bluuebunny/crossref_metadata_2025_split huggingface dataset:
1758 Front door frailty team reviews of care home residents in a North Wales District General Hospital
Authors: Speare C , Begum H , Mrittika S , Healy J , Abbott C 
Published: January 2024

Abstract

Introduction
Care home residents are increasingly presenting to hospitals. In October 2022, a frailty team was formed in our district general hospital, consisting of two SHOs, one SpR and one consultant, with support from pre-existing care home ANP and community resource team (CRT). Focusing on patients presenting to the Emergency Department, their aims were early identification of care home residents in order to optimise their care by facilitating discharge, tackling polypharmacy and seizing opportunities for advanced care planning.

Method
Care home residents were highlighted on the ED clinical system, using a unique icon, and reviewed by the frailty team. Anonymised patient statistics were logged into a bespoke e-database. This generated a dashboard of graphs showing trends in outcomes. The statistics from the first 8 months (3/10/22 to 5/6/23) were utilised to show patient demographics, number of reviews and rates of discharge.

Results
297 care home residents were reviewed. 83.8% of these patients had a Rockwood Clinical Frailty Score of ≥ 7. Delirium was present in 91 (30.6%) patients. 121 (40.7%) had at least 1 medication stopped. 165 (55.6%) were discharged after frailty review. Do not resuscitate forms were completed for 208 (70.0%) patients. Advanced Care Planning was discussed with 138 (46.5%) patients and 6 (2.0%) patients were not for re-admission. End of life care was commenced for 17 (5.7%) patients.

Conclusion
It is clear that patients attending the Emergency Department would benefit from an early comprehensive geriatric assessment. The benefits this has provided in one North Wales DGH are significant and have made strides in reducing unnecessary admissions, reducing polypharmacy and providing holistic, interdisciplinary and patient centred care including advanced care planning. Whilst the Emergency Department is not an ideal environment for this, the team have demonstrated the benefits to this model.
2042 Implementing the principles of Shared Decision Making into a Hospital at Home service, as part of a wider organisation adoption
Authors: Lewis L , Olden S , Waldon M , Loulaki M 
Published: January 2024

Abstract

Background
NICE (2023) Shared Decisions Making (SDM) Guidelines ensure Health Care professionals work together with a person to reach a decision about care based on their individual preferences, beliefs, and values. Local Problem. We conducted an Audit across our community services to assess NICE SDM, achieving 71% compliance. Results informed the project problem statement “Clinical Teams are not fully compliant to NICE SDM guidelines therefore a shared decision-making approach is not guaranteed”.

Methods
A fishbone diagram was applied to understand why SDM wasn’t routinely occurring in clinical practice. Our aim is to achieve organisation wide adherence to SDM. We propose a multi modal approach to increasing awareness of SDM across the organisation. We used a driver diagram working backwards from the goal, identifying the drivers and determining the project activities.

Interventions
Due to the enormity of rolling out a pan-organisational programme we decided to use the Frailty NHS@Home virtual ward to test and learn before greater adoption. We firstly processed mapped how the “What Matters to you?” question is embedded into our Comprehensive Geriatric Assessments. A decision support grid for treatment option decision making was created for dehydration or high risk of dehydration within the NHS@Home service, adapted from Marrin et al (2014). Three options are described underpinned by five questions. Feedback from Patient and public involvement ensured the language was appropriate. After the first PDSA cycle, the tool was reviewed by the project team and two further questions were added, “Did you understand the options which were explained to you?” and “What matters most to you as we decide together how best to treat your dehydration?”

Conclusion
A re audit and colleague survey will reveal increased knowledge and understanding of the SDM concept. We continually seek Feedback from individuals who use our services for their experience of SDM processes.
1941 Working as a multidisciplinary team to reduce weight loss - a quality improvement project to improve nutrition in older patients
Authors: Wright L , Newman C 
Published: January 2024

Abstract

Introduction
Weight loss is common during acute hospital admissions, and can be devastating to the older patient where weight loss is associated with an increase in mortality over a 12-month period. Patients who lack the ability to communicate their food preferences are at risk of receiving food they do not like, especially as food orders are often taken when family/carers are not present.

