Introduction Empowering patients to ‘age well’ (NHS England Long Term Plan, 2019) has become a key driver to meet the rising demand for healthcare. Despite a growing body of evidence regarding ageing well and the benefits of patient empowerment (Selman et al, 2017) and reducing demand on resources (Age UK, 2020), there remains confusion regarding applied meaning for the spectrum of older persons health. This research will consider expert view on the topic of ‘ageing well’ related to the predictable patterns of ageing. The aims of this study will be to develop a new interventional frailty
Introduction Older people living in care homes sometimes experience episodes of acute functional decline. These represent a diagnostic challenge to healthcare professionals and can result in antibiotic prescriptions or hospital admissions, though this may not always the most appropriate management strategy. We aimed to understand how episodes of acute functional decline are recognised, managed and escalated by care home staff in the UK. Method This was a qualitative interview study with UK care home staff, including managers, nurses and carers. Participants were recruited through
Introduction: Neck of femur fractures (NOFFs) are a clinically significant diagnosis, with 10% of patients dying within one month of diagnosis [1]. There is a strong association between earlier surgery and improvement in postoperative outcomes [2]. Taking anticoagulation can cause delays in patients being operated on. At Homerton University Hospital (HUH), no previous guideline existed to aid specifically in the management of patients with NOFFs on anticoagulation. We created a guideline in order to reduce delays to theatre, in keeping with national guidance (
Background: Guidelines recommend that all older hospital patients are screened for cognitive comorbidity (i.e. dementia, delirium) and frailty to inform care and target multidisciplinary team resources, based mainly on evidence from studies in elective or specialty-specific settings. Unselected hospital-wide data are needed to inform guidance and service design and delivery, so we set up the Oxford Cognitive Comorbidity and Ageing Research Database (ORCHARD) using routinely-acquired electronic patient record (EPR) data. Methods: ORCHARD includes pseudonymised EPR data on all patients >65 years
Introduction Falls are a major cause of morbidity and mortality in patients over 65. Unrecognised postural hypotension is a significant and treatable contributor. Training nurses and health-care assistants (HCAs) in correct measurement technique can be challenging, as these groups are rarely able to fully attend single sessions due to urgent clinical commitments, night duties and staff-shortages. We aimed to improve the frequency and quality of lying-standing blood pressure (LSBP) measurement in a Geriatric inpatient cohort. Methods 3 PDSA cycles were performed over a 10-month period on a
Topic We identified a deficiency in the identification and treatment of bone health in the Day Rehabilitation Unit. DRU is an Out-patient clinic where older people with falls or reduced mobility receive comprehensive geriatric assessment. We aimed to improve early screening for osteoporosis, prompting targeted investigation and intervention to improve patient outcomes. Intervention Our first intervention was consultant teaching specifically to the junior doctors working in clinic. This was followed up by the introduction of a Medical Assessment Proforma to include osteoporosis risk assessment
Pressure injury (PI) management is a challenge in dependent patients in acute care wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition). A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long Term Care (LTC) wards and thus may improve outcomes. The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical
Background This study aimed to determine trajectories of depressive symptoms among older adults in England, overall and for those with hip fracture. The study aimed to explore the differential characteristics of each trajectory identified. Methods Analysis of adults aged 60 years or more (n=7,050), including a hip fracture subgroup (n = 384), from the English Longitudinal Study of Ageing. Latent class growth mixture modelling was completed. Depressive symptom prevalence was estimated at baseline. Chi-squared tests were completed to compare baseline characteristics across trajectories. Results
Introduction The health benefits of physical activity for older people are well recognised and include reduction in falls, improvement in frailty status and physical function. Nonetheless, physical inactivity remains a significant problem among older adults. This study aimed to determine the feasibility and acceptability of implementing online volunteer-led group exercise for community-dwelling older adults. Methods This pre-post mixed methods study was conducted among older adults attending community social clubs. Eligible participants were aged ≥ 65 years, able to walk independently, and
Improving the Quality of Anticipatory Care Planning for Patients with Recurrent Aspiration Pneumonia
Introduction: Recurrent episodes of aspiration pneumonia (RAP) are a significant problem in frail patients leading to high re-hospitalization and mortality rates. Anticipatory care planning (ACP) enables improved quality of life and end of life care. We reviewed the assessment, ACP discussions and communication with Primary Care for patients admitted with RAP. Methods: We used PDSA methodology, reviewing patients with RAP referred to Speech and Language Therapy (SLT) in Elderly Medicine wards. Educational interventions were implemented. An illustrative case and pre-intervention results were
