary review identified several factors to be considered when determining suitability for stoma formation in a cognitively impaired patient. However, little quantitative research exploring this association was identified. Further work is required to better characterise the risks posed by stoma formation in this patient group.
945 EFFECTIVENESS OF CREATINE SUPPLEMENTATION ON MEMORY IN HEALTHY INDIVIDUALS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Prokopidis K , Giannos P , Triantafyllidis K K , Kechagias K
Published: June 2022

Introduction

The benefit of creatine monohydrate supplementation in improving memory performance in healthy humans is unclear. The aim of this study was to determine the effectiveness of creatine monohydrate supplementation on memory performance in healthy humans.

Method

A literature search of PubMed, Web of Science, Cochrane Library, and Scopus for randomized clinical trials (RCTs) published from database inception until September 30, 2021, examining the effects of creatine supplementation on measures of memory in healthy humans was conducted. The control groups consisted of placebo. The main outcome was performance measures of memory that were further examined according to age, sex, treatment duration, and dose of creatine monohydrate supplementation.

Results

Ten RCTs met the inclusion criteria and 8 were included in the meta-analysis. Overall, creatine supplementation improved memory compared to placebo (SMD: 0.29, 95% CI: 0.04–0.53, I2 = 66%, P = 0.02). Subgroup analyses revealed a significant improvement on memory in older adults (66–76 years) (SMD: 0.88, 95% CI: 0.22–1.55, I2 = 83%, P = 0.009). Creatine dose, duration of intervention, and sex did not influence the findings.

Conclusion

These data support that the use of creatine monohydrate supplementation enhances memory performance in healthy humans compared to placebo, especially in older adults. However, caution is warranted due to the combination of various assessment tools designed to measure memory, which would increase the heterogeneity of the data.
959 OPTIMISING MEDICAL CARE IN OLDER EMERGENCY UROLOGY PATIENTS USING A GERIATRICIAN-LED PERI-OPERATIVE SERVICE
Authors: Lam R , Dhesi J , Forsyth E , Streeter E , Kommu S , Thomas M , Meilak C
Published: June 2022

Introduction

Older and frail patients account for a large proportion of urology service use (Drch GW, Griebling TL., JAGS, 2003; 51: S355–8). Frail patients are at higher risk of complications and readmissions (Suskind A et al., BJUI, 2016; 117:836–42). Emergency patients may not be optimised before admission, leading to further increased risk and time restraints on care planning. Therefore, a geriatrician-led Perioperative Care for Older People Undergoing Surgery (POPS) service was established within the urology department at a District General Hospital to improve older emergency urology inpatients’ outcomes. We reviewed the impact on medical management, readmissions, and care planning.

Method

Retrospective documentation review of emergency urology patients aged over 65 admitted in the 3 months before the POPS service implementation, compared to those reviewed by POPS in the 3 months following. Median clinical frailty score of the POPS group was 6. The Comprehensive Geriatric Assessment based inpatient perioperative service was created using co-design and staff questionnaires were completed post-implementation.

Results

100% of staff (n = 26) would recommend POPS to other surgical wards and comments on improvements focused on expansion (9/15).

Conclusion

The POPS service significantly improved the recognition and management of medical conditions and reduced medical readmissions. Increased end of life recognition and planning allowed patients’ wishes to be acted on. This service was successfully implemented with high staff acceptance.
967 USING CLINICAL INFORMATICS TO IMPROVE OUTCOMES AND PATIENT EXPERIENCE FOR ADMISSIONS TO WWL WITH PD AND RELATED CONDITIONS
Authors: Alicehajic-Becic D
Published: June 2022

Introduction

Patients with PD depend on timely administration of their regular medication regimen to optimise their motor function. Using Clinical Informatics Database to allow analysis of medication doses, a service evaluation of PD and related conditions was undertaken using QI methodology with a particular focus on omitted and delayed doses. Alongside this, prospective qualitative data capture took place on patients’ experience during hospital stay. The impact of specialist team was also analysed.

Method

Using electronic prescribing records, a database of all doses for co-beneldopa was used as a starting point of identifying gaps and areas for improvement. Various interventions were implemented to address these using QI methodology. Ongoing mechanism for data capture was developed to analyse the results. Patient experience via data capture questionnaire was sought on how the changes affected their experience of hospital stay. Specialist team input was anlaysed using report on ‘PD Team’ notes.

