Introduction It is well recognised that patients with Parkinson’s disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting. Method In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson’s
Introduction: A large proportion of Morriston Hospital’s acute medical take consists of elderly patients admitted with falls. Postural hypotension is a cause of syncope and fall which contributes to morbidity, disability and death in cases of injury in the frail and elderly population 1. Hence, diagnosing and treating postural hypotension is crucial. It is important that the measurement of lying-standing blood pressure (LSBP) is consistent to ensure reliability of results as this would affect patients’ management. The aim of this project is to assess how postural hypotension is diagnosed in
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel
Background : Three challenges for ageing populations are frailty (a state of reduced physiological reserve), social isolation (objective lack of social connections), and loneliness (subjective experience of feeling alone). These are associated with adverse outcomes. This study aims to examine how frailty in combination with loneliness or social isolation is associated with all-cause mortality and hospitalisation rate using data from UK Biobank, a large population-based research cohort. Methods: 502,456 UK Biobank participants were recruited 2006-2010. Baseline data assessed frailty (via two
Introduction: Frailty is a long term condition with potentially significant associated healthcare costs and resource usage. The gold standard evidence based intervention is a comprehensive geriatric assessment. The NHS Long Term Plan highlights the importance of ageing well and developing proactive services in the community. Care home residents often have unmet health and social care needs, and are frequently frail. Methods: 59 patients with severe or very severe frailty (Rockwood clinical frailty score 7 or 8) across three care homes with both residential and nursing provision were reviewed
Introduction Vertebral fragility fractures (VFF) are the most common osteoporotic fracture. VFF can result in significant pain requiring hospitalisation. However, there is little data on patient numbers, hospital bed days and costs, contributed to by these patients. Methodology We report a retrospective analysis of patients aged 55 years and over admitted to hospitals across England from 2017-2019. ICD-10 classifications for VFF and OPCS codes were used to identify admissions and patients who had undergone vertebral augmentation (VA). Results There were a total of 99,240 patients (61% Female)
Title: Care of Older People undergoing emergency surgery: meeting the standards of the National Emergency Laparotomy Audit (NELA) Introduction: There are well documented in-equalities for outcomes for surgical intervention 1,2,3 associated with Age and Frailty including emergency laparotomy 4. NELA data has shown over half of such patients are over 65 years old about one fifth are over 80. These patients having significantly higher mortality, longer hospital stays and it has also shown frailty to be an independent marker of poor outcomes. Through application of key standards these outcomes
Introduction: Many commonly prescribed medications have inadvertent anticholinergic effects. People living with Dementia (PLWD) are vulnerable to these effects and at risk of adverse outcomes, the risk being higher with greater anticholinergic exposure. We investigated prescribing patterns and anticholinergic burden (ACB) in a cohort of community-dwelling PLWD and explored the effect of ACB on cognition, neuropsychiatric symptoms, quality of life (QoL), and functional independence. Method: The medication and demographic information for 87 (39 female) community-dwelling PLWD were obtained from
Introduction: Older people in care homes with atrial fibrillation (AF) have complex health needs and would benefit from taking part in research. This study assessed the feasibility of pharmacist implementation of the Atrial Fibrillation Better Care (ABC: Anticoagulation; Better symptoms; Cardiovascular comorbidity management) pathway, and collection of an AF-specific, resident-centred outcome. Methods: Older residents (aged ≥65 years) with AF were recruited from care homes within Liverpool and Sefton and randomised to receive the pharmacist intervention, or continue their existing treatment
Introduction: The pandemic has shown how vital patient-centred treatment escalation planning (TEP) is for older people. Locally we have seen inappropriate transfer of dying patients to acute hospitals from rehabilitation units. Mortality review found a lack of useful TEPs in these cases. Baseline data in our rehabilitation hospital showed 54% of patients had a TEP and 16% a decision made about repatriation during acute illness. We aimed to increase the proportion of patients in this setting with a TEP to 80% over six months. Methods: A multidisciplinary team of doctors, ANPs and senior nurses
The National Mortality Case Record Review Programme commissioned in 2016 aimed to improve the learning from deaths process. As part of this aim, several reports were published, which identified barriers in implementing the mortality review process. Mortality and Morbidity (M&M) meetings can be an important mechanism for removing these barriers, and while have been in place for a long time in surgical specialties, are only recently becoming more common in medical specialties. We have developed an innovative M&M meeting in our geriatric department to integrate Mortality case reviews with
