bluuebunny/crossref_metadata_2025 huggingface dataset:
2210 The adjustable Transobturator male system (ATOMS) for urinary incontinence: 9 year sub analysis within the geriatric population
Authors: Lavigne A , Rosser S , Foley S , Yang B
Published: August 2024

Introduction

The ongoing rise in prostate cancer rates and consequent prostatectomy have led to an increase in rates of male stress urinary incontinence. ATOMS is an adjustable sling requiring no manual input and suitable for frailer patients. We investigated the long term efficacy of the ATOMsin managing SUI and performed a sub-analysis within the geriatric population (aged 75+).

Method

69 men (mean: 70.2, range 50–81) underwent an ATOMS insertion between 2015–2019. Follow up data for up to 9 years were analysed (mean: 5.8, range 5–9 years). Out of the 69 men in the original cohort, 19 were aged 75+ (mean: 76.5, range: 75–81). 17 had SUI post radical prostatectomy, 1 post TURP and 1 post AP resection.

Results

Out of the 19 men, 14 (74%) were dry post ATOMsimplant insertion (ie using maximum one pad per day for reassurance). This rate is lower compared with the original cohort (79.7%). The average number of top ups to achieve dryness was 3 (same as the initial cohort). Out of the 14 men who remained incontinent in the initial cohort, 5 were 75+. Of these, 2 reported a significant improvement in their incontinence without meeting the ‘dry’ criteria. 1 had his ATOMsdevice removed due to infection. 1 was switched to an artificial urinary sphincter. 1 remains incontinent and is being managed with botox injections. There were no cases of mechanical failure.

Conclusions

ATOMS appears to be an efficacious and safe procedure in the geriatric population, with only marginal difference in dry rates compared to the non-geriatric cohort. The main benefit over an artificial sphincter is that it exerts a passive effect to prevent incontinence and requires no patient input for every void. This is especially prudent as geriatric patients may lose hand dexterity or cognitive ability over time.
2242 Retrospective study of inpatient falls resulting in patient harm April–September 2023. Comparing our care to the BSG guidelines.
Authors: Quartano M , Alićehajić-Bečić D
Published: August 2024

Objective

To identify good practices and highlight areas for improvement in the prevention and management of inpatient falls.

Method

Fifteen patients had serious inpatient falls between April and September 2023 within the hospital. Electronic notes and fall panel meeting minutes were used to provide an analysis of the ‘pre-fall’ and ‘post-fall’ assessments. Data was collected and analysed using AMaT and then compared to the standards set by RCP National Audit of Inpatient Falls (NAIF)—from KPI overview, 25% of patients had good quality Multi Factorial Risk Assessment (MFRA) in our Trust compared to National average of 33%.

Results

70% of patients had been identified as high risk of falls at admission. Patients were prescribed a median of 10 medications, with a median of 3 falls-risk increasing drugs (FRID). Before the inpatient fall: the majority of patients received an ECG and mobility assessment early in admission. Only 40% of patients had a lying/standing blood pressure (LSBP) 100% of those that showed a deficit were acted on appropriately. Only 20% had a documented medication review. Following the inpatient fall: A LSBP was done in only 33% of patients. A medication review was completed in 53% yet the average patient was discharged with 3 more medications. 73% of patients suffered fragility fractures due to the fall however bone protection was only considered in 40%.

Conclusion

This audit highlights that there are areas of MFRA that require improvement, specifically LSBP, and a medication review. 33% of falls occurred in ‘medically-optimised’ patients—resulting in at least 60 additional inpatient days. The results have been discussed with the multi-disciplinary team—intervention to improve performance will be piloted in two areas with the highest incidence of inpatient falls, with continuous learning and sharing of lessons embedded into our Falls Collaborative Initiative.
2308 A pilot project implementing a dysphagia screening tool for femoral fracture patients.
Authors: Paxton D , Buist M , Bradley R
Published: August 2024

Background

Evidence suggests 30–40% of patients with a neck of femur fracture (NOF#) develop oropharyngeal dysphagia (OPD) during the perioperative period. 1–2 Our data, collected over two months, shows our Speech and Language Therapy Team (SLT) identified only 12% of cases. Given the importance of nutrition and medication in the perioperative period, early identification of OPD is critical. We launched a new dysphagia screening tool for all patients admitted to our hospital with a NOF#.

Methods

A retrospective review of patient notes allowed collection of data regarding age, hip injury, frailty score, comorbidities, and staff compliance with tool. Patients with a completed screening tool had outcomes recorded (low, medium, high risk), timeliness of referral to SLT if appropriate, and if OPD was present on assessment. Balancing measures included length of time kept nil by mouth. We completed four PDSA cycles over 5 months.

Results

During this period, 157 patients were admitted with a NOF# and 58 had a completed screening tool. By producing a training pack and expanding into the emergency department, compliance improved by 33% over the 4 cycles. 19 of the 58 patients with a completed screening tool had OPD; 79% had mild, 14% moderate and 7% severe. The screen was adjusted during each cycle improving the suitability of SLT referrals from a 25% identification rate in cycle 1 to 100% in cycle 4. No patients were kept nil by mouth.

