bluuebunny/crossref_metadata_2025_split huggingface dataset:
961 ‘WE CARE!’: CARE WORKERS’ SELF-PERCEIVED MEANING OF RESIDENTIAL AGED CARE WORK
Authors: Yau I S-Y , Huang S , Lee L , Lee Y , Li S , Yau S , Lai S , Law S 
Published: June 2022

Abstract

Introduction
Aged care workers in residential care homes of the elderly (RCHEs) are socially devalued as less skilled, low-paid, and doing ‘dirty work’. Care workers’ insider experiences with the meaning of residential aged care work are largely absent from the community and the literature.

Method
A qualitative study was conducted to examine the self-perceived meaning of work (MOW) among care workers in RCHEs in Hong Kong, an East Asian metropolis with a rapidly aging population, and unique socio-cultural meanings of elderly care. Adopting the Grounded Theory Method, in-depth interviews with 27 care workers in 6 RCHEs were conducted.

Results
Findings suggest that regardless of the job requirements of carrying out ‘dirty tasks’ and shared experiences of public devaluations, RCHE care workers find positive meanings in their work including: contributing to the greater good of helping the elderly; establishing meaningful relationships; forming a professional identity of geriatric care; achieving personal growth; ensuring job security and benefits in the aged care job market. Care workers find their work meaningful primarily because it is essential to maintain the elderly’s health and quality of life, which echoes with the Chinese cultural values of ‘accumulating fortune’ and ‘respecting the elderly’. Engaging in residential care work allows care workers to build long-term relationships with the elderly, through which they found joys and knowledge of life such as letting go. Care workers propose that geriatric care is highly skillful and professional, requiring communication, coordination, and chronic illness care skills. Care workers identify several inhibitors of attaining MOW, including heavy workloads, manpower shortage, and dehumanizing bureaucratic practices.

Conclusion
Care workers offer counter-narratives of public devaluation and reframe the meaning of care work in RCHEs. These findings have broader implications on policy, professional, and education interventions in promoting the public recognition of aged care work.
The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (UGC/FDS16/M12/20).
996 EFFECT OF COVID-19 ON HIP FRACTURE CARE IN WALES - AN ANALYSIS OF HOW ORGANISATION OF SERVICES AFFECTED HOSPITAL LENGTH OF STAY
Authors: Probert A , Davis K , Singh I , Holleyman R , Gregson C , Johansen A 
Published: June 2022

Abstract

Introduction
The National Hip Fracture Database (NHFD) report that length of stay (LOS) fell (from 19.7 to 16.9 days) in the first year of the COVID-19 pandemic, as patients, families, cares, and staff in health and social care responded to this challenge. This analysis examines trends in Wales where LOS can be profiled very completely as it predominantly remains within a single health board.

Method
We used data from the NHFD www.nhfd.co.uk to define pre-pandemic LOS (in the year to 1st March 2020) and compare this with the following 18 months. We set figures for all 12 hospitals in Wales against the changes in service organisation which each reported to the NHFD's 2020 Facilities Survey, and against the local incidence of COVID-19 among their hip fracture patients.

Results
Monthly LOS fell markedly at the pandemic's onset; the national figure falling 8.3 days (from 31.2–22.9 days) between February and June 2020. Overall LOS in Wales fell by 1.6 days across the year as a whole, but this ranged from a fall of 6.3 days in one hospital to a rise of 4.5 days in another. Five hospitals reported a rise in LOS. These hospitals had either never had orthogeriatric support, or lost this to COVID-19 duties, they did not achieve the initial fall in LOS in response to the pandemic, and they reported pressures with ‘outliers’ after the first wave. Unlike other units in Wales they cited problems with workload, particularly in terms of physiotherapy.

Discussion
NHFD data provide a detailed picture of hospitals’ response to the COVID-19 pandemic, and allow us to examine service factors underpinning their resilience in the face of this challenge. More detailed work should be carried out for the 150 hospitals in England using the same sources of data.
1024 THE IMPACT OF FRAILTY ON 30-DAY MORTALITY FOLLOWING PRIMARY HIP AND KNEE ARTHROPLASTY DUE TO OSTEOARTHRITIS
Authors: Cook M J , Lunt M , Board T , O'Neill T W 
Published: June 2022

Abstract

Introduction
We determined the association between frailty and 30-day mortality following total hip and knee arthroplasty (THA/TKA) due to osteoarthritis and also the impact of THA/TKA on 30-day mortality compared to a control population.