Introduction By 2030, it is estimated that 25% of Europeans will be aged over 65.[Dugarova;UNDevelopmentProgramme;2017] Frailty in this group is a key contributor to poorer outcomes.[Eamer;BMCAnesthesiology;2017;17:99] The term is common in healthcare but research into the issues faced by staff around assessment and management of frailty has been limited. We undertook a survey to identify challenges faced in providing care to those living with frailty and considered potential interventions. Method The survey was across three hospitals in our health board (which serves a population of around
Introduction NICE Clinical Guideline CG103 states that adults aged 65 and older should be screened for delirium within 48 hours of emergency hospital admission. The Geriatric Medicine Research Collaborative (GeMRC)'s World Delirium Day data from 2019 showed an average screening rate of 27% nationally. After an inpatient fall on the Medical Assessment Unit resulted in hip fracture for a patient who had not been screened for delirium with the recommended 4 A's Test (4AT), we decided to collect data on screening rates and devised a way of improving these. Method Baseline data was collected
BACKGROUND Physical rehabilitation is related to better surgical and medical outcomes for patients (WHO, 2021). In hospitals, the role of the rehab team is essential to promote faster and better recovery and to prevent falls (Brett et al., 2019). We wanted to review the communication between the rehab, nursing, and medical team to aid discharge planning. Better communication can reduce repetition. METHODS A baseline survey was given to doctors, nurses, and rehab staff in a geriatric ward to review communication. The intervention was an A4 template highlighting the patients’ baseline and
Introduction: Postural Hypotension is a very common presentation in the elderly population. Appropriate knowledge to record postural hypotension & non-medicinal management for this is very important among MDT members working in the care of the elderly wards. Method: We set out a questionnaire to assess the knowledge among MDT ( multidisciplinary) members. An educational programme was initiated to improve the knowledge among MDT members. A complete audit cycle was done and the knowledge was reassessed with the same questionnaire based on the principles of the PDSA (Plan, Do, Study & Act) cycle
Background: Weight loss in the older adult is often multifactorial and can be associated with increased morbidity and mortality. Our quality improvement project focused on nutritional care of patients 75 years or older. This hospital has a standardised Nutrition and Hydration Policy based on NICE guidelines to prevent malnutrition in hospital inpatients including weighing patients every 72 hours, daily screening and food/hydration charts. Our project aimed to increase adherence, with a focus on increasing the percentage of patients being regularly weighed over a 6-month period to 90%. Methods
Introduction Critical Illness Acquired weakness (ICU-Acquired Weakness (ICU-AW)) is an umbrella term used to describe Critical Illness Myopathy (CIM) and Critical Illness Polyneuropathy (CIP). The condition exerts high prevalence in the elderly admitted in the ICU and is associated with deteriorating patient outcomes, namely mortality and morbidity. The prevalence of the syndrome is highly variable in the current literature hindering our ability to objectively quantify the scale of the problem. Moreover, several preventative methods and treatment for ICU-AW as a result of sarcopenia have been
Introduction: Hip Fracture Surgery (HFS) can result in balance impairment which is associated with an increased risk of falls in the elderly as well as limitations in their mobility. Balanced Training (BT) is a rehabilitation method used aiming to minimize the balance impairments post HFS. BT options include stepping, balance task-specific exercise, standing on one leg, yoga. Our main outcome is to evaluate the effect of BT on the physical functioning of elderly patients post an HFS. Methods: We conducted a systematic review using the PubMed-Medline, Cochrane Library and Embase databases to
Introduction The Fracture Liaison Service (FLS) is a multidisciplinary service for individuals over 50 presenting with fragility fractures. It is designed to assess future fracture risk, and appropriately diagnose and manage patients with osteoporosis.1 At Wrightington, Wigan and Leigh Teaching Hospitals (WWL), concerns were raised that access to this service was poor, meaning some patients presenting with fragility fractures were not receiving appropriate management to reduce risk of recurrent fracture. This project was designed to increase referrals to the service. Methods A cohort was
Background This project was completed by a team of junior doctors working across two general medical wards at Queen Alexandra Hospital. Introduction Due to persistently high bed occupancy, patients are increasingly subject to multiple moves, increasing the risk of missed or delayed communication (Toye C et al, Clin interv aging, 2019, 14, 2223-2237). Importantly, families who receive good communication from staff are more likely to feel satisfied with the care of their loved one (Ersek M et al, J pain symptom manage, 2021, 62(2), 213–222). Our aim was to increase the occurrence and