Conclusions

The screening tool has increased OPD identification by 21%. However, this requires staff training and high compliance rates to be effective. Next steps include adding the tool to the NOF# proforma, creating a training pack for the wider MDT, and improving the specificity of the tool.

References

1. Love et al. Age and Ageing, 2013. 42(6):782–5. 2. Mateos-Nozal J et al. Age and Ageing, 2021. 28;50(4):1416–1421.
2307 ICPOP community rehabilitation service
Authors: Kenny B , Laycock B , Nee R , O’Toole R , Hogge E , O’Neill N , Clarke E , Keating S , O’Shea J , Quinn A , Higgins A
Published: August 2024

Hip fractures are a major public health issue due to ageing populations and Ireland has one of the highest hip fracture rates in Europe1. The cost of acute hip fracture care was 48.5 million euros in 20221. The Irish Hip Fracture Database in 2022 revealed that 84% of people presenting to acute hospitals with hip fracture were admitted from home, however only 29% were discharged directly home1. NICE guidelines recommend early supported discharge for patients who are medically stable and mentally fit to participate with rehabilitation and who can transfer and mobilise short distance but have not yet achieved their full potential2. The National Integrated Care Programme for Older Persons (NICPOP) improves the life of older people by providing access to integrated care and support that is planned around their needs and choices, supporting them to live well in their own homes3.

This poster outlines the rehabilitation pathway established by the SJH ICPOP team to provide early supported discharge for hip fracture patients.
2222 Individual telephone calls to frail older adults improve outpatient clinic attendance rates
Authors: Thorn N , Tullo E
Published: August 2024

Introduction

The multidisciplinary assessment clinic (MDAC) is an outpatient service for older people at a district general hospital. Patients are triaged to the MDAC clinic if they have geriatric syndrome (for example falls) plus comorbidity and/or mobility, social or cognitive concerns. The service had a high ‘did not attend’ (DNA) rate compared with other geriatric outpatient clinics. This project aimed to reduce MDAC DNA rates and improve cost effectiveness through implementation of a new pre-appointment telephone service.

Method

We analysed six months of attendance data prior to establishing the pre-appointment telephone service. The existing system consisted of a standardised trust appointment letter and a text message reminder. For the new system a healthcare assistant (HCA) telephoned patients the day before their appointment to confirm attendance and discuss any concerns. We analysed six months of attendance data following the implementation of the new system and compared DNA rates.

Results

Prior to implementation of the new pre-appointment telephone service, 29 of 268 patients DNA (11%). From the second data set, following implementation of the new telephone system, 11 of 253 patients DNA (4%). Successful contact was made with 72% of those phoned, allowing confirmation or cancelled appointments to be rebooked. Chi square analysis found a significant difference between the two systems, with a p value of <0.01 indicating an improvement in attendance rates with the new system.

Conclusion

Telephoning frail older patients prior to an outpatient clinic appointment significantly reduces DNA rates—a similar system could be implemented in other geriatric medicine outpatient settings.
2159 Feasibility study: the use of the Edmonton frail scale in a psychiatric inpatient facility
Authors: Shah P , Khongsueb K , Gathii E , Breen K
Published: August 2024

Introduction

Frailty is an important consideration in the health and wellbeing of older adults, particularly as it is associated with a risk of falls, and mental health difficulties such as depression. There has been no validation of frailty assessment tools among older adults with Psychiatric disorders. This was a feasibility study exploring the use of the Edmonton frail scale (EFS) among patients with highly complex mental health needs within a Psychiatric Inpatient Setting with a view to develop a service integration process leading to further research.

Methods

45 participants were recruited from 8 older adult wards across Neuropsychiatry and Medium Secure divisions. EFS assessments were completed every six months by trained members of Multidisciplinary Teams over a 12-month period.

Results: About 118 assessments were administered to approximately 45 patients, regardless of a patient’s length of stay at the hospital during the 12-month period. There was a 55% assessment completion rate. This was largely the result of difficulties in administering the cognitive domain of the EFS (Clock Drwing test) to patients with highly complex mental health needs, as the completion rate was 32%. It was also quite challenging for patients to understand and comply with the assessment instructions in the Functional Performance Domain (Timed Get Up and Go Test). As a result, many assessments in this domain were conducted through covert observation of patients’ movement during the course of the day. 29 of the 45 patients were found to have at least moderate level of frailty.

Conclusion

Older adults with psychiatric disorders may benefit from having an adapted assessment of the cognitive domain to promote complete administration of assessments. Prevalence of frailty is high in this setting. Continuous support towards staff engagement and education would be beneficial in promoting EFS use in determining frailty and integrating it into care planning.
2184 QIP: to assess the effect of education, timesheets and timers on the administration times of Parkinson’s medications
Authors: Miller G , Rybka E , West K
Published: August 2024

Background

NICE guidance for administration of dopaminergic medications is within thirty minutes of the prescribed time. Patients with Parkinson’s Disease are frequent attenders of the ED, often leading to admission for a variety of reasons. Medication timing as an inpatient is frequently sub optimal, leading to potential harm of the patient and prolonged inpatient stays. Interventions previously seen to be beneficial include medication posters and alarms, tested across multiple wards at a different trust. This project aims to assess three interventions looking to improve the administration time of dopaminergic medication at Aintree University Hospital.

