bluuebunny/crossref_metadata_2025 huggingface dataset:
1907 Completing the ‘This is me’ document within the first 48 hours reduces length of stay and improves patient experience
Authors: Payne H , Foxley H , Wilton R , Clift E
Published: January 2024

Introduction

By 2025 over 1 million people will be diagnosed with dementia in the UK. Person-centred care is the best practice for looking after patients with dementia, but this is often not managed well within acute hospital settings. This can result in poor hospital experience and longer than necessary stay. A snapshot of data was taken retrospectively from May 2023 within the ED & AMU at an acute hospital. This showed an average length of stay (LOS) of 5.25 days. A study in 2013, which implemented This Is Me (TIM) documents in hospital saw a reduction in inpatient falls, improved patient experience and in turn LOS reduced.

Aim

To reduce LOS and improve the patient experience for people with dementia presenting to the hospital following a fall.

Method

A two-week pilot was implemented in ED & AMU 7 days a week, 8-6pm. Patients were identified through the ED therapy screening process. Paper copies of the TIM were filled in for patients meeting the criteria. Inclusion criteria were admission with a fall and had a dementia diagnosis. LOS data was collected and follow-up data was collected.

Results

Twenty-five patients met the inclusion criteria. Every patient had a TIM document completed within 48 hours. The average LOS was 1.87 days. All patients/relatives reported the TIM was important, and that it improved information transfer. There were several limiting factors including the time involved to complete the TIM, reduced weekend staffing and limited awareness from the multidisciplinary team of the TIM document.

Conclusion

To conclude, using the TIM Document facilitates a reduction in LOS and an improvement in patient experience. Further recommendations such as launching this project for a longer time frame, using an electronic version of TIM and MDT teaching.
1975 Does attendance at a geriatrician led, oncogeriatric clinic, improve the symptoms for older adults with cancer?
Authors: Samy F , Teo M , Colquhoun K , Seenan P , Downey T , Kelly D
Published: January 2024

Introduction

In the cancer setting, Comprehensive Geriatric Assessment (CGA) reduces chemotherapy toxicity, improves QOL and increases advance directive completion (ASCO 2020: The Geriatric Assessment Comes of Age; Soto-Perez-de-Celis et al; The Oncologist). We wanted to look at whether CGA improved symptomatology, as patients attending our oncogeriatric clinic complained of a range of symptoms, related to their cancer, as well as other co-morbidities and frailty.

Methods

We retrospectively analysed follow up clinic letters of patients who had attended the oncogeriatric clinic, between June 2022 and June 2023. We used a Lirkert scale, to see whether symptoms they had complained of had 1 – got worse, 2 – stayed the same, 3 – improved or 4 – resolved.

Results

32 patients with a wide range of malignancies were included. 59 patients were excluded because they: died before the 2nd appointment, did not require a second appointment, had their second appointment outside the analysis window, DNA or in 1 case the follow up letter could not be found. On average each patient complained of 3 symptoms. 30 different symptoms were noted (2 excluded as there was no mention of them in the 2nd visit.) The top presentations were pain, constipation, low mood, breathlessness, reduced mobility, falls and dizziness. 68% of the symptoms complained of showed improvement – including all the top presentations. The average score on the Lirkert scale was 2.76. 78% of patients had shown improvement or resolution in at least some of their symptoms.

Conclusions

Our retrospective review shows that older, cancer patients, have a high burden of varied symptomatology, because of their cancer, co-morbidities and frailty. Attendance at an oncogeriatric clinic results in improvement in the symptom burden for the majority of older adults, and an improvement in some symptoms, whether they are related to cancer, or other frailty syndromes.
1710 Using the Visual Assessment Tool (VAT) on all patients at risk of falls in the day assessment unit (DAU)
Authors: Gurung P , Sathiananthamoorthy S
Published: January 2024

Objective

To conduct a QIP to ensure that >80% of DAU patients’ vision was assessed via the VAT as per National Audit of Falls Prevention Guidance.

Background

Patients with visual impairment are twice as likely to fall than those without. The NAIF 2015 report identified <50% of elderly patients had their vision assessed in hospital; also evident at Southend Hospital.

Methods

Data collection from 56 patients over 8 weeks following weekly interventions helped us analyse their impact on VAT use. Control data (week 1) was pre-intervention.

Intervention

Six interventions were applied over 7 weeks: teaching to nurses, HCAs and doctors about VAT; email to Geriatrics team; reminder email to DAU nursing team and a feedback questionnaire.

Results and Discussion

Mean age was 82 and 38% of patients attending DAU had an ophthalmic history. Pre-intervention (week 1) identified 0% VAT use. In week 2, there was a 75% increase in VAT use after teaching nursing and HCA staff. In week 3, there was only 12.5% VAT use after the poster intervention. In week 4, there was a 25% uptake on VAT use with no intervention. Week 5’s intervention witnessed 100% in VAT use, which remained high in week 6 (85.7%), 7 (100%) and 8 (100%). The final intervention questionnaire highlighted that 100% of staff were (i) previously unaware of VAT, (ii) agreed on its importance in assessment of elderly patients, (iii) found teaching adequate, (iv) thought there was enough awareness on VAT use via the QIP, (v) agreed that an incomplete VAT was due to inability to undertake section 4 and 5.