Methods
While working on a Department of Medicine for Older People and Stroke (DMOPS) ward, we worked with the Multidisciplinary team (MDT) with the aim of reducing weight loss. We implemented two interventions. The first being ‘MUST Mondays’, where patients were weighed and had a Malnutrition universal screening tool (MUST) completed on admission to the ward, and then weekly. We also implemented A3 Laminated menus - where patients and their families/carers were given food choices for the week in advance, and could use a marker to identify foods they did/did not like. These were then displayed above the bedspace. All patients were over the age of 65. We excluded patients who were actively dying, patients who were aiming for weight loss (Such as in fluid overload) and patients who were admitted for fewer than 8 days.

Results
Prior to putting the interventions in place, we audited 23 patients admitted over a 3-month period. 70% of patients lost weight over the course of their admission, and 48% had MUST assessments completed weekly. We re-audited 5 months after the interventions were implemented, we audited 20 patients over a 5-month period and found 55% lost weight over the course of their admission, and 80% had weekly MUST assessments.

Conclusion
Working as an MDT to put in place small interventions can have a meaningful impact on reducing weight loss in older patients during acute hospital admission.
1725 From care home to the emergency department; a snapshot of frailty admissions
Authors: Blackburn S , Sherif S Abou , Syed M , Hughes A , De Rohan C 
Published: January 2024

Abstract

Background
Care home residents form a large number of admissions to the Emergency Department (ED). Over an 8-month period, care home admissions to ED were reviewed, examining the nature of admissions to inform how to improve current pathways.

Method
Patients with a frailty score ≥6 (N=180), admitted from 34 care homes to Chelsea and Westminster Hospital ED over 6 months were included. Data was collected from medical and London Ambulance Service (LAS) records. Data collected included; Presenting Complaint (PC), LAS attendance times, prior discussion with a Health Care Professional (HCP), Length of Stay (LOS).

Results
LAS attendances during normal working hours (9am-5pm Monday- Friday) formed 34% (N=61) of admissions with only 43% (N=26) being discussed with an HCP prior to attendance. Of these, 30% (N=18) were discharged &lt;24hrs and up to 39% (N=7) of these may not have required emergency admission. For all admissions, ‘fall’ was the most common PC, 33% (N=59) followed by ‘respiratory issue’ 21% (N=38). Overall, 24% (N=47) of total admissions were discharged &lt;24hrs but total care home admissions accounted for a total of 454 bed stay days. Factors impacting discharge included COVID status, requiring care home re-assessment prior to discharge and no longer having a bed available.

Conclusion
This data demonstrates that there is an opportunity to improve care home support and admission pathways. Discussing patients with an HCP prior to contacting LAS may reduce requirement for ED attendance alongside access to rapid response community teams. Expanding an HCP accessible service out of hours (OOH) could facilitate this and implementing a frailty telephone service may also support with this initiative. Collaboration with care homes and community partners will form the next steps in this quality improvement work.
2038 Advanced care planning in severe frailty - quality improvement project two-year summary
Authors: Robinson S , Sawney P , Bethel S , Clarke E , Woods S , Alićehajić-Bečić Ð 
Published: January 2024

Abstract

Introduction
NICE guidance recommends that clinical teams should identify patients who are approaching their final year of life. It advises using tools such as the Clinical Frailty Score (CFS) to identify this cohort. Wigan has a significant proportion of severely frail patients would benefit from this conversation. The aim of this project was to increase the percentage of patients with severe frailty who have an advanced care planning (ACP) conversation during their hospital stay.

Method
Retrospective data collected from discharge letters was used to identify patients aged &gt;65 years with a CFS ≥7 Astley ward. Exclusion criteria included patients &lt;65 years old, patients who died during admission, patients who moved wards prior to discharge and re-admissions if within 30 days. The cohort was examined to see if firstly they had been highlighted as a patient who would benefit from ACP, and if an aspect of ACP had been completed during their admission.

Results
10 PDSA cycles were completed over the two years (2021-2023). Our data showed that teaching on ACP and dedicated Registrar sessions on the rota had the greatest impact on improving the completion of ACP discussions. While unified method of CFS assessment on admission and documentation of ACP on shared platforms did not change the ACP uptake significantly.