Results

The percentage of omissions had a mean of 10.8% from the 19,462 doses of co-beneldopa analysed while the delays in administration improved from initial figure of 40% in 2019 to 34.7% although the trend in 8 months of 2021 increased back up to 39% (17,313 doses of co-beneldopa). The overall total percentage of co-beneldopa doses administered had also increased (88%, 90% and 90.4% for 2019, 2020 and 2021 (Jan-Aug)). Patients reported different views on medicines management during hospital stay. PD team input more than tripled between 2019 and 2020 (192 vs 611notes) with 421 placed in 2021 up to Aug.

Conclusion

Clinical Informatics data can be used to improve patient pathways and improve outcomes. Further work on patient experience will be completed to ensure their feedback is incorporated into future pathway design. Specialist input is essential in safe care of PD patients.
970 FRAILTY IS INVERSELY CORRELATED WITH SERUM ALBUMIN IN ACUTE HIP FRACTURE
Authors: Pathmanathan K , Mubin M , Sevilla C , Zaman M , Chan R , Hussain M , Brown E , McDevitt G , Khan R , Nandi A , Mukherjee B , Obiechina N
Published: June 2022

Introduction

Frailty and sarcopenia have been shown to significantly increase the risk of falls, traumatic hip fractures and all-cause mortality in the elderly. The assessment of frailty using a validated clinical frailty scale such as that proposed by Rockwood et al., therefore, continues to remain an important step in determining post-operative prognosis in patients undergoing hip fracture surgery. The purpose of this study was to examine the relationship between frailty and serum albumin—an independent biochemical predictor of survival in hip fracture patients (1).

Method

This retrospective cross-sectional study analysed 190 patients, aged above 60 years, admitted to Queen’s Hospital Burton (QHB) between the 1st January and 28th December 2019 with a newly diagnosed hip fracture. Pre-operative serum albumin levels (g/L) and Rockwood clinical frailty scores (rCFS) were recorded from electronic medical records (EMR). Using the SPSS 27 statistical package, Pearson’s correlation co-efficient and linear regression analysis were carried out using these variables.

Results

A total of 190 patients were included in the study (57 male, 133 female). Mean patient age was 82.2 ± 8.47 years. More than 50% of patients had a Rockwood CFS ≥5. Mean serum albumin (g/L) was 37.3 ± 6.56. A statistically significant inverse correlation was demonstrated between pre-operative serum albumin levels and Rockwood CFS (r = −0.243, p < 0.001).

Conclusion

This study showed how serum albumin, a negative acute phase reactant and marker of chronic malnutrition, is inversely associated with frailty in hip fracture patients and the important role of Rockwood CFS and pre-operative serum albumin levels in the prognostication of hip fractures in the elderly. References 1) Bohl D, Shen M, Hannon C, Fillingham Y, Darrith B, Della Valle C. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. Journal of Bone and Joint Surgery. 2017;99(24):2110–2,118.
972 EXPLORING THE IMPACT OF FRAILTY FOLLOWING TRAUMA: AN ANALYSIS OF EMERGENCY DEPARTMENT (ED) MANAGEMENT AND LONG TERM OUTCOMES
Authors: Cuthbertson R , Ellis K , Reda E , Chaplow K , Gordon M W G , Capek E
Published: June 2022

Introduction

Major trauma represents a large number of hospital presentations in Scotland. 1 We aimed to: -Describe the population of ‘major trauma’ patients presenting to the Emergency Department of QEUH, Glasgow -Compare assessment, management and clinical outcomes in frail versus non-frail patients with trauma.

Method

This was a retrospective, cohort study. Patients were identified using the Scottish Trauma Audit Group (STAG) database. 2 Patients aged over 18, admitted between 01/11/18 and 31/01/19 were included. STAG data was supplemented by individual case note review. Clinical Frailty Scale (CFS) and Charlson Comorbidity Index (CCI) were calculated.

Results

203 patients (173 non-frail, 30 frail) were included. Median age was 58 years (range 19–98). Isolated head injuries were the predominant injury type in frail patients (36.7%) versus polytrauma in non-frail cohort (44.5%). Injury Severity Score (ISS) was similar across both groups (median score: 10v9.5). CCI score correlated well with frailty. Frail patients were less likely to:

-Have ambulance pre-alert call (10% v 28%, p = 0.041).

-Be managed in ‘Resus’ (17% v 54%, p < 0.05).