Conclusion

VAT use identified 3 ophthalmic problems that would have otherwise not been managed. While the QIP did not meet the target of >80% VAT use, it successfully informed DAU staff in proper conduct of VAT in falls patients.
1705 Geriatrician involvement with community multi-disciplinary teams to support people living with frailty and reduce readmissions
Authors: Rahman S , Shamsad S , Bafadhel L
Published: January 2024

Introduction

Factors contributing to frailty result in increased hospitalisations, with 5- 10% of patients attending Accident and Emergency department living with frailty, and 30% of those patients admitted to acute medical units (Conroy, 2013). Hospital admissions result in functional decline and deconditioning (Get It Right First Time, 2021). The number of people in the UK over the age of 85 is set to double in the next 20 years and treble in the next 30 (Office of National Statistics, 2013). Their needs are best met in the community with a multi-disciplinary approach.

Method

Patients, residing in Benfleet and Leigh-on-sea, discharged from Geriatric wards at Southend Hospital were identified during ward MDT meetings. Inclusion criteria: • Recurrent admissions • Prolonged hospital stay • Clinical Frailty Score > 5 • Social support Using this criteria, 216 patients were included. 7-day readmission and 30 day readmission data was collected and compared to readmission rate prior to intervention. Intervention On discharge patients were linked with Frailty Nurses within their Primary Care Network and were reviewed within 48-72 hours of discharge. Community support was provided via MDT, with involvement from consultant geriatrician. Concerns that could result in readmission were highlighted during these meeting, with patients being seen in Day Assessment Unit for review of sub-acute frailty syndrome if appropriate.

Results

Following intervention of utilising community MDT there was a reduction in rate of readmission. 9 patients (4.1%) were readmitted within 7 days of discharge and 14 patients (6.4%) were readmitted within 30 days, in comparison to 7.6% and 19.3%, respectively, prior to commencement of MDT.

Conclusion

This concludes that utilising community MDT with review following discharge has positive impact in reducing readmission rates. Highlighting potential risks of readmissions allows the MDT to address issues within the community and use bridging services appropriately.
1894 Enhancing detection of possible sarcopenia and delivery of targeted physiotherapy interventions among hospitalised older patient
Authors: Tan S Y , Tan L L S , Cheng Z C D , Yong H W Q , Wong L L , Seow C C D
Published: January 2024

Introduction

Sarcopenia, defined as age-related loss of muscle function and strength, has a reported prevalence of up to 40.4% in the older adult. Despite its association with frailty, disability and mortality, it is underdiagnosed among hospitalised older patients. Exercise interventions have also been shown to improve fall risk scores for sarcopenic patients. A QI initiative was started by a team comprising doctors and physiotherapists.

Method

Our aim was to enhance detection of possible sarcopenia and reduce time to delivery of targeted physiotherapy interventions to 1 working day from admission in patients aged > 65 admitted to our ward. Interventions were grouped into three main categories – strength training, balance and gait stability training. A pilot study of 12 patients showed that no sarcopenia assessments were carried out and mean time to PT review was 2.6 days from admission, with an average of 1.08 interventions performed per patient. Fishbone analysis and Pareto chart were conducted to identify and prioritise factors behind low screening rates of sarcopenia, before driver diagram was performed to develop solutions. Our team established that education of junior doctors on sarcopenia and implementation of SARC-CAIF screening were the most appropriate interventions to achieve our objective.

Results

A total of 26 patients were identified, with an average age of 76.7 [6.7] years old. The mean SARC-F and SARC-CaIF scores were 4.51 [3.5] and 14.6 [2.4] respectively. 50% (13/26) of patients were admitted for falls. After implementation of SARC-CaIF screening, mean time to PT review was shortened to 1.38 days from admission, with an increase in PT interventions to 2.23 per patient. Prevalence of possible sarcopenia is high among inpatients.

Conclusion

More can be done to enhance its detection among frail hospitalized older patients, so as to deliver targeted physiotherapy interventions. Doctor education and SARC-CaIF screen are simple and practical tools that can be utilised.
2052 Polypharmacy reviews in outpatient clinics - beginning the structured medication review in bone health clinic
Authors: Alićehajić-Bečić Ð
Published: January 2024

Introduction

Inappropriate polypharmacy is recognised as a contributing factor towards adverse outcomes in frail patients. Current efforts at national level are centred around primary care initiatives in completing structured medication reviews (SMR) where shared decision making takes place with open discussion around risks and benefits of treatments. The aim of this review was to assess whether recommendations for discussion in SMR have been adopted for patients attending frailty bone health clinic led by Consultant Pharmacist, in hospital outpatient setting.