Method
We used linked primary and secondary care data and Office for National Statistics mortality data. Frailty was assessed using the electronic frailty index and categorised as fit, mild, moderate, and severe frailty. The association between frailty and 30-day mortality following THA/TKA was assessed using Cox regression, adjusted for year of birth, sex, quintile of index of multiple deprivation and year of surgery. Mortality following THA/TKA was also compared to a control population who had osteoarthritis but no previous THA/TKA, matched on year of birth, sex, and quintile of index of multiple deprivation.

Results
103,563 cases who had a THA, 125,367 who had a TKA, and matched controls contributed data. Among those who had surgery, 30-day mortality increased with increasing frailty; adjusted hazard ratio (HR) (95% CI) among severely frail vs fit: following THA, 2.85 (1.84, 4.39); following TKA, 2.14 (1.29, 3.53). Compared to fit controls who did not have surgery, 30-day mortality was higher among fit people who had THA and TKA, respectively, adjusted HR 1.60 (1.15, 2.21) and 2.98 (1.81, 4.89). There was, however, no statistically significant difference in 30-day mortality among cases with mild, moderate and severe frailty compared to controls in the same frailty category.

Conclusion
Among people who had THA and TKA, 30-day mortality increased with increasing frailty. A healthy surgery (selection) effect may have impacted on the comparison of mortality among cases who had THA/TKA and controls who did not have surgery.
933 FACTORS ASSOCIATED WITH LENGTH OF STAY ON OLDER PEOPLE’S MEDICINE WARDS
Authors: Bunn J , Lewis E G , Cropp A , Baldwin  , Wilson C , Frith J , Kilsby A 
Published: June 2022

Abstract

Introduction
The Newcastle upon Tyne Hospitals NHS Foundation Trust’s Older People’s Medicine (OPM) department includes six inpatient wards. It was hypothesized that an increasing prevalence of inpatient frailty would be associated with increased length of stay.

Method
Data were collected on OPM wards, on a single day of February 2020 and July 2021. Demographic details, mobility, presence of delirium, resuscitation status, length of stay (LOS), and Clinical Frailty Scale (CFS) status was recorded (frailty defined as CFS score ≥ 5). Descriptive statistics and tests of significance comparing 2020 with 2021 data were performed. Independent associations with above-median LOS were analysed using binary logistic regression.

Results
There were 172 inpatients in 2020, and 160 in 2021. Median age was 84 (range 66–98 years) in 2020, and 85 (range 64–99 years) in 2021. 87 (54.4%) in 2021, and 102 (59.3%) in 2020 were female. Prevalence of pre-admission frailty was higher in 2021 (n = 143, 89.4%) compared to 2020 (n = 125, 72.7%, p &lt; 0.0001). The prevalence of delirium was higher (n = 60, 37.5%, p &lt; 0.0001) and fewer were independently mobile (n = 53, 33.1%, p = 0.013) in 2021 than in 2020. Nevertheless, median LOS was shorter in 2021, 9 days (range 1.0–106.9) versus 15 days (range 0.7–87.0) in 2020, p = 0.006. Being admitted from home and having a DNACPR were independent predictors of increased LOS (OR 2.4 [95% CI 1.4 to 4.0] for both), controlling for age, sex, frailty, delirium, and reduced mobility.

Conclusion
Despite the increased prevalence of frailty, delirium and reduced mobility, these factors were not associated with increased LOS. Residence at home and DNACPR were associated with above-median LOS, irrespective of the patient’s frailty, delirium or mobility status. Overall, this suggest appropriate high quality care is being delivered, despite increased pressures due to shorter LOS and higher frailty prevalence.
936 IMPROVING DELIRIUM SCREENING IN OLDER ADULTS AT THE ROYAL UNITED HOSPITAL, BATH
Authors: Cross R , Trew C , Howell K , Dyer C 
Published: June 2022

Abstract

Introduction
Delirium affects up to 20% of older patients within hospital and is associated with increases in mortality, length of stay, institutionalisation and accelerated cognitive decline in patients with dementia. 30% of cases are preventable. NICE therefore advocates for delirium screening on admission in the elderly and those with cognitive impairment. We aimed to determine the compliance of the RUH Bath with delirium screening. National guidelines advocate for the use of a CAM, 4AT and/or SQiD. The RUH internal policy accepts a full AMT10, AMT4 plus an assessment of alertness, 4AT or a comment from a Consultant geriatrician about the presence of delirium.