-Have consultant-led care in ED (6.6% v 36.4%, p = 0.001).

-Undergo CT within 60 minutes (10% v 34.7%, p = 0.0095).

They were more likely to be admitted under a Medical Team (20% v 2.9%, p < 0.05). Frailty was associated with poorer outcomes:

-Mortality 30% v 9.8%: significant difference in unadjusted, 1-year survival curves (Log-rank test p = 0.0026). Frailty carried a hazard-ratio of death of 5.02 (CI:2.13–11.79, p = 0.0002) compared to non-frailty through the first year after trauma.

-Longer median Length of Stay: 22 v 8 days.

Conclusion

We identified poorer clinical outcomes in our frail patient cohort. Despite this, and with similar ISS scores across both groups, our data would suggest a tendency to under-recognise significant trauma in Frail patients. References [1] Audit of Trauma Management in Scotland. Public Health Scotland, 2021 [2] Scottish Trauma Audit Group https://www.stag.scot.nhs.uk/
992 RESULTS OF A PILOT HIV/FRAILTY CLINIC - CAN COMPREHENSIVE GERIATRIC ASSESSMENT BENEFIT FRAIL PEOPLE LIVING WITH HIV?
Authors: Morrow H , Horner M , Thomson-Glover R
Published: June 2022

Introduction

Frailty has been recognised among people living with human immunodeficiency virus (HIV) and will become more prevalent in coming years given treatment success (Pathai et al J Gerontol A Biol Sci Med Sci 2014;69:833–842). Assessment of frailty and its common syndromes through comprehensive geriatric assessment (CGA) is routinely delivered by geriatricians and is likely to benefit these patients. We piloted a clinic to assess whether a future service would be beneficial for people living with HIV and frailty.

Method

10 patients from the local HIV service, with suspected frailty, were referred to the Frailty Unit for assessment in May 2021. Each patient was assessed for frailty using the Fried model. They underwent CGA which included medication review, therapy assessment, cognitive assessment, using the Montreal Cognitive Assessment (MOCA), and review by a geriatrician.

Results

Seven people attended. Six underwent full assessment and one left prior to undergoing medical review. Patient demographics: all white males; mean age 53 years; mean years since HIV diagnosis 11.3; mean Nadir CD4 count 220.4; four with undetectable viral load and three low level viraemia. Four were classified as frail and three pre-frail. All were multimorbid (mean no. co-morbidities, 7.1). Significant medical issues were identified in four patients requiring further investigation and/or referral to other specialities. Polypharmacy was prevalent (mean no. medications 11.1) and medication adjustments were suggested for all patients. The mean MOCA score was 25.7, with two scoring less than 26 prompting memory service referral. Five patients had ongoing physiotherapy/occupational therapy needs.

Conclusion

This pilot demonstrated that a CGA approach to frail patients living with HIV identified significant multimorbidity, polypharmacy, cognitive impairment and therapy needs. This allowed for recommendations to be made to improve medical care, optimise function and improve quality of life. Consequently, a permanent HIV/Frailty service and referral pathway have been developed.
999 ACUTE FRAILTY ASSESSMENT UNIT: A 6-MONTH QUALITATIVE STUDY OF READMISSIONS WITHIN 28 DAYS OF DISCHARGE & COLLECTIVE CASE ANALYSIS
Authors: Hart C , Shadbolt L , Kaklamanos M
Published: June 2022

Introduction

Readmissions can have a negative impact on the care of frail individuals in regards to increased length of stay, healthcare-related harm, reduced quality of life and mortality. Review of frailty readmissions should lead to improvements of frailty care and clinical effectiveness.

Method

We conducted a retrospective, qualitative analysis of readmissions of frail individuals discharged from our Acute Frailty Unit (AFU) over a six-month period. This is a collective case study in which we used instrumental cases to highlight specific learning points. We used the Electronic Patient Records database to measure the total number of readmissions related to AFU discharges. The Framework methodology was then utilised to further analyse and cluster cases. Common themes linked to readmissions and the time-to-readmission were studied, leading to structured (SMART) quality improvement interventions.