Method

Retrospective analysis of notes was undertaken in a sample of 30 patients reviewed in clinic in the period 01.09.22-28.02.23 who were on at least five medications, were still alive six months post review and where suggestions with regards to actions to discuss during a structured medication review were made.

Results

Average age of patients sampled was 79 years with average CFS of 5.75. Number of medicines documented at outpatient appointment was on average 10.6 which reduced to 9.95 at review six months after the appointment. Around a third of recommendations were adapted fully, with another third partially completed and a third not completed. Interventions included review of falls risk increasing drugs (FRIDs), reduction of anticholinergic load, identification of possible prescribing cascades, review of opioid medication in chronic pain context and review of medicines where benefit may no longer be derived due to frailty progression. In cases where review of medication with high anticholinergic load was advised, an average reduction of -3 was achieved at six-month review.

Conclusion(s)

Starting a structured medication review in outpatient clinic has the potential to reduce the risk of adverse events and improve outcomes for patients. Further work will be undertaken to ascertain reasons for not adopting the recommendations and continuous collaboration with primary care colleagues will continue to address problematic polypharmacy.
1882 Treatment Escalation Plans (TEP): benefits in adult in-patient facilities
Authors: Jenkins C , Patel H P
Published: January 2024

Introduction

Treatment escalation plans (TEP) guide level of life sustaining therapeutic interventions that should occur for each patient admitted to hospital and can prevent inappropriate and undignified interventions. However, implementation of TEP in routine clinical practise has been ad hoc partly due to the paucity of literature on their benefits. Our aim was to systematically review the literature to ascertain the use and benefits of TEP in adults.

Methods

A systematic search for studies reporting TEP use were performed in the databases OVID Medline, Embase, Scopus and Web of Science. Search terms were ‘Treatment Escalation Plan’ Treatment Limitation, ‘Therapy Escalation’, ‘Escalation of Care’, ‘Palliative’, End of Life’, ‘Advanced Care Plan’. Exclusion criteria included studies prior to 2007, systematic reviews, case reports and letters.

Results

468 records were retrieved, 117 duplicates removed, 351 records were screened. 302 were excluded by date or relevance. Of 49 eligible records, 39 were excluded by criteria or unavailability of full text articles. 10 Studies using case control and quality improvement methodology conducted between 2010-2022 involving 1614 patients were subject to a narrative review. 8 different TEP proformas were used. All studies reported an increase in TEP use across all clinical settings and after each PDSA intervention ranging from 78%-100%. TEP reduced the frequency of non-beneficial interventions and was associated with an average saving of £220 per patient.

Conclusions

TEP lead to more frequent and proactive discussions with patients on ceilings of care and provide clear guidance to clinical staff out of hours, facilitate patient handover over successive shifts and enable proactive discussions with critical care. We identified the need for TEP to be successfully implemented in a unified manner across all healthcare facilities in order to improve patient care, reduce the burden of non-beneficial interventions and align with the NHS Long Term Plan.
1987 Capillary blood glucose testing on older inpatients at the Norfolk and Norwich University Hospital (NNUH)
Authors: Navaneetharaja N , De Silva R , Mattishent K , Loke Y
Published: January 2024

Rationale

Inpatient glycaemic management is a challenge in older people. Clinicians at the Norfolk and Norwich University Hospital noticed substantial numbers of finger-prick capillary blood glucose (CBG) tests being documented. This quality improvement project explored the frequency of CBG testing on older people’s medicine wards, to determine if improvements in service provision and patient safety could be made.

Methods

Setting: Electronic records of inpatients on geriatric medicine wards at NNUH (May-July 2023)

Patient selection: Older people with recorded CBG testing

Measures: Type of diabetes, medication regime and frequency of CBG testing. Staff survey of CBG monitoring knowledge.

Analysis: Compliance with the Joint British Diabetes Societies for Inpatient Care guidelines for frail older adults with diabetes (February 2023). Staff knowledge.

Results

240 inpatients included - 23% had type 2 diabetes. 32% had regular CBG monitoring (once daily or more). Of these patients, 70% had tests that were not compliant with guidance. In a single day, we calculated 120 CBG tests that were not clinically indicated. 43% of patients were on single-therapy treatment (not including sulphonylureas) or diet-controlled type 2 diabetes, all of whom underwent excessive testing during their inpatient stay. A staff survey of 15 ward sisters, nurses and healthcare assistants revealed no consensus on who determines frequency of CBG testing and target CBG ranges for frail, older inpatients.

Conclusions

Ad hoc CBG testing has resulted in potential harm to our inpatients and overuse of staff time and resources. Future work is underway to ‘Think Glucose’ and implement protocols for appropriate CBG monitoring frequencies and target CBG ranges for our inpatients.
2002 An observational study of the effectiveness of FIT test as a risk stratification tool in frail patients presenting with anaemia
Authors: Khatun M , Khanom S , Rasheed R
Published: January 2024

Introduction

Faecal-immunochemical-test is employed as a screening tool for colorectal cancer. Our observational study examined the FIT in primary care as a risk stratification tool in frail patients.