Method
Notes of 60 patients on geriatric wards were inspected for compliance with screening in the first 24 hours of the patient’s admission. Following this, we implemented education sessions for junior doctors, changed the hospital admission proformas and re-wrote the hospital guidelines for delirium to re-emphasise the need for screening. We re-screened the notes 6 months after these changes and then again at 18 months to look for longstanding change.

Results
Initially, only 25% of patients were screened according to national standards and 63% met the hospital criteria. At 6 months 52% met the national standard and 82% met the hospital policy. At 18 months 41% the national standard and 87% met the hospital standard. There was also an increase in the proportion of patients being screened for delirium via multiple different method.

Conclusion
There has been significant, long-term improvement in delirium screening at the RUH Bath. This is particularly remarkable for the hospital standard where, despite no further intervention, the figures were maintained over 18 months. Despite a slight degradation in those meeting the national standard, the proportion was still higher than pre-intervention.
957 THE USE OF IPADS AS PART OF PERSON CENTERED CARE IN A TEACHING HOSPITAL IN SINGAPORE
Authors: Oo T , Aung Z , Barrera V , Arroyo S , Lim S 
Published: June 2022

Abstract
The elderly patients are currently the main occupants of acute hospital beds and this trend will likely increase as the world ages. The elderly patients with cognitive issues frequently have behavioural symptoms which may be challenging for the care staff to manage, especially the staff who have not been formally trained in Gerontology. The use of restraints for this group of vulnerable patients should be discouraged as restraints can cause harmful effects.
The use of iPads as a non pharmacological strategy for managing the behavioural symptoms among the elderly in-patients with cognitive issues was effective in reducing agitation, with an improvement in mood and sundown symptoms. The patients were actively and meaningfully engaged with their iPads during therapy.
The nursing staff too, benefited from iPads as a novel therapy for their elderly in-patients with cognitive issues in providing cognitive and social stimulations, which they had no time to provide for. While the patients showed improvement in their behavioural symptoms, the nurses’ stress levels reduced with improved self-reported job satisfaction.
964 MOUTHCARE MATTERS: QI PROJECT TO IMPROVE ORAL HEALTH IN ELDERLY HOSPITAL INPATIENTS
Authors: Daniel C , Gaunt V 
Published: June 2022

Abstract

Background
A quality improvement (QI) project completed over four months on an elderly-care ward comprising 34 inpatients in a UK district general hospital. The QI team comprised the ward Foundation Year 1 (FY1) and Consultant, with Nursing staff consultation.

Introduction
There is evidence that oral-health in elderly people deteriorates with hospitalisation (Terezakis et al. J Clin Periodontol. 2011;38(7):628–636). Poor oral-health is associated with increased incidence of hospital-acquired infections and reduced oral intake (Kaneoka et al. Infect Control Hosp Epidemiol. 2015;36(8):899–906; Poisson et al. Gerodontology. 2016;33(2):61–168). We had no data on oral-health among our hospital inpatients, nor on nursing measures to maintain or improve it. We aimed to collect baseline data and implement ward-based improvements to oral-health assessment and care.

Method
Interventions were identified using a ‘drivers-for-change’ flow-diagram: main interventions were introduction of a mouthcare proforma (for nurse-led assessment of patient oral-health and documentation of mouthcare given), ensuring availability of mouthcare products and providing relevant ward-staff education. Two ‘Plan-Do-Study-Act’ cycles were completed; intervention implementation was staggered two-monthly, following evaluation of preceding changes’ impact. Data to measure impact of changes was collected two-monthly by the FY1 on patient oral-health (subjectively scored with assessment tool), rate of proforma completion and patient-reported completion of routine mouthcare.

Results
Over the four-month period, there were significant improvements to rates of oral-health assessment (proforma completion increased by 86%), completion of routine mouthcare (increased by 32%), and overall patient oral-health: proportion of ‘good’ or ‘excellent’ oral-health scores increased from 21% to 66%. We aim to deliver further ward-based education to maintain progress.