Results

Four hundred and thirty individuals were discharged from AFU. Eighty-nine (21%) were readmitted within 28 days of index hospital admission. Fifty-eight percent (50/89) of individuals were readmitted to hospital (any ward) with a different presenting complaint compared to index admission. Twenty-two (25%) cases were readmitted with the same initial complaint, while nine (10%) experienced problems due to ineffective discharge planning. In eight (7%) cases, readmission was linked to healthcare-associated complications. Forty (45%,40/89) individuals stayed at home for <7 days after their index discharge, whilst the remaining forty-nine (55%) returned to hospital after 7–28 days. Only eight (9%) readmissions were from care home settings. A bundle of SMART interventions has been developed, including post-discharge support with acute frailty clinics, enhanced frailty dietetic support and improved communication with community partners.

Conclusion

(s) This collective case study shares important learnings related to the readmission patterns of acute frailty units. Individual case studies are essential in understanding the ways that patient-centred care should be tailored to become more effective.
1002 A CASE STUDY OF GENDER DYSPHORIA IN THE ELDERLY
Authors: Weatherley J , Dick G , Mithani P , Bogdan N
Published: June 2022

The aging Lesbian, Gay, Bisexual, Transgender (LGBT) population is a patient group which has not been extensively researched in terms of its specific clinical needs. There is growing improvement in the awareness of LGBT patients; however there appears to be a disparity between care provided for younger and older LGBT individuals. The LGBT community suffers from disproportionately reduced access to care as well as healthcare discrimination and a lack of specialist medical expertise thereby increasing the risk to their physical and mental health. Combined with the implications and challenges of living with frailty, older LGBT individuals are some of the most vulnerable members of our society.

Our patient

a 90-year-old man with gender dysphoria, falls into this subset. This case study follows our patient’s internal struggle with his longstanding concealment of his transsexualism, issues accessing specialist care, reduced treatment options in view of his age and the repercussions. These include an impact on his physical health by means of a self-inflicted injury resulting in a urethral fistula and his mental health with worsening depression and reduced ability to rationalise his gender dysphoria.

The study presents challenges from both a clinical perspective, in terms of an accurate psychiatric diagnosis, as well as the challenges experienced by the patient in the healthcare setting.

While this case explores both the causes and effects of these difficulties; the specific needs and experiences of older LGBT patients remain largely unknown. Through highlighting this patient’s experiences, we hope to encourage thought and discussion of such issues amongst other healthcare professionals to ensure a holistic approach of care.
1014 OPTIMISING BONE HEALTH IN FRAIL OLDER ADULTS: IS INTRAVENOUS BISPHOSPHONATE THERAPY DURING ACUTE ADMISSION WARRANTED?
Authors: Hosty J , Vethanayagam N
Published: June 2022

Introduction

Recommendations on bisphosphonates focus on 10-year risk of osteoporotic fracture. Evidence in frail older adults is limited. The HORIZON Pivotal Fracture trial1 included patients aged ≥80 years and showed a relative risk reduction of 60% for vertebral fractures at 1 year. Patients admitted with a fall should undergo bone health assessment, and if at moderate/high risk should be considered for treatment or referral to metabolic bone clinic (MBC). Oral bisphosphonates are poorly tolerated in older adults due to side effects and compliance2. Anecdotal evidence suggests high rates of non-attendance at MBC. We reviewed outcomes in patients admitted following a fall to review whether inpatient zoledronate during acute admission should be considered.

Method

100 patients admitted to Sheffield Frailty Unit between 1/10/19–12/11/19 presenting with a fall were identified. Data was collected from electronic records and physical notes. Basic statistical analysis was performed.

Results

There was a female preponderance (60%), a mean age of 86.7 years and a median clinical frailty score (CFS) of 6. 26% of patients had no recorded bone health assessment. 32% required no further action, either scoring low-risk or already on treatment. 12% of cases had active decisions against therapy. 30% scored moderate or high risk. Of these, 11 patients started bisphosphonates and 4 had plans for GP review on discharge. 15 patients were referred to MBC but only one-third attended, due to a combination of missed referrals, cancelled appointments, or ‘did not attend’. 59% were readmitted with further falls over the next 18 months. 39% of patients died within 12 months.

Conclusion

Patients with a CFS of 6 or chronic cognitive impairment could be considered as candidates for inpatient intravenous bisphosphonate therapy. Factors to consider include ability and desire to attend outpatient appointments, compliance and tolerance of oral therapy and the overall functional status and prognosis.
1015 AN OBSERVATIONAL STUDY OF THE CORRELATION OF FRAILTY SEVERITY WITH MENTAL HEALTH
Authors: Rasheed R , Patel A , Shanthakumaran Y
Published: June 2022

Introduction

The eFI (electronic Frailty Index) is used to assess the severity of frailty in elderly frail patients using a cumulative deficit model based on routine interactions with their GP. Frailty is associated with an increased risk of falls, reduced mobility, hospitalisations, disability and death.