Method

The records of 217 frail patients over a 24-month period were analysed. Patients with haematological indices of anaemia were offered FIT to detect GI haemorrhage as part of assessment for selection for lower GI investigations. Patients were risk stratified based on FIT results based on the presence or absence of red flags. Patients who were FIT positive were referred for urgent lower GI endoscopy versus those who were FIT negative were managed without bowel investigations unless there were red flags such as abdominal mass, changed bowel habits or family history of bowel cancer.

Results

Of 217 patients over a 24-month period of these 42 patients (19.4%) were FIT positive. All of these (n = 42) underwent colonoscopy of which 15 (normal)16 (colonic polyps) 6 (diverticulosis) 3 (colorectal cancer). Of the 42 FIT positive patients 16 were on direct oral anticoagulant (DOAC). Patients on DOACs and those on dual anti platelet agents were more likely to be FIT positive. We also found a positive correlation between higher frailty indices, HAS BLED scores and chronic kidney disease and low creatinine clearance r=0.82, p=0.001. Despite the small numbers in this study the correlation is statistically significant

Conclusion

There is a statistically significant positive correlation of FIT positive and frailty indices with DOACs, Dual anti platelet agents, CKD, low creatinine clearance (r=0.82 and p=0.001). Following this the HASBLED scores increased hence our practices implemented an enhanced surveillance of monitoring these patients quarterly due to the increased risk. We advocate frailty indices should be incorporated in the HAS BLED scores for improved patient safety.
1990 Acute Sedation Prescribing in the Older Person
Authors: Ashcroft-Quinn S , McKenna M , Roberts M V
Published: January 2024

Introduction

Anti-psychotics and benzodiazepines are commonly prescribed for older people. They are usually indicated in the short term for delirium and agitation. There are known risks associated with these drugs in the older population including functional decline, increased falls risk and overall mortality. Moreover, chemical sedation is a form of restraint and deprives patients of their liberty. Sedative prescribing should be protocol driven and preceded by non-pharmacological intervention. However, these prescriptions are often initiated prematurely and evade review, continuing in the long-term.

Method

Our QI team aimed to reduce prescribing of new sedating drugs by 60% in patients using an MDT approach. Our strategies focused on increasing awareness and utilisation of existing protocols, to improve non-pharmacological management of delirium. This was achieved through the strategic delivery of teaching sessions for nursing, pharmacy and medical staff. Further, we utilised force function techniques and management charts to encourage review of these prescriptions. We gathered our data on a weekly basis over a five-month period by reviewing all prescribed medicines for patients on an older people’s ward.

Results

We exceeded our initial aim achieving a reduction of 82% in the prescribing of new lorazepam and haloperidol. We also attained a significant and sustained uptake of over 95% in the use of the delirium protocol. Where a review sticker was used, 80% led to discontinuation of the target prescription. Although these improvements were focused on one ward, the wider changes and improvements were observed throughout the hospital.

Conclusion

The significant reduction in sedative prescribing demonstrates the need and potential for improving the quality and safety of this aspect of patient care. The wider success of this project highlights the importance of addressing human factors to drive and sustain change. Improving the understanding of MDT members is integral to changing behaviours and improving patient safety.
1977 Multimorbidity patterns and aged residential care admissions in Aotearoa New Zealand
Authors: Teh R , Kerse N , Ranchhod D , McBain L
Published: January 2024

Introduction

Multimorbidity is complex and impacts patients' quality of life, health outcomes, and health care utilisation. This project aims to identify multimorbidity patterns and their impact on long-term care admissions in community-dwelling older adults.

Methods

Multimorbidity was ascertained using primary care data Tū Ora COMPASS Health. Adults aged 65+ (55+ for Māori and Pasifika) were included in the analysis. Aged residential care (ARC) admission was determined from interRAI. Twelve conditions ascertained were hypertension, ischaemia, congestive heart failure, stroke, diabetes, cancer, chronic obstructive pulmonary disease, depression, hypothyroid, osteoporosis, dementia, and neurological diseases. Latent class analyses were completed to identify multimorbidity patterns by ethnicity, i.e., Māori, Pasifika, and non-Māori/non-Pasifika (nMP). For the latter group, analyses were also completed by age groups (<80 years and ≥80 years. Cox-regression models were used to examine the association between multimorbidity patterns and 5-year ARC admission.

Results

The sample comprises 45,178 older adults: nMP (88%), Māori (8%), and 1,755 Pasifika (4%). The average age for Māori and Pasifika was 65.1, respectively, and nMP was 74.1. We identified three multimorbidity patterns for Māori and Pasifika, and four for nMP (<80 and ≥80). All twelve conditions clustered differently in these samples. Eleven-per-cent Māori were in a 'complex-cluster', and they had a three times higher risk of ARC admission than 'healthier-cluster' [aHR(95%CI): 2.96 (1.81-4.36)]. We did not observe an association between condition clusters and ARC admission risk in the Pasifika sample. In the nM/nP<80y sample, those in 'complex-cluster' (4%) had a 5.5 times higher risk of ARC admission (5.48, 4.68-6.41) than in the 'healthier-cluster'; a similar association was observed in nM/nP≥80y in 'complex-cluster' (8%) when compared to 'healthier-cluster' (4.08, 3.67-4.53).

