bluuebunny/crossref_metadata_2025_split huggingface dataset:
992 RESULTS OF A PILOT HIV/FRAILTY CLINIC - CAN COMPREHENSIVE GERIATRIC ASSESSMENT BENEFIT FRAIL PEOPLE LIVING WITH HIV?
Authors: Morrow H , Horner M , Thomson-Glover R 
Published: June 2022

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

Our patient
a 90-year-old man with gender dysphoria, falls into this subset. This case study follows our patient’s internal struggle with his longstanding concealment of his transsexualism, issues accessing specialist care, reduced treatment options in view of his age and the repercussions. These include an impact on his physical health by means of a self-inflicted injury resulting in a urethral fistula and his mental health with worsening depression and reduced ability to rationalise his gender dysphoria.
The study presents challenges from both a clinical perspective, in terms of an accurate psychiatric diagnosis, as well as the challenges experienced by the patient in the healthcare setting.
While this case explores both the causes and effects of these difficulties; the specific needs and experiences of older LGBT patients remain largely unknown. Through highlighting this patient’s experiences, we hope to encourage thought and discussion of such issues amongst other healthcare professionals to ensure a holistic approach of care.
1014 OPTIMISING BONE HEALTH IN FRAIL OLDER ADULTS: IS INTRAVENOUS BISPHOSPHONATE THERAPY DURING ACUTE ADMISSION WARRANTED?
Authors: Hosty J , Vethanayagam N 
Published: June 2022

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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