Method

Patients were selected for annual frailty assessments by searching the electronic clinical system (SystmOne) using the eFI tool. Patients were assessed using the Comprehensive Geriatric Assessment (CGA) framework. In addition, all patients were screened for coexisting anxiety and depression using the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder (GAD-7) questionnaire.

Results

Of the 118 patients who ranged from mild to severe frailty, we found there was a positive correlation of the frailty severity eFI scores with increased rates of anxiety and depression evidenced by higher scores on the PHQ-9 and GAD-7 scoring tools. We found a positive correlation of the eFI with the PHQ-9 depression scores of (r = 0.819 p < 0.001). Within the same data set, we found correlation coefficients of eFI and anxiety GAD-7 scores (r = 0.651 p < 0.001). Increasing frailty was found to be associated with a higher rate of depression and anxiety.

Conclusion

We found in this study higher (eFI) electronic frailty indices are associated with worsening physical impairment and higher rates of anxiety and depression. We would recommend annual frailty assessments in patients with high electronic frailty indices and this should include screening for mental health deterioration. Early detection of deterioration will enable patient centered supportive measures and targeted treatment strategies. Health maintenance programs should ensure patient centered holistic assessment of both physical and mental health needs for early identification to avoid deterioration of both physical and mental health.
1017 EVALUATION OF FRAILTY DOCUMENTATION PRE AND DURING THE COVID-19 PANDEMIC IN A LARGE REGIONAL CENTRE
Authors: Venkatesh A , Burberry D J , Davies E A , Ansar A , Aye  , Mwendwa E
Published: June 2022

Background

Identifying frailty can lead to improvements in patient outcomes through interventions such as CGA and prompt discussions around resuscitation and ACP. [Welsh; International Journal of Clinical Practice; 2014; 290– 293] Frailty is associated with a higher risk of postoperative mortality and morbidity, and mortality due to COVID-19.[Parmar; Annals of Surgery; 2021; 709–718, Dumitrascu; Journal of the American Geriatrics Society; 2021; 2, 419– 2, 429] Our audit considers whether the pandemic had any effect on documentation of frailty, and identifies interventions to improve this process.

Method

We retrospectively reviewed notes to look for elements of social history which identify frailty including mobility, ADLs, and CFS. We conducted a series of spot audits in February 2020 (pre-pandemic), April 2021 (Wave 2), and November 2021 (Wave 3) across surgical and medical wards.

Interventions and Results

February 2020 This cohort consisted of 62 patients and showed poor documentation across both medicine and surgery with an average of only 21% relevant social history recorded and 0% CFS scoring. Interventions that followed included an educational series by geriatricians and introduction of triaging tools based on CFS in response to the pandemic e.g. Swansea Hip interrogation Fracture Tool (SHiFT). [Cronin; British Orthopaedic Association; 2020] April 2021 The relevant documentation improved to an average of 31% in this cohort of 37 patients. Interventions that followed included further educational sessions on frailty, a surgical liaison service, and the appointment of an orthogeriatrician. November 2021 This cohort consisted of 149 patients, average relevant social history continued to improve to 49%. Subgroup analysis showed 76% of orthopaedics patients had a CFS score, including 100% of NOF patients.

Conclusion

Frailty is important as it is linked to an increased risk of mortality and morbidity. In the pre-pandemic cohort, the results were poor. Improvements were seen after interventions such as educational sessions, pandemic triaging tools, and the surgical liaison service. However, there are still inconsistencies between teams. Future interventions include a CFS app, expansion of the surgical liaison service, and improved proformas.
1052 CLINICAL MEDICATION REVIEWS AND OPTIMISATION FOR INPATIENTS IDENTIFIED AS FRAIL ON THE ELDERLY CARE WARDS AT EAST LANCASHIRE HEALTH TRUST
Authors: Harborne E , Singh B , Fazeel H
Published: June 2022

Introduction

Inpatient medication review occurs daily on our elderly wards and NICE (clinical guideline NG5) advocates using a Stopp/Start tool. Polypharmacy and tablet burden are common issues in frail patients and medications should be under regular review. Evidence of these reviews can be laborious to identify in written notes, particularly for frail patients with complex discharges. We aimed to determine whether clinical medication reviews are documented clearly at ELHT and to improve this.