Conclusions

Complex clusters were associated with an increased risk of five-year ARC admission. Multimorbidity patterns are helpful for a more strategic approach to managing multimorbidity better in primary care settings.
2022 Association between severe mental illness and risk of osteoporosis and fragility fractures: analysis of UK primary care data
Authors: Avgerinou C , Walters K , Bazo-Alvarez J C , West R M , Osborn D , Clegg A , Petersen I
Published: January 2024

Introduction

Severe Mental Illness (SMI), particularly schizophrenia, has been associated with reduced bone mineral density and increased risk of fractures, although some studies have shown inconsistent results. We aimed to examine the effect of SMI on recorded diagnosis of osteoporosis and fragility fracture in older people in the UK, accounting for age, sex, social deprivation and lifestyle factors (smoking, alcohol and Body Mass Index (BMI)).

Methods

We used de-identified data provided as part of routine primary care (IQVIA Medical Research Database). Patients with a diagnosis of SMI (schizophrenia, bipolar disorder, other psychosis) aged 50-99y between 1/1/2000-31/12/2018 were matched 1:8 to age- and sex-adjusted controls without SMI, using Exposure Density Sampling (EDS). We estimated Hazard Ratios (HR) and 95% Confidence Intervals (95%CI) based on Cox Proportional Hazards model. We stratified the analysis by sex, accounting for age, social deprivation, year (model 1), and the above plus smoking, alcohol, and BMI (model 2). We imputed missing lifestyle data using Multiple Imputation.

Results

In total 444,480 people aged ≥50 years were included in the analysis (SMI N=50,006; controls N=394,474). In men, prior diagnosis of SMI increased the risk of osteoporosis diagnosis by 64% (HR 1.64; 95%CI 1.44-1.88) and the risk of fragility fractures by 87% (HR 1.87; 95%CI 1.70-2.06) in model 1. SMI also increased osteoporosis risk by 49% (HR=1.49; 95%CI 1.30-1.71) and fragility fracture risk by 82% (HR=1.82; 95%CI 1.65-2.00) in model 2 in men. In contrast, prior diagnosis of SMI had no significant effect on recorded osteoporosis risk in women. Prior SMI in women increased fragility fracture risk by 53% (HR 1.53; 95%CI 1.45-1.61) in model 1 and by 51% (HR=1.51; 95%CI 1.43-1.58) in model 2.

Conclusions

SMI is associated with increased risk of osteoporosis in men, and fragility fractures in both men and women, with a greater effect in men.
2027 Protein consumption and determinants in community dwelling older adults: National Diet and Nutrition Survey (NDNS) years 9-11
Authors: Taylor K , Goodwin V , Hope S
Published: January 2024

Introduction

Reference nutrient intake for protein amongst the general population is 0.75 grammes of protein per kilogram of body weight per day (g/kg BW/d). Expert groups recommend healthy adults over 65years have 1.0-1.2g/kg BW/d to support good health and maintain functionality (Deutz, Bauer and Barrazoni, Clinical Nutrition, 33(6):929-36). A recent paper suggested age specific recommendations of 1.2g/kg BW/d (Dorrington, Fallaize and Hobbs, Journal of Nutrition, 150(9):2245-2256). This study aimed to quantify percentage of community dwelling older adults meeting recommendations for protein intake and explore factors associated with low consumption.

Methods

The study population comprised >65s completing the NDNS survey years 9-11 (2016-2019). Dietary intake was recorded in food diaries. Protein consumption was calculated as grammes per kilogram adjusted body weight per day (g/kg aBW/d). Adjustment made for body mass index (BMI) below 22kg/m2 and above 27kg/m2. Percentage of participants meeting protein recommendations for 0.75, 1.0 and 1.2g/kg BW/d was calculated. Chi-squared test for independence was utilised to determine association between social, health and lifestyle factors and low protein intake.

Results

Data from 385 participants were included; 43% male, 98% white. Mean protein intake was 0.98g/kg aBW/d (SD ±0.25). Prevalence of protein intake below 0.75g/kg aBW/d was 16.4% (n=63), below 1.0g/kg aBW/d was 52.2% (n=201) and below 1.2g/kg aBW/d 82.1% (n=316). Current and ex-regular smoking was associated with protein intake <1g/kg aBW/d (p=0.01). No other analysis reached statistical significance although prevalence of low protein intake was higher in those without their own teeth (p=0.08), use of dentures (p=0.14) and BMI of 27-30kg/m2 (p=0.09).