Method

Three interventions were assessed: education, medication timesheets ad medication timers. These were assessed on one surgical and one medical ward. Baseline data was collected prior to implementation, then following each data was recollected. Nursing staff opinion and knowledge were also assessed using surveys at baseline, following education and at the end of the project.

Results

Baseline data showed an average of 18.75% of doses given out of range on the surgical unit. Education proved to be useful, reducing the average to 12.5%. Medication timers were the most promising intervention, improving the average to 10.7%. However, when plotted on a control chart the changes appear unconvincing for significance. Surveys showed an initial reluctance for the use of timers, but following their use they then became the preferred intervention. Obstacles to their use were identified, such as loss of instructions and difficulty in changing the settings.

Conclusion

This project has found evidence to support the use of medication timers to facilitate more accurate administration of dopaminergic medications. However further assessment is required with a follow up QI project given the uncertainty seen on the control charts.
2223 Older patients admitted with a fragility fracture—a review of discharge summary documentation in accordance with HIQA national
Authors: Redmond C , Thankachan N , Fallon A , McDonough A
Published: August 2024

Background

Fragility fractures, defined as fractures resulting from low energy trauma (1), are consistent with a diagnosis of osteoporosis. When a patient is discharged from hospital, guidelines recommend principal and additional diagnoses, relevant co-morbidities contributing to primary diagnosis, medications and relevant investigations are recorded (2).

Methods

This audit reviewed discharge summaries of all patients discharged from a rehabilitation unit over two months, in accordance with the Health Information and Quality Authority’s (HIQA) National Standard for Patient Discharge Summary Information (2). Patients with fragility fractures were identified through medical record review. Principal and additional diagnoses were reviewed, with cause and mechanism of falls considered relevant co-morbidities. Discharge prescriptions for anti-resorptive medications were noted. Dual-energy x-ray absorptiometry (DXA) was recorded as a relevant investigation (3).

Results

33 discharge summaries met inclusion criteria. 12 patients were admitted with fragility fractures with a mean age of 81 years (69–90). 83.3% (n = 10) were female. Osteoporosis was mentioned in 50% (n = 6) of discharge summaries of patients with fragility fractures. On review of relevant co-morbidities, likely cause of the fall was documented in 58.3% (n = 7) and mechanism in 75.0% (n = 9). Bone protection was planned in 83.3% (n = 10). Plan for DXA was documented in 8.3% (n = 1).

Conclusion

This audit demonstrates suboptimal communication between hospital and community teams, despite chronic disease being predominantly managed in the community. In Europe, Ireland has one of the largest disease burdens relating to osteoporosis and the largest increase predicted in the next ten years (4). It is of utmost importance we improve communication to minimise disease burden.
2276 IN REACH. It’s everyone’s responsibility. Improving inpatient access to food and drink.
Authors: Pottinger A , Tanner S , Saunders S , Gagliani R , Shaah E
Published: August 2024

Background

‘IN REACH’ was established, having identified a significant need to improve nutrition for cognitively and physically frail hospital inpatients, admitted to the Complex Medical Units (CMU) at the John Radcliffe Hospital. The IN REACH team includes the CMU multi-disciplinary team (MDT), representatives from patient and volunteer groups, caterers and medical illustrators.

Introduction

IN REACH identified that food and drink is often unreachable by inpatients. The project’s aim is to ensure food and drink is always within patient reach, improving nutritional intake, avoiding dehydration, reducing weight loss, reducing family anxiety, promoting independence and improving health outcomes.

Method

MDT members, patients and their families were engaged in the design. Baseline observational data included whether both food and drink were in reach and whether the patient had cognitive impairment. Interventions to be evaluated by Plan-Do-Study-Act (PDSA) methodology include: Focussed education, presenting observational data to MDT and catering team; raising awareness at daily MDT meetings, emphasising shared responsibility. Prompting by signage, physical and digital. IN REACH Champions to be introduced. PDSA cycles 1 and 2 were completed. 3. and 4. are planned. Improved inpatient nutrition will be correlated with data on length of stay and health outcomes, monitored by repeat PDSA cycles. Improved rates of return to baseline function and independence are anticipated, by keeping food and drink, in reach.

Results

Out of 319 inpatients, 33% had both food and drink within reach. 67% had cognitive impairment; 73% of those were unable to reach their food and drink. Following PDSA cycles 1–2, 34% of patients had food and drink within reach, a negligible change.

Conclusions

Most CMU patients have food and drink left out of reach. Patients with cognitive impairment are particularly at risk. Changing ward culture is challenging. Further and repeated interventions are necessary.
2278 Adding value to the patient experience through a clinically optimised pathway approach
Authors: Poddar S , Gunarathna D , Bowen B , Puffet A , Phillips T , Rogers L , Griiffiths Z
Published: August 2024

Introduction

High numbers of clinically optimised patients in a DGH were having daily clinical input. RAAC clinical incident resulted in movement of clinically optimised patients from the district general hospital to a community hospital increasing the community bedbase from 32 to 72. This gave the opportunity to review how these patients were managed.