Method

Patients with a Rockwood frailty score of ≥6 were identified and inpatient notes and charts audited for written detail of medication reviews and drug changes, then compared to the trust Stopp/Start toolkit. Cycle 1 was prior to intervention. We then delivered clinical education on medication optimisation and prompted use of ‘medications review’ proforma on existing trust documents. Cycle 2 occurred after this, then following changeover of junior doctors educational sessions were repeated and cycle 3 data collected.

Results

82% of all patients audited had altered medications with a mean hospital stay of 8 days. On cycle 1 65% of patients with altered medications had documentation to explain medication changes, on cycle 2 this improved to 88% and 72% on cycle 3. 92% of patients had a documented medication review (even if this involved no drug changes) at cycle 1 which improved to 100% on cycle 2 and remained at 92% on cycle 3. Both before and after intervention medications were appropriately rationalised or introduced.

Conclusion

We were already conducting regular reviews and optimising medications for frail patients. Prior to intervention there were inconsistencies on how this was documented. Through education and proforma for documentation this greatly improved, in turn improving communication and continuation of care on discharge. We are introducing electronic records to the trust and aim to include medication reviews into this system.
1053 AGEING WELL: THE EXPERIENCE OF AGEING IN CHILDLESS ELDERLY CHINESE WOMEN
Authors: Tiu M M H , Low L P L , Lee L Y K , Cheng V S
Published: June 2022

Introduction

Hong Kong is a Chinese-based community. The life expectancy of Hong Kong female is 88 which is the longest in the world. However, the fertility rate has been declining over the past 38 years. This specific situation leads to an increasing number of childless elderly Chinese women. In Chinese culture, one of the major purposes in raising child/children is to secure support in old age. Without a child, the childless women are expected to receive less support in a number of aspects than those who have a child. The way how they experience ageing is believed to be unique. The aim of the study is to explore the experience of ageing in elderly Chinese women.

Method

This exploratory qualitative study was conducted in Hong Kong. Purposive sampling was adopted. Six childless elderly Chinese women, who aged 65 or above, were recruited. This study used an in-depth semi-structure interview to generate data. Interviews were audiotaped, transcribed, and then analysed using thematic analysis.

Results

Four themes emerged in the study, they were: (i) putting a great effort to maintain physical independence; (ii) keep learning new things; (iii) capture the present pleasure moments by various technological means; and (iv) do not waste time in worrying about what will happen as one ages.

Conclusion

Overall, participants are leading an active style of living which is characterised by maintaining and even increasing own capabilities in living, enjoying the present moment, and avoiding to worry about the future. Having positive attitude to ageing and being receptive to new things (including information technology) are the essences of ageing well in childless Chinese elderly women. These results could help policy makers to formulate appropriate policies and instill relevant resources to support the childless elderly Chinese women, thereby enabling this growing population to age well.
1061 AN EMERGENCY FRAILTY UNIT AS AN INTERVENTION TO PREVENT INPATIENT FALLS IN THE EMERGENCY DEPARTMENT
Authors: Yusoff A , Davies E A , Howells C J B , Quinn P , Burberry D J
Published: June 2022

Introduction

There is evidence that dedicated units that provide comprehensive geriatric assessment can reduce inpatient falls and other iatrogenic harm1. The Emergency Department (ED) in Morriston Hospital has 90,000 attendances a year. 4,000 patients >65 years presented with falls. Between January 2018–November 2021, ED reported 207 incidents of falls via the Health Board Datix System.

Intervention

Phase 1 In April 2018, the Older Person’s Assessment Service (OPAS) (Geriatrician led Multidisciplinary team) began a liaison service to ED, taking referrals from the medical and ED teams for patients presented with frailty syndromes. Phase 2 In June 2020, OPAS was allocated a dedicated Emergency Frailty Unit within the Emergency Department footprint, allowing patients to be assessed rapidly by a specialist team and nursed in a specialist environment.