Conclusion

A large percentage of older adults are below expert recommendations for protein intake. There is a need for clarity over recommendations so that a clear public message can be given to optimise health and function in ageing. Factors influencing poor protein intake require further examination.
1826 Development of inter-professional simulation-based education in geriatric medicine
Authors: Irvine J , Nelson E
Published: January 2024

Background

Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles (1). We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence.

Method

We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty.

Results

Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being “not at all confident” and ten “extremely confident”). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment.

Conclusion

Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.
1995 Constructing a Frailty Index using routinely collected measures to study its relationship with adverse health outcomes
Authors: Rockwood K , Nar A , Godin J , Theou O
Published: January 2024

Introduction

Any Frailty Index (FI) measures overall health. The FI-Lab employs common laboratory data and clinical measures to do so.

Objective

To examine how an FI-lab constructed from vital signs, laboratory tests, and electrocardiographic data is associated with in-patient admission and time to death. FI-Lab performance was compared with an FI from a Comprehensive Geriatric Assessment (FI-CGA), the Clinical Frailty Scale (CFS), and the Canadian Triage Acuity Scale (CTAS).

Method

Participants were Emergency Department (ED) patients aged 65+ years referred to Internal Medicine, staffed by a geriatrician (KR). Fifty-seven FI-Lab variables were binarized (0 = no deficit; 1 = deficit) using standard normal ranges. Each FI was calculated as the fraction of items present as deficits. Age- and sex-adjusted Cox proportional hazard and logistic regression models were used to assess relationships with all-cause mortality, and in-patient admission, respectively.

Results

Of 808 patients, an FI-Lab was calculable in 807. Median age was 81 years (IQR:13); 55.7% were female. FI-Lab values ranged from 0.05–0.78 (Mean: 0.51; Standard deviation (SD) 0.10). Females (0.50±0.11) had lower FI-Lab scores than males (Mean: 0.52±0.09; p=0.003). At 30 days, each 0.01 FI-Lab unit increase showed higher mortality Hazard Rate (HR) (95% Confidence Interval (CI):1.04 (1.02–1.06) and inpatient admission risk: Odds ratio (OR) 1.02 (1.00–1.03), as did the FI-CGA (1.04; 1.02-1.04) and CTAS (1.46; 1.02-2.10). Similar results held for inpatient admission, save for CTAS (0.95; 0.54-1.64). By two years, only the FI-lab and CFS significantly predicted mortality risk.

Conclusion

FI-Lab scores were associated with higher mortality rates and in-patient admission risk in older ED patients referred to Medicine. In acute care, the FI-Lab appears to integrate baseline frailty with illness severity. As such data often are routinely available, the FI-Lab might be an additional passive measure of frailty-related risk, potentially available in real time.
1895 Three-year nationwide analysis of falls risk prescribing for over 65 care home and non-care home patients
Authors: Shroufi A , Garbuzov M , McPherson M
Published: January 2024

Introduction

In 2021 the NHS Business Services Authority Data Science team openly published the first comprehensive nationwide analysis of over 65 care home versus non-care home prescribing (https://nhsbsa-data-analytics.shinyapps.io/estimated-prescribing-patterns-for-care-home-patients/). The analysis has been expanded to include three years of prescribing data and key falls risk prescribing metrics, offering new insight into falls risk prescribing for the over 65s in England.

Method

Patient address information from 800m prescription forms was matched against 35m Ordnance Survey Address Base addresses. Patient addresses from prescription forms were classified as belonging to a care home or otherwise. Prescribing metrics around volume, cost, polypharmacy and falls risk were generated, with falls risk metrics informed by the STOPPFall study drug groups (https://www.prescqipp.info/umbraco/surface/authorisedmediasurface/index?url=%2fmedia%2f6019%2f300-medication-and-falls-20.pdf). These metrics were the mean number of falls risk medicines and proportion of patients prescribed three or more falls risk medicines within a given month.

Results

Over 65 care home patients received more prescribing of falls risk drugs than non-care home patients, whilst the proportion of care home patients on three or more falls risk drugs within a given month was double that of non-care home patients. Nearly 40% of care home patients aged 65-69 were prescribed three of more falls risk drugs within a given month, far more than both older care home patients and non-care home patients. Falls risk prescribing metrics displayed a great deal of variation by ICS and Local Authority.

Conclusion

Aside from headline figures and key findings, the analysis (due for public release in September 2023) allows granular analysis of over 65 falls risk prescribing, by patient age band, gender, geography and care home setting. The exploratory nature of the analysis lends itself to further investigation by healthcare analysts and clinicians, with the aim to gather feedback, iterate and expand the content annually.
2010 The scope of CT in investigating iron deficiency anaemia in the context of frailty
Authors: Amin M , Tilley C , Pabani U , Kaneshamoorthy M
Published: January 2024

Introduction

Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of clinically frail patients with IDA.

Methods

We review notes for patients referred for OGD to investigate IDA without additional symptoms over a six-month period. The inclusion criteria were IDA, age of 65 years or greater and a clinical frailty score of 5 or greater.