Conclusion
These interventions are simple, low-cost and could be implemented across many elderly-care wards. Wider adoption would improve mouthcare across larger patient-numbers, with potential benefit to both patient experience and morbidity. Ongoing education and integration of the proforma into existing ward ‘patient-care-bundles’ will promote sustained improvement.
1001 IMPACT OF THE INTRODUCTION OF ROUTINE GERIATRICIAN REVIEW FOR OLDER ADULTS UNDERGOING EMERGENCY LAPAROTOMY
Authors: Kiang J , Jegard J , Kaneshamoorthy M 
Published: June 2022

Abstract

Introduction
The number of older adults having emergency abdominal surgery is increasing nationally. In the last National Emergency Laparotomy Audit (NELA) report, 55% of patients were over 65 and 18% were over 80. The wide disparity in mortality rate between under- and over-65 s has persisted since data began collection in 2013. (NELA Seventh Report, 2021). There is already good evidence in Orthopaedic and Vascular surgery that Geriatrician input can improve outcomes including mortality and length of stay. We introduced a Consultant-led service to review every NELA patient aged 65 and above and review the effect on post-operative outcomes.
Method We clinically reviewed NELA qualifying patients aged ≥65 years between September 2020–September 2021. Data including Rockwood Clinical Frailty Score (CFS), NELA mortality risk prediction score, 30-day mortality and discharge destination were analysed.

Results
In total we reviewed 88 patients in 1 year. The median age was 77.5 (range 64–96) years. The median CFS was 3 (range 1–7). 23% patients had a CFS ≥5. 65% patients had a NELA score &gt; 5% (high risk) including 30% with a NELA Score &gt; 20%. The average NELA score was 13.8%. The overall 30-day mortality rate for our cohort was 5.8%; comprised of 10% and 4.7% for patients with a CFS ≥5 and CFS &lt;5 respectively. On discharge, 92% of patients returned to their own home.

Conclusion
We have demonstrated routine review of NELA patients ≥65 years by a Geriatrician-led service has drastically improved outcomes. The mortality rate for both 1) Overall ≥65 (5.8%) and 2) CFS ≥5 (10%) are significantly lower than the national average of 14.6% (ELF Study, 2021) and 18.6% respectively. Importantly, most of these patients were also able to return to their own home. Further research needs to be done on assessing whether reviewing patients pre-operatively can further improve outcomes.
1003 UTILITY AND TOLERABILITY OF CSF AD BIOMARKERS IN A GERIATRICIAN-LED MEMORY SERVICE
Authors: Clancy C , Dolphin H , Kennelly S P 
Published: June 2022

Abstract

Introduction
People with mild cognitive symptoms often require diagnostic clarity and with the advent of disease modifying therapies for Alzheimer’s disease (ad), establishing diagnostic accuracy for amyloid and tau pathology in ad will become more clinically relevant. CSF biomarker analysis via lumbar puncture (LP) is the most accurate and cost-effective means of establishing ad pathology. Despite their clinical validation, few centres offer LP biomarker analysis, frequently citing patient intolerance and reluctance as factors. This study aimed to assess memory clinic patients’ tolerance of LP as a diagnostic tool in the work-up of memory symptoms.

Method
A consecutive sample of patients offered CSF analysis as part of their diagnostic plan in a tertiary memory service of a University Teaching Hospital were included. After clinician discussion, an LP for ad biomarker detection is offered to all patients with amnestic/non-amnestic mild cognitive impairment, or those with atypical motor-cognitive symptoms in this service.

Results
119 patients offered an LP from 2019–2020 were contacted, fifty-four (45%) of whom participated in this study. The average age was 70.1 (±7.5) years, 50% female. Forty-two (42/54, 78%) had an LP performed. More women declined an LP than men (8/12, 66%). Almost all of those who had an LP, (38/42, 90.4%) thought it yielded useful information. Side effects included mild back pain relieved with simple analgesia (11/42, 26%) and headache (3/42, 7%). There were no incidences of neurological sequelae or requirements for dural patch. Of the 12/54 (22%) who declined CSF analysis; reasons included pre-existing back pain (3/12, 25%), needle phobia (3/12, 25%), and only 2/12, (16%) declined because they did not wish to know the results.