Method

In the first PDSA cycle, it was recognised that daily medical ward rounds for clinically optimised patients were neither necessary nor optimal and potentially perpetuated the impression that patients required in hospital care. These observations were sought using process mapping and fish bone diagram. In the second cycle, all clinically optimised were planned to be seen once a week on ward round. All patients were discussed on the daily multidisciplinary board round and if needed were changed on the board to not clinically optimised which prompted review. Nurses could also ask for review outside of the board round.

Results

During a four-week period one third, (24/72) of patients needed review outside of the weekly planned review. Of these 79.2% required only one review. Consequentially junior doctors reported to save an estimated cumulative of 16–48 hrs per week. Balancing measures of falls, mortality, pressure sores and complaints showed no change in the four months after implementation of the change. Patient, family and staff qualitative feedback was gathered. The next two cycles involved polypharmacy review and offered clinically optimised patients a ‘What Matters to Me’; meeting with their family utilising the time saved to improve communication, medication review and future care planning.

Conclusion

Data suggested no adverse impact of change in practice. Staff were redeployed to the front door frailty team rather than community hospital to improve access to Comprehensive Geriatric Assessment, and a new pathway was designed to create uniformity in flow for admissions to frailty.
2326 Improving recording and documentation of lying standing blood pressure In patients > 65 admitted with/At high risk of fall(s)
Authors: Shipperbottom L , O'Toole R , Singh N , Ajit A , Eze P
Published: August 2024

Introduction

The World Falls Guideline 2022 recommends that measurement of lying-standing blood pressure (LSBP) is an integral part of the multifactorial falls assessment (1). Pre-intervention less than half of eligible patients had a LSBP recorded and documented. The aim was to improve the recording and documentation of LSBP for adults aged 65 and over admitted with a fall or at high risk for falls.

Method

All patients aged 65 and over admitted with fall or identified as at high risk for falls to a care of the elderly ward were included over the period of 15th September 2023-15th November 2023. Royal College of Physicians (RCP) guidance (2017) for standard measurement of LSBP was used2. Data was collected on electronic spreadsheets from electronic observation charts. Two plan do study act (PDSA) cycles were conducted. Firstly, ward posters demonstrated how to record and document LSBP. Secondly ward-based one-to-one teaching interventions using RCP LSBP lanyard flashcards (2) were conducted.

Results

Following cycle one, 50% of eligible patients had LSBP documented. Following cycle two, 80% of eligible patients had LSBP documented. Following two PDSA cycles, there was a 37.1% increase in the average number of eligible patients who had LSBP correctly recorded and documented.

Conclusion(s)

Interventions of aide memoirs and education for nursing and medical staff improved the recording and documentation of LSBP. Indications and correct measurement guidance for LSBP should be included in future ward staff induction information and departmental teaching sessions.

References

1) Montero-Odasso, M, Van der Velde N, Martin FC et al. The Task Force on Global Guidelines for Falls in Older Adults, World guidelines for falls prevention and management for older adults: a global initiative, Age and Ageing, Volume 51, Issue 9, September 2022. 2) Measurement of lying and standing blood pressure: A brief guide for clinical staff. 2017. https://www.rcplondon.ac.uk/projects/outputs/measurement-lying-and-standing-blood-pressure-brief-guide-clinical-staff.
2294 Improving communication and documentation in patients receiving end of life care
Authors: Hal K , Ahmad V , Chatterjee A
Published: August 2024

Introduction

Improvement project in response to several bereavement meetings with families reporting concerns with communication and care received during their loved ones’ end of life care (EOLC).

Methods

Retrospective review of 79 inpatients documentation who died between August 2021–March 2022 in comparison against the Royal College of Physicians National Care of the dying audit to identify targets for intervention. Survey of 22 members of ward staff between (January–March 23) including medical, nursing, and allied health professionals to understand confidence, clinical knowledge and available resources to care for EOL patients and families.

Results

Retrospective audit showed 13.9% of families expressed concerns about EOLC received. Discussions held of the potential for progression into EOLC were 82.4% of cases and that of approaching the terminal phase of life 83.5%, which is similar to the national findings of 83% and 79% respectively. There was an absence in offering holistic support to families and patients like food vouchers, parking permits, and referral to chaplaincy team at only 27.8% cases. This theme was seen in the staff survey, with 16.5% of staff suggesting offering parking permits and 15.2% suggesting food vouchers. The survey also highlighted the relative lack of confidence of allied health professionals 5.9/10 vs the remaining team average of 8.1/10 when providing EOLC.