Results

Between June 2020–November 2021, the service saw 1,317 new patients. The average age of an OPAS patient was 83 years and had a Rockwood Clinical Frailty Scale Score of >5. 73% of patients presented with falls as a primary presenting complaint. Between June 2020–November 2021, there was one reported fall within the unit. The mean incident reported of inpatient falls in ED in phase 2 (M = 5.50, SD = 2.66) is statistically significantly higher than phase 1 (M = 3.96, SD = 1.87), t(42) = −2.26, p = 0.03. The service did not show any impact on the incidence of inpatient falls in ED.

Conclusion

The unit was an effective intervention to prevent falls for the patients it assessed within the unit but had no impact on inpatient falls within the main ED. The impact of this service is difficult to determine given the low reported falls in ED. 1. Fox MT, Persaud M, Maimets I et al. J Am Geriatr Soc, 2012, 60:2237–2,245.
1063 THE CHALLENGES OF PROVIDING ADEQUATE AND APPROPRIATE NUTRITION AND HYDRATION CARE TO HOSPITAL MEDICAL INPATIENTS
Authors: Kim J U , Khizar M H , D’Cruz R , Glasser M , Rochford A
Published: June 2022

Introduction

Nutrition and hydration are essential components of hospital inpatient care. Inadequate provision has been shown to be linked to poorer outcome. We performed a cross-sectional study of nutritional care in a London teaching hospital.

Method

Data collection was undertaken in October 2021 across two medical wards. Data for demographics; morbidity factors including: Charlson Comorbidity index (CCI), length of stay (LoS), cognitive score (AMTS); nutrition parameters and their recorded accuracy including: weight, ‘MUST’ score, fluid balance, food chart, and evidence of dietetic referral and review were examined.

Results

52 patients were assessed [male 24/52 (46.15%), median age 80.5 (IQR 61.75–85.25, range 30–98)]. The median CCI score was 5, corresponding to 21.36% estimated 10-year mortality, with median LoS of 8 days (IQR 3–15.25). AMTS was recorded in 12/52 (23.08%). Variable recording of nutrition parameters was observed (weight: 57.69%, ‘MUST’ score 23.1%, fluid balance 63.5%, food chart 15.4%). Only 54.6% of the recorded fluid balance charts were clinically accurate. Where oral nutritional supplement (ONS) was prescribed, 57.1% (8/14) of patients had not received a dietetic review. Upon comparison the care of the elderly ward demonstrated a significantly higher accuracy of fluid balance chart (60% vs 46%, p < 0.001).

Discussion

Supporting patients to meet nutrition and hydration goals is a core component of clinical care. Our results demonstrate that nutrition and hydration care is poorly documented across several parameters, and by inference, poorly delivered irrespective of age, co-morbidity or cognitive impairment. Less than 1/3 of patients had a formal nutrition screen suggesting that identification of patients at risk of malnutrition should be the priority for future work. An electronic health record allows easy access to data that can be used for improvement. As an achievable first step, an improvement in awareness of nutritional scores, such as MUST, will be important in identification of malnutrition.
1064 THINK STOOL CHART
Authors: Crawford J , Khanum T , Lau E , McNamee M
Published: June 2022

Introduction

Bowel care is an important part of care for older people. This quality improvement project (QIP) was carried out on the Older Person’s Assessment Unit at Arrowe Park Hospital which is a 24 bed acute frailty unit. Locally we found inadequate documentation of stool charts. This had the potential to cause problems related to constipation such as pain, increased use of catheters, delirium, bowel obstruction, thereby increasing length of hospital stay. Our aim was that all our patients would have a completed stool chart.

Method

Three Plan Do Study Act (PDSA) cycles were designed with input from the medical team, ward charge nurse and QIP lead. The first intervention was to discuss the importance of stool charts at board round. The second intervention included displaying a Bristol stool chart poster. The final intervention involved discussion with the clinical support workers and notices were displayed. Baseline audit data was collected and the audit repeated following each intervention. 12 patients were selected per cycle using alternate even and odd bed numbers. Data included if the amount, colour and stool type had been documented on the chart or the notes. Data was collected and presented using Google Sheets and Slides.

Results

Baseline data showed 40% of patients had a completed stool chart. Following the first intervention this improved to 50%. Data collected in PDSA cycle 2 showed the worst results with 25% of charts documented. After the final intervention stool charts were completed for 42% of patients. This information was less frequently documented in the notes. Staff experience and workload were likely factors affecting documentation.

Conclusion

The first intervention of active discussion with the multi-disciplinary team was most effective. Passive interventions such as displaying a poster was much less effective. There remains room for improvement and further PDSA cycles are planned.