Conclusions
Systematic approach to improving ACP in severe frailty has the potential to improve patient experience and allow them to highlight their wishes at the end of life. Despite trialling multiple activities to increase ACP uptake it was clear whole multidisciplinary team engagement is required to maximise ACP. Therefore, future cycles will examine the impact of implementing a focused approach to ward rounds. Although we have progressed towards our goal, more work needs to be done to maximise uptake of ACP for severely frail patients during hospital admissions.
1871 Encouraging Mental Capacity Act assessments in cognitively impaired or delirious patients over 65 at an orthopaedic hospital
Authors: Fattahi A , Shah K 
Published: January 2024

Abstract

Introduction
The Mental Capacity Act (MCA) is designed to protect patients who may lack capacity to make decisions about their proposed treatment. At the Nuffield Orthopedic Centre (NOC), Oxford, nurses obtain a baseline abbreviated mental test score (AMTS) during the pre-operative assessment clinic. Post-operatively, the AMTS should be repeated with the 4AT to screen for delirium. If the AMTS is less than 8, or the patient is clinically believed to be delirious, then an MCA assessment should be undertaken and documented for the decision to accept treatment. The aim of this QI project was to widen this practice to all the junior doctors at the NOC.

Method
Baseline AMTS and MCA data were collected from one month of inpatients &gt;64 years old at the NOC. Patients with post-op AMTS of &lt;8 or those with delirium were identified and checked for documented MCA assessments. The results, teaching and training on capacity and consent were presented to the junior doctor team and a repeat audit cycle was performed to assess if the practice was being implemented.

Results
Data collected from 10/01/23 – 10/02/23 (n=125) showed that out of 10 patients meeting the AMTS criteria, only 4 had MCA assessments completed. Once the QI project was presented on 25/05/23, data collected from 12/06/23 – 15/07/23 showed that out of 5 eligible patients, 4 of them had MCA assessments documented.

Conclusion
Prior to this QI project, only 40% of patients with suspected cognitive impairment were undergoing an MCA assessment. Following the teaching and training to the junior doctors, the data collected shows that this figure had increased to 80%. In conclusion, this QI project has shown an improvement in appropriate application of the MCA. It should be repeated every 4 months to account for each new rotation of junior doctors.
1775 Delirium education and documentation - Quality improvement project in geriatric assessment unit
Authors: Zamir H , Shield L , Brodie L 
Published: January 2024

Abstract

Introduction
Delirium is a common presentation in older people (&gt;65 Years age) and associated with falls risk, longer inpatient stay, post-discharge institutionalization, accelerated cognitive decline and higher mortality. While median duration of delirium is reported as 1 week but for one third patients, symptoms may persist 3 months or more, even a proportion of patients will never fully recover to their pre-delirium cognitive baseline. It is essential to educate patient and family that staying in the hospital can only make delirium worse and they will need extra support on discharge for usual daily activities to avoid falls and readmissions. Physicians should be aware that delirium sufferers often have an awareness of their experience and for affected person and their family, delirium can be a cause of significant distress. Identification of risk factors, education, and a systematic approach to management can improve the outcome and experience of the syndrome.

Aim
To provide delirium education and Improve documentation up to 95 % in GAU.

Method
• Prospective data collection
• Jan 2023 to March 2023
• Monthly data analysis of 20 patients in GAU with the confirm diagnosis of delirium.
• PDSA 1 Departmental teaching and delirium leaflet awareness and availability
• PDSA 2 Poster as Visual prompt

Results
After 2 PDSA cycles, we noticed significant improvement in delirium education and documentation up to 95%. Another QIP is ongoing to incorporate delirium time bundle in our practice to timely identify diagnosis, manage potential triggers and provide education to better understand its nature.

Conclusion
Along with prompt diagnosis and management, good educational approach and clear documentation will lead to improve understanding about delirium, reduce distress and facilitate safe early discharge. References https://www.sign.ac.uk/sign-157-delirium.
1971 Five years of the National Audit of Inpatient Falls
Authors: Whitney J , Sheshi N 
Published: January 2024

Abstract

Introduction
There are around 250,000 inpatient falls in English hospitals each year. Inpatient falls are associated with poor outcomes. Evidence suggests multifactorial assessment and intervention is the most effective way to prevent inpatient falls. There are National Institute of Health and Care Excellence (NICE) quality standards for safe post fall management. National audit supports improvement in the quality and safety of clinical care.