Introduction: Major trauma including Traumatic Brain Injury (TBI) is an increasingly common cause of hospitalisation in older adults. We studied post-discharge recovery from TBI using a remote healthcare monitoring system that captures data on activity and sleep. We aim to assess the feasibility and acceptability of this technology to monitor recovery at home following a significant acute clinical event in Older adults. Methods: We installed Minder, a remote healthcare monitoring system, in recently discharged patients >60 years with moderate-severe TBI. We present descriptive analyses of post
Background: Guidelines recommend screening for frailty in all hospitalised older adults to inform care, based mainly on studies in elective and speciality-specific settings. However, most hospital bed-days in older people are for acute, non-elective admissions to general medicine, for which the prevalence and prognostic value of frailty might differ. Therefore, we undertook a systematic review of frailty prevalence and outcomes in older people with unplanned hospital admissions. Methods: We searched MEDLINE, EMBASE and CINAHL up to 30/04/2021 for observational studies using validated frailty
Background: Guidelines recommend screening for frailty in all hospitalised older adults to inform care, based mainly on studies in elective and speciality-specific settings. However, most hospital bed-days in older people are for acute, non-elective admissions to general medicine, for which the prevalence and prognostic value of frailty might differ. Therefore, we undertook a systematic review of frailty prevalence and outcomes in older people with unplanned hospital admissions. Methods: We searched MEDLINE, EMBASE and CINAHL up to 30/04/2021 for observational studies using validated frailty
Background: Multimorbidity patterns is associated with future mortality among older adutls. However, the addictive effect of disability for distinct multimorbidity patters is unclear. Our aim was to identify the multimorbidity patterns of Taiwanese people aged over 50 years and to explore their association between multimorbidity patterns with/without disability and future mortality. Methods: This longitudinal cohort study used data from the Taiwan Longitudinal Study on Aging. The data were obtained from wave 3, and the multimorbidity patterns in 1996, 1999, 2003, 2007, and 2011 were analyzed
Introduction Approximately one-third of older patients leave hospital with a new functional impairment. Tracking rehabilitation progress following acute illness could improve recognition and understanding of hospital-acquired disability. However, traditional mobility and functional scores include measures that are not part of routine rehabilitation therapy, adding a time burden for staff to report. Capturing data already recorded in routine electronic records could provide an efficient patient tracking measure of rehabilitation success. Methods A scoping literature review appraised existing
Introduction Care home residents can have variable access to eye care services & treatments. We developed a collaborative approach between optometrists, care homes, and primary & secondary care to enable personalised patient-centred care. Objective To develop and evaluate an integrated model of eye care for care home residents. Methods Small scale plan-do-study-act (PDSA) service tests were completed in three care-homes in Southwark (2 residential, 1 nursing) between November 2021 to May 2022. Processes were compared to historical feedback & hospital-based ophthalmology clinic attendances (Mar
Introduction The prevalence of eye disease and visual impairment in care home residents is disproportionately higher compared to the general population. Access to eye care services and treatment can be variable for this vulnerable population. Objective This narrative synthesis reviews the available evidence of services and interventions for delivering eye care to care home residents. The key review questions: 1. What is the existing evidence for eye care interventions or services (including service configuration) for care home residents? 2. Does the provision of these interventions or services
Introduction: Co-morbidities and frailty are common in older heart failure patients. The aim of this study is to explore the relationship between co-morbidity, frailty and ejection fraction (EF) in older heart failure inpatients. Methods: A cross-sectional, observational, retrospective analysis of consecutive patients aged 60 years and over who were admitted with heart failure in a UK hospital. Patients with incomplete data were excluded. Carlson’s comorbidity index (CCI) was used to compute comorbidity, and the Rockwood Clinical Frailty Scale (CFS) was used to measure frailty. The EF was
Introduction: Dementia-friendly hospitals (DFH) are mentioned as one of several key initiatives in national dementia strategies. In our previous integrative review, we identified 17 descriptions of DFHs and analysed six characteristics of DFH: continuity, person-centredness, consideration of phenomena within dementia, environment, valuing relatives and knowledge and expertise within the hospital (Manietta et al., BMC Geriatrics, 2022, 22, 468, 1-16). We also learned that the term DFH is based more on healthcare practice than research. To address this research gap, one step of our
Introduction: Community-based care such as adult day services (ADS) are preferred by people with dementia. ADS offers the opportunity to support the health and social needs of their clients and provide respite to family members, contributing to a stable care situation at home. The psychological needs of humans according to the self-determination-theory (SDT) (autonomy, competence, and relatedness) can be fulfilled by leisure activities and thus improve well-being and quality of life. The implementation of leisure activities that reflect individual preferences support active participation