Conclusions

The audit and survey identified gaps in patient care and communication for our ward staff. To improve quality of care, teaching sessions in collaboration with palliative care team are set to start for ward staff. To improve communication, two proformas were developed; one tackles patient and family communication preferences in cases of acute health deterioration. Another proforma aims to standardise death verification documentation across the trust. These are first cycle interventions to help improve patients and families holistic.
2246 Mind the HAP – an initiative to improve the diagnosis, management and prevention of hospital acquired pneumonia on elderly care
Authors: Nanayakkara T , McLaren C , Miah R , Narayanasamy S , Kobbegala V , Iyer S , Chatterjee A , Faisal K , Black S , Weerasinghe D
Published: August 2024

Introduction

The commonest nosocomial infection in the UK is Hospital Acquired Pneumonia (HAP), associated with prolonged length of stay and mortality. The HAP incidence on Elderly care wards was >5% of admissions, exceeding the national average. An initiative ‘Mind the HAP’ was launched which included doctors, nurses, pharmacists, SLTs, physiotherapists and coders to improve HAP diagnosis, management and prevention.

Methods

To monitor the effectiveness of the interventions 3 audit cycles were performed between 2019 and 2023. Several interventions were implemented between 2019–2023.A multidisciplinary steering committee was formed with 3 work streams (diagnosis, management and prevention). To improve the accuracy of diagnosis and management of HAP, focused educational sessions were conducted for junior doctors with monthly meetings with coders. Nurses championed implementing the HAP prevention strategies i.e. hand hygiene, mouth care and positioning at 30–45 degrees. Regular comprehensive training sessions were held. HAP awareness and education campaign was launched. Daily nursing huddles helped to identify high risk patients. Physiotherapists provide chest physiotherapy to yield sputum sample collection among pneumonia patients. An electronic dashboard of incidence of HAP against the preventative measures and sputum culture reports has been launched with help from informatics. Information leaflets on HAP were created for patient awareness. An electronic HAP power plan to facilitate diagnosis and management of HAP will be launched from February 2024.

Results

HAP incidence has dropped to <2%, diagnostic accuracy improved from 35% to 81%, and sputum collection has increased from 9% to 24%. The HAP Quality Improvement Project received first prize for the most impactful Quality Improvement initiative at the Trust-wide conference in 2023. The results have been shared with the regional Microbiologists.

Conclusion

The collaborative efforts coupled with effective leadership and guidance, have been pivotal to the success of ‘Mind the HAP’ project.
2151 A retrospective analysis of outcomes in inpatient fallers who sustain a neck of femur fracture
Authors: Lee H , Green S , Dickenson C , Russ J , Roberts M , Ng K
Published: August 2024

Introduction

Inpatient fallers make up the minority of neck of femur fractures (NOF) in Morriston Hospital but it was observed that outcomes were less favourable than those in patients who sustained their fracture outside of hospital.

Method

Retrospective analysis was conducted of all NOF patients managed in Morriston Hospital whose injury was the result of an inpatient fall between January 2022 and December 2023. Outcomes were compared to those in all other NOF patients including pathological and occult fractures managed in the centre over the same two-year period. Anonymised data were collected from departmental and electronic patient records.

Results

A total of 1383 NOF patients were analysed of whom 51 sustained their fracture whilst as inpatients across four hospital sites. Among inpatients 35% were identified as requiring supervision when mobilising, the majority required walking aids (73%) and fell on medical wards (65%). Median length of stay prior to falling was 25 days (range 1–171). Patients who sustained a NOF as an inpatient had a lower initial abbreviated mental test scores (p 0.001) and higher frailty scores (p 0.0001) compared to all others, they also had a longer length of stay post injury (Median 23 days vs 17 days p 0.002). Mortality was significantly higher among inpatient fallers Odds Ratio (OR) 4.0 and they were significantly less likely to be discharged to their own home OR 0.3. Post-operative delirium was also seen more frequently OR 2.1.

Conclusion

This data demonstrates that morbidity and mortality is significantly greater among those who fall and sustain a NOF fracture as an inpatient compared to all others. Further work, particularly the timing of inpatient falls in relation to staff handover, is being continued to investigate whether there are any modifiable factors to reduce inpatient falls and the burden of their consequences.
2323 Prevalence of delirium, dementia and cognitive test deficits, hospital-wide and by specialty in > 50,000 unplanned admissions
Authors: Boucher E , Gan J , Shepperd S , Pendlebury ST
Published: August 2024

Introduction

Over one-third of older people with unplanned admissions to hospital are frail, but data on the burden of delirium, dementia and other cognitive frailty are lacking. Reliable hospital-wide and specialty-specific prevalence estimates are needed for service-planning including understanding the role of non-geriatricians in caring for this population.

Methods

ORCHARD includes pseudo-anonymised EPR data for consecutive admissions with a length of stay of >1 day (2017–2019) to four hospitals in Oxfordshire (population = 800,000). Data are collected using a standard cognitive screen comprising dementia history, delirium diagnosis (Confusion Assessment Method-CAM), and 10-point Abbreviated Mental Test-AMTS that is mandated on admission for all patients >70 years. Cognitive frailty was defined as delirium, diagnosed dementia, delirium+dementia or AMTS<8 without delirium/dementia. We analysed the ORCHARD data to determine the prevalence of delirium/cognitive frailty trust-wide and by specialty (n = 29 with >50 admissions).