Methods
The National Audit of Inpatient Falls (NAIF) began collecting continuous data from all femoral fractures (as identified on the National Hip Fracture Database) in England and Wales from 2019. Prospective documentation review collects data on multifactorial falls risk assessment (MFRA) prior to the femoral fracture as well as immediate post fall management and presents performance indicators related to NICE guidelines/quality standards.

Results
There are around 2000 inpatient femoral fractures each year. Those with an inpatient fracture have double the 30-day mortality of those who fracture elsewhere, highlighting the vulnerability of this group of patients. There has been improvement in most aspects of MFRA and the proportion of patients checked for injury before moving from the floor has increased from 69 to 77%, use of flat lifting equipment from 22 to 29% and medical assessment within 30mins of the fall from 52 to 60%.

Conclusion
There have been steady improvements in guideline compliant inpatient fall-prevention and post-fall management, but there is more to do. The programme also produces improvement resources and activities and will be expanding the range injuries covered in the next 2 years.
1848 Risk of severe COVID-19 increases with the number of comorbidities in fully vaccinated individuals aged ≥65: results from INFORM
Authors: Dube S , McNulty R , Arnetorp S , Yokota R , Carty L , Taylor S , Peters J , Justo N , Lu Y , Evans K , Yates M , Nguyen H , Olson V , Quint J , Evans R 
Published: January 2024

Abstract

Objective
Ageing is associated with reduced vaccine efficacy due to immunosenescence. Severe COVID-19 outcomes are associated with comorbidities prevalent in older people. We report results from the INFORM study on severe COVID-19 outcomes in vaccinated older individuals with varying numbers of comorbidities.

Methods
A retrospective observational cohort study was conducted in England using a 25% random sample from NHS databases. COVID-19related outcomes (hospitalisations and mortality) in fully vaccinated (≥3 doses) older individuals from 1 Jan to 31 Dec 2022 are reported.

Results
Of a reference population of 7,180,205 fully vaccinated individuals ≥12 years, 2,232,140 were ≥65 years. The proportion of older people with ≥1 COVID-19 hospitalisation increased with age (≥65, 0.6%; ≥70, 0.7%; ≥75, 0.9%; ≥80, 1.2%) compared to overall population (OP, 0.2%). Incidence rates (IR) (95% CI) per 100 person years also increased with age for hospitalisation (≥65, 0.58 [0.57-0.59]; ≥70, 0.71 [0.69-0.73]; ≥75, 0.90 [0.88-0.92]; ≥80, 1.20 [1.18-1.22] versus OP, 0.22 [0.21-0.23]) and death (≥65, 0.16 [0.15-0.17]; ≥70, 0.20 [0.18-0.22]; ≥75, 0.28 [0.26-0.30]; ≥80, 0.42 [0.39-0.45] versus OP, 0.05 [0.04-0.06]). In those ≥65, 1,375,470 were not immunocompromised (IC) but had ≥1 high-risk comorbidity (no-IC/+Com), 586,155 had neither IC or comorbidity (noIC/noCom). An increased number of comorbidities was associated with increased hospitalisation and death IRs. In those ≥65 noIC/+Com, IRs (95% CI) were 0.63 (0.61-0.65), 0.88 (0.86-0.90) and 1.25 (1.22-1.28) for hospitalisation vs 0.20 (0.17-0.23) in noIC/noCom; and 0.16 (0.14-0.18), 0.23 (0.21-0.25) and 0.32 (0.29-0.09) vs 0.06 (0.03-0.09) for noIC/noCom for death where individuals had ≥1, ≥2 and ≥3 noIC/+Com, respectively.

Conclusions
Despite vaccination, older people are at increased risk for severe COVID-19 outcomes, with higher risk associated with more comorbidities. Even older patients with no-IC conditions have increased risk, especially those with other high-risk comorbidities. Additional interventions may be required to protect older people against severe COVID-19 outcomes.
1867 Efficacy and safety of metformin as a therapy for older people with sarcopenia and frailty - the MET-PREVENT randomised trial
Authors: Witham M D , McDonald C , Clegg A P , Hancock H , Hiu S , Nicholson K , Storey B , Simms L , Steves C J , von Zglinicki T , Wason J , Wilson N ,   on behalf of the MET-PREVENT study group, Sayer A A 
Published: January 2024

Abstract

Introduction
Metformin has pleiotropic biological effects which might improve muscle function in older people. The MET-PREVENT trial tested the efficacy and safety of metformin as a therapy for sarcopenia and frailty in older people.