Results

53 patients met the inclusion criteria. A single case (1.8%) UGI malignancy using OGD was identified prior to CT. Thus, demonstrating low yield of OGD in malignancy. 35.6% of patients underwent CT scanning 3 months prior to OGD. Approximately 90% of OGD findings were benign. 23% of patients died within 90 days of OGD. No significant adverse events during OGD or significant complications were recorded in our cohort. It is therefore highly unlikely that the undergoing of an OGD had a direct impact on mortality.

Conclusion

This review shows there is a low yield of UGI malignancy on OGD following a negative CT. Benign upper GI condition is the most common finding. Thus, CT imaging alone may be an adequate investigation to rule out UGI malignancy in this group. Considering there is a high mortality rate in older patients with frailty, following an OGD, we suggest considering starting empirical treatment with PPI and iron replacement as a suitable and less invasive alternative to OGD after a negative CT in frail patients.
1964 Wearable devices to measure gait and balance remotely that could be used in Comprehensive Geriatric Assessment: A scoping review
Authors: Bollen J , Morley N , Jamaludin E Arjunaidi , Hall A , Bethel A , Mahmoud A , Crocker T , Lyndon H , Del Din S , Frost J , Goodwin V , Whitney J
Published: January 2024

Introduction

Comprehensive Geriatric Assessment (CGA) is widely used in the management and assessment of older people living with frailty, however optimal ways of delivering CGA are not well understood. Gait and balance impairments, common in those living with frailty, are assessed in CGA. Advancements in digital technology provide opportunities to improve patient outcomes by digital monitoring, rather than observation-based assessments - which may be less accurate. As part of the Digital and Remote Enhancements for the Assessment and Management of older people living with frailty (DREAM) study, the aim of this review was to identify devices to assess gait and balance remotely, to enhance CGA.

Methods

Searches were conducted across six databases. Papers published since 2008 were included if: participants were over 65; evaluated gait or balance using wearable technology suitable for community use; presented data on validity, reliability, or acceptability of the device.

Results

Of 6,203 papers identified, 48 papers were included evaluating 49 devices. 35 evaluations assessed gait, 7 assessed balance, and 7 assessed gait and balance. The most common modality was a single sensor (n= 30) on a participants’ back (n=22). Seven studies assessed more than one aspect of validity, but the majority examined criterion validity (n=35) and reliability (n=12). Good-excellent agreement between the wearable and a comparable method of analysing gait/balance was found in 15 studies. Devices could distinguish between healthy populations and those with Parkinson’s disease (n=8), cognitive impairment (n=4), falls (n=4), mobility disability (n=3) and frailty (n=3).

Conclusion

Wearable technologies offer accurate and reliable assessment of gait and balance that could be used to enhance CGA. These tools could be applied remotely in domiciliary settings, freeing up healthcare professionals to focus on other components of CGA, such as ensuring the delivery of interventions to address identified gait and balance impairment.
1982 A new way of involving experts by experience in social care research
Authors: Faraday J , Brown B , Brown N , Rowland D , Shenton F , Hand A
Published: January 2024

Introduction

Meaningful involvement of experts by experience in the design of health and care research is now well-established as good practice (Staniszewska, 2018). For example, it is essential that the voices of residents and staff are properly heard in care homes research, since they provide important perspectives not necessarily shared by the wider multidisciplinary team (Shepherd et al. 2017). Nevertheless, there are concerns that involvement can be tokenistic, or vulnerable to power imbalances (Baines & de Bere, 2017; Jennings et al., 2018).

Methods

A care home in northeast England is working with researchers to pioneer a new approach to involvement, with residents and staff at the centre. The care home has helped to shape a number of research projects, for example a feasibility study of mealtime care training. In this study, an advisory group was set up initially within the care home itself, comprising residents, staff and family carers. Subsequently the group was joined by people from other care homes in the area, with support from the local authority. In parallel to this, health and social care professionals have contributed to the advisory group through one-to-one meetings with the researcher.

Results

Advisory group meetings in the care home have provided an inclusive and equitable platform for residents and staff to share their views on the research topic and design. Other stakeholders have been able to input into the project, but separately and in a way that has left room for key voices to be properly heard. Contributors have felt valued and are keen to continue in the process.

Conclusion

This study offers an alternative and authentic model for the involvement of experts by experience in social care research, inverting the more typical approach so that residents and staff are at the centre not the periphery.
1972 A scoping review of remotely delivered cognitive assessment tools that could be used in comprehensive geriatric assessment
Authors: Whitney J , Jamaludin E A , Bollen J C , Hall A , Bethel A , Frost J , Mahmoud A , Morley N , Freby S , Goodwin V
Published: January 2024

Introduction

Community-based comprehensive geriatric assessment (CGA) reduces hospital admissions but the optimal way in which CGA can be delivered is not well understood. Digital and Remote Enhancements for the Assessment and Management of older people living with frailty (DREAM) is a programme of research seeking to develop an enhanced community CGA intervention. We aimed to identify candidate cognitive assessment tools (CATs) that could be undertaken remotely and enhance CGA.