Results

Among 51,202 admissions with mean/sd age = 82/7 years and Hospital Frailty Risk Score = 8/6, any cognitive frailty was present in 34.5% (95%CI 34.0–34.9%; n = 17,466) of which delirium accounted for 14.6% (n = 7411), delirium+dementia = 9.4% (n = 4757), dementia = 7.5%, (n = 3784), AMTS<8 = 3% (n = 1514). The prevalence of cognitive frailty in general medicine, general surgery and trauma/orthopaedics, which accounted for 80% of admissions (n = 41,016), was 41% (n = 13,879), 21% (n = 801) and 35% (n = 1304) in each, respectively. The prevalence was 44% in geriatric medicine admissions (n = 133/301), 36% in palliative (n = 128/356), 29% in stroke (n = 135/468), 27% in infectious disease (n = 41/152), 22% in neurosurgery (n = 154/702) and 10–20% in all other specialties except two. Delirium was the most prevalent form of cognitive frailty in 24/29 specialties.

Discussion

Cognitive frailty is common in older unplanned hospital admissions across a broad range of specialties, with delirium accounting for most cases. Our findings support the need for hospital-wide and specialty-specific training and service development to reflect the needs of these older complex patients and increased emphasis on delirium in policy.
2245 Disease trajectories and medical expenditures of older long-term care residents in China: prospective observational study
Authors: Zeng L , Tan H , Yang S , Wu J , Dong B , Dou Q
Published: August 2024

Introduction

Global ageing and an increasing disability population impose huge health and economic burdens on societies, and understanding the impact of disability on mortality and medical expenditures among the elderly is vital.

Methods

This study was based on the government-led long-term care insurance program initiated in July 2017 and followed up to June 2021. Diagnosis and hospitalisation costs were extracted from electronic medical records and medical insurance system. The networks of the disease trajectories were established by combining disease pairs with overlapping diseases. Medical expenditures relating to exact disease were calculated and compared between age groups.

Results

The 30,003 participants had a mean age of 79.6 ± 11.1 years, with 57.0% females. After a mean follow-up time of 21 ± 16 months, 17,428 (58.1%) death were observed. Diseases with the highest HRs included septic shock (HR 3.59, 95% CI, 3.36–3.84), respiratory failure (HR 3.19, 95% CI, 3.05–3.34), sepsis (HR 2.98, 95% CI, 2.80–3.18), malnutrition (HR 2.38, 95% CI, 2.27–2.48), and decubitus ulcer (HR 2.27, 95% CI, 2.14–2.41). The disease trajectories were initially related to hypertension and diabetes mellitus, while mortality was associated with malnutrition, infectious diseases, and organic failure. In subgroup analysis, participants with older age, those living in nursing institutions, and males had more complex disease trajectories. The medical costs gradually decreased with increasing age, and there was a rapid increasing trend before death for the decedents. Among the diseases of top 30 frequent hospitalisation visits, intracerebral haemorrhage, sepsis, and respiratory failure ranked as the top three total medical costs.

Conclusions

The study shows that malnutrition and infection-related diseases contribute to death in older disabled and the latter account for part of the highest medical cost, calling for comprehensive strategies for infection prevention and treatment.
2199 The prevalence of pre-admission vitamin D levels in the management and outcomes of proximal femur fractures
Authors: Hunter C , Krishnan S , Ullah A , Rajeev A
Published: August 2024

Introduction

The aim of this study was to examine the prevalence of vitamin D deficiency in elderly patients with fragility fractures of the hip by estimating 25-hydroxyvitamin D levels, whether low levels of Vitamin D at the time of admission affects the functional outcomes and mortality at 28 day and one year.

Methods

A retrospective study of all the patients admitted with a fracture neck of femur from Jan 2018 to March 2021 was carried out. The data was obtained from NHFD (National Hip Fracture Database) and Medway software. A total of 1221 patients were admitted during this period. Patient demographics including age, sex, fracture pattern, Vitamin D levels at the time of admission, function at 120 days, mortality at one month and one year were calculated.

Results

Of the 1221 patients, 106 patients did not have the Vit D levels checked at the time of admission. The average age was 81.91 (range-60 to 108). There were 845 (70%) females and 376 (30%) males. The serum Vit D levels were low in 611 (55.3%) patients. The mobility in patients with Vit D deficiency 261 (40.9%) has dropped significantly in the 3 months after surgery for fractures of proximal femurs. The 28 day and one year mortality was 6.74% and 30.3% compared to 4.7% and 27.3% for those with low and normal levels of vitamin D respectively. Patients with low Vit D levels at the time of admission with proximal femur fractures has got higher 28 day and one year mortality rates compared to those with normal levels.