Methods
Double blind, randomised, parallel-group, placebo-controlled trial. Participants aged ≥65 with walk speed &lt;0.8m/s and low muscle strength (handgrip &lt;16kg for women, &lt;27kg for men, or 5x sit to stand &gt;15s) were recruited from primary care and hospital clinics. Participants were randomised 1:1 using a web-based interactive system to receive 4 months of 500mg metformin or matching placebo 3x/day. The primary outcome, analysed by intention to treat, was the between-group difference in 4m walk speed at 4 months, adjusted for baseline values. Secondary outcomes included grip strength, short physical performance battery, six-minute walk distance, muscle mass by bioimpedance, quality of life and activities of daily living. All adverse events were recorded.

Results
Seventy-two participants were randomised, mean age 80 (SD 6) years. 42 (58%) were women, 42 (58%) were frail (Fried score ≥3); mean baseline 4m walk speed was 0.59 m/s (SD 0.22). 70 (97%) completed the trial (metformin 34/36, placebo 36/36). 14 (40%) discontinued metformin and 5 (14%) discontinued placebo. There was no difference in the primary outcome between the metformin (0.57 m/s [SD 0.19] m/s) and placebo group (0.58 m/s [SD 0.24]); adjusted treatment effect was 0.001 m/s (95%CI -0.06, 0.06); p=0.96. There was no significant effect on measures of muscle mass, physical performance, quality of life or activities of daily living. The metformin group had more adverse events (110 vs 77) and more hospital admissions (12 vs 3)

Conclusions
MET-PREVENT achieved successful recruitment with high retention rates, however metformin did not improve physical performance and was poorly tolerated with high rates of adverse events in older people with sarcopenia.
1878 Sarcopenia screening in older community-dwelling adults: findings from Southampton Longitudinal Study of Ageing (SaLSA)
Authors: Laskou F , Westbury L D , Bevilacqua G , Bloom I , Cooper C , Aggarwal P , Dennison E M , Patel H P 
Published: January 2024

Abstract

Introduction
The SARC-F questionnaire can be rapidly implemented by clinicians to identify patients with probable sarcopenia. A score ≥4 is predictive of sarcopenia and poor outcome. We sought to identify the prevalence and demographic correlates of probable sarcopenia (SARC-F score ≥4) in community-dwelling older adults.

Methods
480 participants (219 men, 261 women) identified from Primary Care completed a questionnaire ascertaining demographic, lifestyle factors, comorbidities, nutrition risk score (DETERMINE) and SARC-F score. Participant characteristics in relation to probable sarcopenia were examined using sex-stratified logistic regression. Age was included as a covariate.

Results
The median (lower quartile, upper quartile) age was 79.8 (76.9, 83.5) years. 12.8% of men and 23% of women had probable sarcopenia. Self-reported walking speed strongly associated with probable sarcopenia (men: odds ratio (OR) 10.39 (95% CI: 4.55, 23.72), p&lt;0.001; women: 11.42 (5.98, 21.80), p&lt;0.001 per lower band). Older age was associated with probable sarcopenia in both sexes (p=0.01) as was higher DETERMINE score (men: 1.30 (1.12, 1.51), p=0.001; women: 1.32 (1.17, 1.50), p&lt;0.001 per unit increase). Among men, being married or in a civil partnership or cohabiting was protective against probable sarcopenia (0.39 (0.17, 0.89), p=0.03) as was reporting drinking any alcohol (0.34 (0.13, 0.92), p=0.03) while in women generally similar relationships were seen though these were weaker. Higher BMI (1.14 (1.07, 1.22), p&lt;0.001 per unit increase) and presence of comorbidities (1.61 (1.34, 1.94), p&lt;0.001 per extra medical condition) were also associated with probable sarcopenia in women. All associations were robust after adjustment for age.

Conclusions
Probable sarcopenia (SARC-F score ≥4) was common in older adults living in their own homes. As expected, self-reported walking speed was highly predictive of probable sarcopenia. In addition to advancing age and malnutrition, socio-demographic factors were also important. Identifying these factors in clinical practice should trigger sarcopenia screening in older adults.