Introduction 16% of adults over the age of 75 years old have a diabetes diagnosis 1 and 1 in 6 hospital beds in the UK is occupied by someone with diabetes 2. Keeping diabetic patients safe during hospital stays is a priority, and in 2023 the Joint British Diabetes Societies (JBDS-IP) published guidance on managing Diabetes in Frail inpatients 3. An audit at our hospital later that year found that 70% of Capillary Blood Glucose (CBG) testing was non-compliant with guidelines resulting in unnecessary patient intervention, use of staff time and consumption of non-recyclable resources. The main
Introduction Around 30,000 emergency laparotomies are performed each year across the United Kingdom. Over half are in people aged 65 years or above, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but longer-term mortality risk has been less extensively studied, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on longer-term mortality (> 90 days) following emergency laparotomy. Methods A retrospective analysis of National Emergency Laparotomy Audit
1. Introduction Care home residents have a greater incidence of frailty and co-morbidities. Polypharmacy and inequitable access to integrated healthcare are confounders to positive outcomes in this cohort. Providing proactive care through the Enhanced Health in Care Homes (EHCH) Framework seeks to address these inequalities using multidisciplinary team (MDT) working. 2. Method A pilot MDT intervention was delivered across eleven older peoples care settings with the most ambulance conveyances in a London borough known for its aging population. MDT members were from general practice (including
Introduction Highly challenging, regular strength and balance exercise classes (SBE) reduces fall risk but there are few options for long-term continuation. SBE could be delivered by the voluntary sector, but care is needed to ensure good fidelity. The feasibility of delivering evidence-based SBE outside the governance of health services is unclear. A voluntary sector-led weekly SBE class ‘Strong and Steady (S&S)’, led by a level 4 qualified postural stability and funded via grants and fees, was set up in December 2022 alongside an existing community coffee morning. Methods Baseline measures
Introduction: Simulation training is a valuable resource to teach clinical skills and mimic emergency settings. Human factors (HF) are non-technical skills that are affected by human attitudes and behaviours. Weaknesses in human factors can cause fatal medical errors. We wanted to assess if simulation can be used as a tool to improve these. We conducted two simulation training days for medical higher specialty trainees (HST) focusing on HF. Methods: 20 HSTs participated in 10 simulated scenarios. Scenarios involved using a high-fidelity manikin and actors. The scenarios were a mixture of long
Introduction End-of-life (EOL) care in care homes includes patients experiencing "ordinary dying" from dementia or frailty, alongside those with chronic diseases and cancer. Recognizing non-specific decline is complex. The One Weston Care Home Hub (CHH) implements comprehensive EOL care, achieving 95% of deaths in the preferred place and prioritising a "good death". Whilst "Just in Case" (JIC) injectable medications are commonly prescribed, a broader understanding of prescribing patterns is useful for learning about medicines waste and recognition of dying. This study investigates the
Introduction University Hospitals Dorset (UHD) wants to provide hospital level care to patients with frailty, in their own home. Our frailty virtual ward (VW) team consists of a consultant geriatrician, lead nurse, pharmacist, advanced nurse practitioner, nurses and therapists. We have a capacity of 20 patients across Bournemouth, Christchurch and Poole localities. Our patients receive care at home for acute medical conditions supported by remote monitoring, blood testing, face to face assessments and daily Geriatrician input. We are collaboratively working with our community partners seeking
Introduction: Clinical decision making for older adults with multimorbidity can be complex and demanding. When facing complex decision-making, patients may experience decisional conflicts, leading to low treatment adherence, adverse health outcomes, and increased utilization of health services, etc. To address these issues, patient decision aids (DAs) have been developed and utilized in the decision-making process to facilitate informed decisions. The aim of this study is to identify DAs developed for patients with multimorbidity and assess their quality. Method: We searched full-text papers
Introduction: The local issue tackled was the suboptimal compliance with the Patient Fall Management Assessment (PFMA) on the Electronic Patient Record (EPR) due to assessments being completed on alternative electronic documents.The goal was to emphasize on this to improve patient safety. Methods: Audit data was collected by reviewing incident reports of inpatient falls across various complex care wards over a 12-month period each, with 109 notes reviewed in the first cycle and 204 in the second. Interventions: The approach involved conducting repeated training sessions for all grades of
Introduction: Clinical frailty scale (CFS) is used to generate a score ranging from 1 (very fit) to 9 (terminally ill) for people aged ≥65 years. A CFS of ≥7 correlates with a one-year mortality rate of ~50%, making it useful for identifying individuals potentially approaching last year of life. NICE recommend this patient group are offered Advance care planning (ACP). ACP is paramount to ensuring individuals receive high-quality, personalised end of life care. We aimed to investigate CFS documentation and frequency of ACP discussions following educational interventions. Methods: We performed