Conclusion

Our study showed that low levels of Vitamin D at the time of admission with proximal femur fractures are associated with poor functional mobility, higher perioperative and one year mortality.
2251 Geriatric medicine competencies required by all hospital doctors caring for older adults: a scoping review
Authors: Buckley E , Bennett D , Barrett A , O'Tuathaigh C , Cooke J
Published: August 2024

Introduction

An ageing population globally has created an escalating demand for age-attuned healthcare services. Most older adults will continue to receive their medical care from doctors without specialised geriatric medicine training. It is important therefore that all doctors possess fundamental gerontological competencies. Which specific competencies and how they might best be integrated into medical education remain unclear. Our aim was to summarise the literature on the geriatric medical competencies required by all doctors caring for older adults.

Methods

We undertook a scoping review following Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). We systematically searched the electronic databases PubMed, Cochrane, Cinahl, PsycInfo, ERIC and Embase for eligible records from January 2012 to December 2022. Studies related to physician or doctor or resident and competencies or curriculum or education and geriatric medicine or gerontology were included. We also searched the websites of included countries’ medical specialty professional bodies for relevant competency frameworks.

Results

Eighty-seven sources were included in the review. The most common competencies identified were medication management, recognition and management of cognitive impairment and management of chronic disease and co-morbidities. Considerable heterogeneity existed among the remaining competencies identified including interprofessional communication skills, advanced care planning and discharge planning. Competencies addressing subspecialty areas including stroke, orthogeriatrics, movement disorders were less prominent.

Conclusion

Multiple attempts to create and implement competency frameworks on local, national, and international levels in addition to educational interventions to address competency gaps locally reflect the wide-ranging challenges faced by healthcare systems in caring for an ageing population. Significant variation in competencies exists among the sources included in this scoping review. An overarching competency framework is now necessary to define the required competencies for all hospital doctors caring for older adults.
2344 The British geriatrics Society’s training programme director survey 2023: a summary of our findings
Authors: True S , Koh A , Arora A
Published: August 2024

Introduction

As we strive to generate more geriatricians we must understand the journey of the training programme. Whilst information is available from the RCP census and BGS workforce survey this study will compliment that data and obtain a broader picture. A similar survey was last undertaken by the BGS in 2019 and since that time much has changed, from a pandemic to the first published NHS Long term workforce plan.

Method

TPDs were contacted directly by the BGS VP for workforce at the geriatric medicine specialty advisory committee and invited to complete an electronic survey. The survey had been designed by the BGS workforce committee in line with the BGS strategic plan to strengthen the workforce for older people. The survey was open for 6 weeks.

Results

Surveys were returned from 14 out of 19 deaneries, some were incomplete. National training numbers have increased since the 2019 survey, in total and with less vacancies. Six trainees had left the training programme in 2023 before obtaining CCT for various reasons. The percentage of trainees working less than full time has doubled from 21.9% in 2019 to 44.8%, the majority for parenting responsibilities. Most deaneries reported at least one trainee spending time out of programme, the majority pursuing additional experience directly related to the curriculum such as stroke. Qualitative data suggested solutions to increasing national training numbers and encouraging doctors to consider the specialty early in their career.

Conclusions

This study was limited by incomplete data, a mixture of non and partial responses. What this study adds is an insight into the paths to becoming a geriatrician and solutions TPDs have found to supporting individual needs. These solutions can now be shared to help our members tend to the workforce crisis by successfully recruiting, training and retaining the geriatricians of the future.
2238 How can effective teaching about dementia be integrated into the undergraduate medical curriculum? A realist review
Authors: Tullo E , Wakeling L , Pearse R , Khoo TK , Teordorczuk A
Published: August 2024

Introduction

The prevalence of dementia is increasing and yet healthcare professionals (HCP) do not always have sufficient education and training to deliver optimal care for patients with dementia (PWD). There is an evidence base as to how to deliver effective undergraduate education about dementia but this is infrequently integrated into the medical curriculum.

Methods

We undertook a realist synthesis to review the barriers to integrating effective interventions on dementia into the medical curriculum. A realist synthesis differs from a traditional systematic review in terms of explaining how interventions might succeed (or not) in a particular context, involving iterative cycles of literature review and synthesis to develop and refine a ‘programme theory’ (PT).

Results

We analysed and synthesised twenty relevant studies of undergraduate educational interventions on dementia to identify common themes. We constructed an ‘initial programme theory’ (IPT) to illustrate the contexts where teaching on dementia occurs and outline four main categories of barriers to curriculum integration: culture, concern for patient welfare, student attitudes, and logistics.

Conclusion

We have identified key barriers to implementation of undergraduate education about dementia, and potential mechanisms to overcome them. The next stage of our realist synthesis is to gather stakeholder feedback on the validity of the IPT before returning to the next cycle of literature review to refine and finalise our PT. This model will serve as a guide for those aiming to successfully integrate effective education about dementia into the medical curriculum.
2214 Using poisons Centre data to identify potential safety risks associated with the use of monitored dosage systems.
Authors: Price H , Edwards E , Thomas C , Gray L
Published: August 2024

Introduction

Monitored dosage systems (MDS) encompass a wide range of devices to help management of medication. This research uses poison centre data to explore risks associated with their use.

Method

A search of accidental overdose enquiries to the UK National Poisons Information Service (NPIS) between 1/01/2017–31/12/22, classified as ‘therapeutic error/medical error’ involving patients aged 65 or over was performed. Enquiries involving an MDS were identified. Data were analysed using descriptive statistics and chi-square test.