Methods

Searches were carried out on Medline, PsycINFO, CINAHL and Cochrane databases. Papers published since 2008 were included if they analysed the validity, reliability or acceptability of CATs that could be undertaken remotely in a domestic setting and were tested on older people.

Results

Of 4286 papers identified, 56 were included. Four types of CAT were identified: computer/tablet/smartphone applications (23tools/27papers), telephone (16tools/23papers), video (2tools/2papers) and specialist equipment (4tools/4 papers). 14 tools demonstrated excellent accuracy for identifying mild cognitive impairment or dementia (specified as AUC >0.80 or sensitivity/specificity>80%). 42 papers presented concurrent/convergent validity, 14 reliability and 16 acceptability data. Time taken to perform tests ranged between 2-30 mins. Of the 23 computer/tablet/smartphone applications, 7 tools are currently available to download.

Conclusions

Remote CATs could be used in CGA. Computer/tablet/smartphone applications and some specialist equipment could enhance assessment by quickly and accurately identifying cognitive impairment, in some cases with greater accuracy than traditional tests. Tools that use ‘games’ may be more appealing than conventional pen and paper tools. However, many of the computer/tablet/smartphone applications tested are not available for clinical use.
1911 Recommendations for a deprescribing approach that can be implemented in care homes: STOPPING study findings and lessons
Authors: Warmoth K , Rees J , Day J , Cockcroft E , Aylward A , Pollock L , Coxon G , Craig T , Walton B , Stein K
Published: January 2024

Introduction

Care home residents often have multiple long-term conditions and experience polypharmacy. Deprescribing is the reduction or stopping of prescription medicines that may no longer be providing benefit. Previous research has found that deprescribing is generally safe but it is unknown how to make it work well in practice, like care homes.

Method

Using the findings from the NIHR-funded STOPPING project, which aimed to support the development of better deprescribing practice approaches within care homes, considering different views and environments, recommendations for designing a deprescribing approach for care homes were developed. The STOPPING project included interviews with residents and their family members/friends, care home staff, and healthcare professionals about their experiences and beliefs about what influences deprescribing in 15 different care homes, and in-depth interviews with care home staff assessing current deprescribing tools/approaches about their acceptability, feasibility, and suitability for use in care homes.

Results

The developed approach included four implementation aspects: (1) plan and coordinate, (2) communicate and collaborate, (3) access and share information, and (4) monitor and evaluate. Proposed actions to encourage deprescribing in care homes were identified for each aspect (e.g., communication with residents and families about medication changes addressing concerns and offering clear instructions about observations).

Conclusion

Deprescribing within care homes is a complex and collaborative process, which involves many individuals with unique clinical and care skills, knowledge, and beliefs. To ensure it is successful, these different people need to be involved and contribute their specific knowledge and views. Communication and collaboration between care homes and healthcare professionals (such as GPs, nurses, and pharmacists) are essential to ensure deprescribing is done well. Information sharing and integrated working may support better communication and collaboration. Further work is needed to develop tools and approaches, and this work must include input from care home staff and residents.
1985 Understanding the Perceptions of Caregivers of Older People in Residential Homes in Cairo
Authors: Rakhawy M , Shahin M , Sabry N , Tadros G , Nawwara R , Ali K
Published: January 2024

Introduction

Institutional care for older people is a relatively new social phenomenon in Egypt that is associated with societal stigma. Traditionally dependent older people are looked after by family members at home. There are currently 145 care homes in Egypt, mostly based in Cairo serving 2% of the older population. The aim of this study was to understand the perspectives of paid caregivers on the strengths, weaknesses, opportunities, and threats (SWOT) associated with their professional roles. This knowledge is crucial to deliver a culturally sensitive training program for caregivers, and enhance their job satisfaction, ultimately leading to person-centred high-quality care.

Method

Two focus group meetings, 90 minutes each, were conducted with 39 caregivers in a private care home in Cairo. Each group was further divided into four working sub-groups using a SWOT approach to guide the discussion. Generic themes were identified, analysed, and agreed on by the group participants.

Results

Thirty-nine caregivers (31 % males), age range 18-50 years, were interviewed including undergraduate and qualified nurses and social workers. Five themes were identified: administration, team values, training, place and equipment, and residents and families. SWOT findings related to each theme are summarised below:

Theme

Strength

Weakness

Opportunities

Threats

Administration

Support and flexibility

Poor incentives

Access to healthcare services

Lack of rest facilities

Team values

Peer support

Mixed qualities in different leaders

Outdoor recreational activities

Lone working

Training

Mentoring programme

Unfulfilled training needs

Regular updates on CGA

No medical cover

Place & Equipment

Resident accommodation

Not always fit for purpose

Health and safety compliance

Cost of accommodation

Residents and families

Sharing knowledge

Discriminatory attitudes toward staff

Documentation of resident’s priorities

Unfounded complaints

Conclusion

Reflecting on the views of paid caregivers provided valuable insight that could enhance the quality of institutional care for older people in Cairo.