Introduction Vertebral fragility fractures (VFFs) are the most prevalent form of osteoporotic fracture, with an incidence of >20% in women >70 years old. While often clinically silent in isolation, VFFs are associated with future osteoporotic fractures, decreased quality of life and an 8-fold increase in age-adjusted mortality. Radiologists may facilitate early diagnosis of VFFs, allowing for more cost-effective intervention with greater patient outcomes. However, a national audit in 2019 demonstrated widespread failings in the radiological recognition and reporting of VFFs, according to
Introduction At Wrightington, Wigan and Leigh we admitted over 400 patients with hip fracture diagnosis in 2023. As part of ortho-geriatric review, denosumab treatment would be utilised in a cohort of patients where this is appropriate, in line with NOGG guidelines. Traditional model of delivering first dose after outpatient appointment led to delays in treatment initiation and did not address the significant risk of “imminent fracture” which was recognised in the latest NOGG guidelines. The aim of this project was to reduce delays in denosumab treatment initiation by introducing consenting
Abstract Content - Introduction We wished to improve the knowledge of care home staff in Leeds in identifying frailty and managing frailty related problems Method We developed a frailty education course ( www.leedsfrailtyeducation.co.uk) which was then refined and modified to target care home staff. We engaged key stakeholders at the council and the ICB to help develop and promote the course. The course was delivered across 4 venues in Leeds by geriatricians, a pharmacist and a community nurse. Results We had 128 attendees across the four days. From the feedback taken immediately after the
Introduction Acute kidney injury (AKI) and hyponatraemia are common causes for hospital admission for frail, elderly people. Some patients could be managed at home using the Virtual Ward model, reducing risk of healthcare related adverse events. We aimed to show plausibility for this treatment model. Methods We produced guidance for managing patients with AKI/hyponatraemia on the Frailty Virtual Ward (FVW). We then collected data from patients treated for AKI (N=12) and hyponatraemia (sodium 126mmolL (N=9) and compared with a similar inpatient cohort (AKI N=14, hyponatraemia N=16). FVW
Introduction The Chandlers Ford, Eastleigh and Southern Parishes Frailty Support Team (FST) identified pockets of high referral rates within independent living facilities. It was hypothesised that this may be because independent living facilities do not have a contractual arrangement for proactive intervention, unlike care homes and nursing homes. This leaves individuals and carers unsure how, when, and where to seek support. In turn, this potentially has a high healthcare burden through unplanned access to GP’s, 999, 111 or admissions to hospital. Methods: An independent living facility was
Introduction: Little evidence exists about decision-making with older adults diagnosed with cancer (Bridges et al 2015). However, older age is associated with changes in physical, social, and psychological health domains in ways that influence treatment decisions potentially impacting on quality and quantity of life. We sought to explore the experiences of older adults, their significant others and healthcare professionals when decisions regarding cancer treatment and support are made. Methods: Synonyms relating to search terms Cancer, Older People, Complexity and Qualitative research were
Telemedicine uses communications technology for remote healthcare. Unreadiness includes difficulties with hearing, speaking, cognitive issues, vision problems, lack of internet-enabled devices, or no recent use of digital communication. Telehealth can enhance access and convenience, especially for rural patients, but faces challenges such as technology issues and impacts on patient-provider relationships, examination quality, care quality, and patient satisfaction. The COVID-19 pandemic has accelerated telemedicine adoption to protect medical personnel and patients, with significant promotion
Introduction: Malnutrition is a significant problem in the hospitalised population, particularly in those with cognitive impairment. Malnutrition has been shown to increase rates of infection, pressure sores, length of stay, readmission and morbidity. Malnutrition Universal Screening Tool (MUST) scoring identifies adults at risk of malnutrition and prompts dietetic referrals where appropriate. MUST score recordings across four Complex Medicine Units in the John Radcliffe Hospital were often inaccurate or incomplete, impacting on the identification of malnutrition and timely referral to
Introduction Global estimates indicate over half of individuals aged 85 and older are frail (1), costing the UK healthcare system approximately £5.8 billion annually(2). Locally, over 6,500 patients aged 65+ are admitted to West Middlesex University Hospital (WMUH) every six months. The proposed frailty team aims to implement early comprehensive geriatric assessments (CGAs) through a multidisciplinary approach. Timely CGAs can increase the likelihood of patients remaining in their own homes at 6 and 12 months(3), reduce length of stay (LoS), and lower healthcare costs, contingent upon
Introduction: Neck of femur (NOF) fractures can cause significant morbidity in elderly patients. Adequate pain control is essential for early mobilisation and improved outcomes. Health board prescription protocols exist offering a multi-modal analgesia approach as well as laxatives on the electronic platform (HEPMA). The aim of this quality improvement (QI) project was to assess adherence to these protocols. Methods: Patients over 65 with isolated NOF fractures admitted to trauma wards from ED at a single district general hospital were included. Baseline data was collected from patients