Results

There were 394 enquiries concerning 393 patients and mean patient age was 81 years. There were significantly more females (n = 266) than males (n = 127), p = <0.0001. Exposures occurred at home (n = 372), in care homes (n = 18), in prisons (n = 2) and in hospital (n = 1). Cognitive impairment was reported in 32.5% patients (n = 127). The 10 most common medications involved were bisoprolol (n = 74), lansoprazole (n = 59), atorvastatin (n = 58), aspirin (n = 47), omeprazole (n = 43), amlodipine (n = 44), paracetamol (n = 42), clopidogrel (n = 42), ramipril (n = 42) and metformin (n = 35). Most patients were asymptomatic (n = 312). Common symptoms recorded were somnolence (n = 16), dizziness (n = 13), confusion (n = 11), fatigue (n = 7) and hypotension (n = 5). Common reasons for incidents were a mistake by patient or family member (n = 189), medications taken unwitnessed (n = 88), MDS incongruent with current prescription (n = 22), patient took another person’s medications (n = 19), patient took medication in MDS in addition to that in normal packaging (n = 15) and extra doses administered by different people (n = 15). Almost 51% of patients were recommended to attend Emergency Department (ED) by the NPIS (n = 200) and 18% were advised to contact their GP (n = 71).

Conclusion

MDS are perceived to improve adherence, these results reveal their potential harm. For example, most of patients in these enquiries were advised to seek medical help. MDS harm is likely underreported as this was a retrospective study and some information was not routinely collected. Further work including a prospective study is needed alongside support of safer medicine use through improved communication, education, and alternative tailored support.
2277 Predictive factors of delirium in neck of femur fracture and post-operative outcomes at Morriston hospital
Authors: Cochrane J , Ng KL , Russ J , Roberts M
Published: August 2024

Introduction

Neck of femur fractures (NOF) remain a significant cause of mortality in the elderly, especially in those who develop delirium post operatively. The aim of our study is to identify risk factors that may contribute to developing a delirium.

Method

A prospective cohort study of 717 patients presenting to Morriston Hospital who underwent operative management for a NOF fracture.

Results

A total of 103 patients developed a post-operative delirium, an incidence of 14.4%. Clinical Frailty Score (CFS) and Abbreviated Mental Test Score (AMTS) proved to be significantly associated with developing delirium (p < 0.0001). Delirium was highly prevalent in patients with moderate frailty (CFS6≥) and an abnormal AMT score (<8), present in 70% and 73% respectively with individual odds ratios of 4.1 and 5.2. Delirious patients suffered higher inpatient mortality (16% v 5%, p 0.0004), an increased length of stay (32 vs 23 days, p < 0.0001) and were more likely to be directly institutionalised (10% vs 3% p 0.002) without rehabilitation. Admission inflammatory markers and prolonged waiting times for theatre were highly prevalent in both groups and not pursued.

Conclusions

Patients presenting with moderate frailty and abnormal AMTS were at greatest risk of developing a delirium which was associated with poorer outcomes. We propose identifying high-risk patients from the point of admission to ensure early targeting of potential reversible factors. A delirium toolkit could aid in identifying these patients and there may also be an argument for the prioritisation of high-risk individuals in theatre list given their increased mortality.
2328 Knowledge of dying in place and preferences for place of death among older adults in Hong Kong
Authors: Lee LYK , Kwan QCM , Cheung MCY , Cheung RTM , Lee MAWS , Po EYP
Published: August 2024

Introduction

The preference for place of death and the concept of dying in place have been subjects of debate in numerous jurisdictions. Despite the growing prevalence of ageing populations and the increasing demand for dying in place, there is a limited body of literature exploring older adults’ knowledge of dying in place and their preferences for the place of death. In Hong Kong, there are ongoing legislative efforts to revise the policy on dying in place. This study aims to investigate the knowledge of dying in place and the preferences for the place of death among older adults in Hong Kong.

Methods

This cross-sectional study recruited 503 older adults. A questionnaire was disseminated through online social media platforms and face-to-face interview. ANOVA was conducted to compare the differences in knowledge scores among participants with varying preferences for the place of death.

Results

Participants demonstrated a sub-optimal knowledge level (mean = 3.55; range 0–8). Notably, 54.7% of participants were unaware of the existing law that regulates dying in place in Hong Kong, and 43.5% did not know about the availability of community resources to support patients who choose to die at home. A greater number of participants (55.5%) preferred to die at home. Other preferences included hospital (18.9%), hospice (17.1%), and care home (8.5%). Participants who preferred to die at home exhibited a higher knowledge score (mean 3.84) compared to those who preferred to die in hospital (mean = 2.79) (F = 5.323, p = 0.001).

Conclusions

The findings of this study provide insights that can inform the revision of current policies, the enhancement of community resources supporting dying in place, and the strengthening of life and death education targeted at older adults.

Acknowledgement: The work described in this paper was fully supported by a fund from Hong Kong Metropolitan University (RD/2022/2.17).