Conclusion
This study highlights high levels of acceptance of CSF analysis when offered as part of routine care, with infrequent side effects. Most patients found the clinical information yielded was useful.
1016 USING VIDEO TELEMEDICINE FOR INPATIENT WORKING: A NOVEL APPROACH TO REMOTE WORKING DURING THE COVID-19 PANDEMIC
Authors: Green V , Joyce N 
Published: June 2022

Abstract

Background
Orthogeriatrics inpatient ward.

Introduction
The COVID-19 pandemic changed working patterns for many trainees. Remote telephone or video outpatient consultations became established practice, with clinically vulnerable staff able to support this provision. We adapted the use of telemedicine to provide remote clinical working for inpatient care and continued speciality training opportunities.

Method
Microsoft Teams video conferencing facilitated interaction between the specialist registrar working remotely and the on-site multidisciplinary team (MDT). Daily activities included virtual handover attendance, inpatient ward round consultations and MDT discussions. A portable computer enabled the clinician to see and interact with inpatients remotely. Access to electronic patient records facilitated timely decision making and enactment of management plans. Anonymous MDT feedback was collected via online questionnaires. This project conformed to service evaluation guidelines and ethical approval was not required.

Results
Fourteen staff members completed the feedback survey. Results were overwhelmingly positive, with 78.6% of respondents strongly agreeing that the senior doctor working remotely supported the MDT, facilitated complex clinical decision making and was beneficial to patient care. Feedback noted that some patients praised the ‘clever’ and ‘innovative’ method. Limitations included technical difficulties due to Wi-Fi connection, which contributed to communication not being as fluid as face-to-face consultations and increased ward round duration. Patient factors, namely hearing and cognitive impairment, limited the interaction that patients were able to have with the clinician via video link.

Conclusion
Video inpatient ward round consultations offer an effective opportunity for physicians to continue clinical patient-facing roles whilst working remotely. Furthermore, this minimises the impact of COVID-19 on specialty trainees, by providing continued training and assessment opportunities for individuals required to shield. This novel method affords a framework transferrable to clinicians from other hospital specialties who may be required to work remotely. Future reviews of patient and relative satisfaction with this process are required.
1048 REDUCING RISK FROM WARFARIN- A COMPLETED AUDIT CYCLE ON NICE COMPLIANCE WITH WARFARIN FOR NVAF IN HOSPITALISED OLDER PEOPLE
Authors: Lee-Johnson L , Dwivedi R 
Published: June 2022

Abstract

Introduction
Traditionally Warfarin has been mainly used for stroke thromboprophylaxis in patients with atrial fibrillation but direct oral anticoagulant (DOAC) are increasingly being used as they have improved safety profiles with comparable efficacy. Recent data from National Reporting and Learning System (NRLS) have discovered safety incidents related to anticoagulation, predominantly Warfarin, contributing in excess of 10% of all medication errors. National institute for clinical excellence (NICE) recommends reassessing anticoagulation choice for patients on Warfarin with poor anticoagulation control, indicated by any of the following: 1 &gt; 2 INR values &lt;1.5 or &gt; 5 or 1 INR value &gt;8, within the past 6 months 2 &gt; Time in therapeutic range (TTR) &lt;65% Intervention An initial retrospective audit on 50 patients on Warfarin for NVAF performed between June—September 18 showed poor compliance with NICE. We reviewed the previous 6 months INR values and recorded any significant deviations outside of the therapeutic range as per NICE. TTR over the last 6 months was calculated using the Rosendaal method. Following departmental audit presentation, a reaudit was carried out between Jan-Aug 2019 to assess improvement.

Results
Median age was 87.5 compared to 83 in the first audit. Warfarin was correctly continued in 7/38(18%) in the 1st audit which improved to 9/28 (32%) in the second. Number of patients discharged on warfarin with unstable INRs decreased significantly from 26/32 (81%) patients in the 1st audit to 10/24 (42%) in the 2nd.

Discussion
Our reaudit shows significant reduction in continuation of warfarin on discharge in patients with unstable INRs (p = 0.0043 Fisher exact test). Although, there is a trend towards improvement with NICE compliance; in general, the compliance with NICE remains poor. We suggest geriatricians to proactively review the appropriateness of warfarin prescription and to consider a DOAC in preference to Warfarin in all elderly patients.