Introduction: Completing a comprehensive geriatric comprehensive assessment (CGA) should be standard practice (Stuck & Lliffe, 2011). Studies have shown some improvement in CFS status following completion of a CGA (Chia-Ming et al., 2010). However, the evidence of community based completed CGA’s in improving health outcomes is limited (Sum et al., 2022). Background:In November 2023, with the creation of Porth Preseli (PP), members of the frailty pathway joined PP as a pilot, working within an integrated care team (ICT) to provide an Multidisciplinary approach (MDT). No additional resources
Introduction Introduction of the medical examiner (ME) service has changed the process in which the Medical Certificate of Cause of Death (MCCD) is completed across South Wales. In a tertiary hospital we endeavoured to improve team ownership of medical cause of death decisions, senior involvement, and communication of this to the medical examiner service, through development of a new process and communication form. Methods Two PDSA cycles have been completed. With stakeholder involvement we produced a process map and developed a Proposed Cause of Death form. In 2022 medical teams on 2 wards (A
Introduction It is estimated that by 2030, 1 in 5 people undergoing surgery will be over the age of 75. These patients are often frail with a higher risk of post-operative complications including delirium. They are also more likely to have multiple co-morbidities and an increased anticholinergic burden due to polypharmacy. Anticholinergics are often linked with an increased risk of dementia, delirium, and falls. Methods This retrospective cohort study analysed anonymised data from 50 emergency general surgery patients the POPS team reviewed between December 2023 and February 2024 at the
Introduction Venous thromboembolism (VTE) risk following acute stroke is high. Current guidelines recommended intermittent pneumatic compression (IPC) stockings for up to 30 days in those who are immobile following acute stroke. The concern post-stroke is haemorrhagic complications when using low molecular weight heparin (LMWH). The CLOTS3 trial favoured IPC for safety in the first 30 days. However, in many cases, doses suitable for VTE prophylaxis can be used but with caution if IPC cannot be used. Method A spot audit of patients current VTE prophylaxis was undertaken in a stroke
Introduction In today's healthcare practice, many patients live longer with multiple health issues, often in a frail or terminally ill state. Their quality of life doesn't necessarily improve. These patients require optimal supportive care that respects their dignity. Advanced Care Plans (ACPs) are crucial here, facilitating person-centered discussions about future care preferences while the patients have the mental capacity for meaningful participation. We aim in this study to assess how many patients in General Internal Medicine department would benefit from ACP and compare that to our
An 80 year old man living independently with his wife presented with progressive unsteadiness, generalised weakness and muscle aches over 2 months, following a short episode of flu-like symptoms. Systems review revealed shortness of breath, a hoarse voice, 2kg weight loss and occasional non-drenching night sweats. Bloods showed elevated WCC, CRP and ESR. He was started on 20mg of prednisolone for a working diagnosis of polymyalgia rheumatica. These symptoms did not improve, even after this increased to 30mg. He was admitted to hospital after he developed left leg weakness evolving over the
Introduction There is a high prevalence of diabetes in patient populations undergoing Vascular Surgery. Appropriate and responsive management of diabetes in the perioperative setting is critical for reducing morbidity and perioperative complications e.g. diabetic emergencies, poor wound healing, delirium. The aim of this project was to review current practice for perioperative management of older people with diabetes against guidance outlined by the Centre for Perioperative Care (CPOC) on a regional vascular surgery ward. Methods A retrospective observational evaluation design was conducted
Introduction: Incident frailty is common among older adults with diabetes mellitus. We have previously demonstrated that elevated serum levels of the soluble receptor for advanced glycation-end products (sRAGE) predict mortality in frail older adults. However, the evidence that sRAGE is associated with higher mortality in older adults with diabetes mellitus is rather inconsistent. Therefore, the aim of this study was to investigate whether frailty status influences the relationship between sRAGE and mortality in older adults with this diabetes mellitus. Methods: Three hundred and ninety-one
Introduction Authoritative medical organisations including the Resuscitation Council UK, NHS and BMA all state that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions should only be relevant to CPR and should not impact other decisions about care and treatment. We set out to examine the reality of decision making in clinical practice. Methods We circulated a clinical scenario of a patient deteriorating with COVID-19 after hip fracture to 128 members of the consultant and trainee geriatrician WhatsApp groups in Wales. Recipients were blindly randomised to one of two versions
Abstract Content - Introduction: Delirium, characterized by disturbances in attention and consciousness, is common in individuals with pre-existing medical conditions, particularly the elderly, but can affect people of any age. It can lead to significant morbidity, mortality, prolonged hospital stays, increased healthcare costs, and long-term cognitive decline. Despite its impact, delirium is often underdiagnosed and undertreated, underscoring the need for better diagnostic strategies. The 4AT tool, recognized by NICE, is valued for its rapid delirium assessment, unlike the AMT-10, which is
Introduction Frailty is a clinical state that predisposes to patients to clinical deterioration in response to minor stressor events. Frailty tends to be more prevalent in patients with chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD). Therefore, we aim to investigate the influence of clinical frailty on mortality in COPD patients. Methods Data collection from electronic records for patients seen in Ysbyty Ystrad Fawr, Neville Hall Hospital, Grange University Hospital or Royal Gwent Hospital between 5-17th June 2024 was completed as part of patient input to the National
Background A mechanism for improving inpatient communication with patients and their families by the multidisciplinary team was desired. Introduction Patients and their families were invited to a 'What Matters to Me' meeting within a few weeks of transfer to a 43 bed community rehabilitation hospital. The 'What Matters to Me' meetings were booked by nurses with families via an invitation letter given during visiting. The letter outlined the purpose and format of the meeting. The patient, family, nurse, therapist, physician associate or junior doctor and consultant participated. A small number
The aging population is often burdened with multiple comorbidities, leading to polypharmacy, which increases risk of adverse drug reactions . Anticholinergic medications are commonly prescribed to elderly patients for various conditions, yet they are associated with a range of adverse effects, including cognitive impairment, falls, and even increased mortality. The Anticholinergic Burden (ACB) score is a validated tool used to assess the cumulative burden of anticholinergic medications in patients. This clinical audit is aimed to evaluate the use of the Anticholinergic Burden (ACB) score as a
Aims Understanding patients’ wishes regarding CPR before surgery is crucial. This study aims to assess the impact of a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision on anaesthetists' actions during theatre. Methods We used WhatsApp, to present a scenario of an 83-year-old with ischemic heart disease, cognitive impairment, and an acute hip fracture. Anaesthetists were asked how they would handle various intraoperative events and whether a prior DNACPR decision would influence their actions. Results A total of 74 UK anaesthetists, all but one of them consultants, completed the
Vitamin D deficiency has become commonplace, especially in older people. Given the role it plays in bone health and falls prevention, as well as the growing evidence of its extra-skeletal actions, it is important to treat vitamin D deficiency adequately. Our practice has been 2 to 3 weeks of daily treatment with 50,000IU ergocalciferol as a loading dose. However, recent guidelines recommend half this total cumulative dose given over a period of 6 to 8 weeks. Rather than promptly following the guidelines and changing our practice, we opted to conduct a quality improvement project (QIP) looking
Introduction: As awareness of hospital-associated deconditioning increases, services to prevent hospital admissions and provide discharge support for older adults are expanding, aiming to reduce admissions and the risks associated with prolonged hospital stays. A Welsh Government IQS titled “Older People and People Living with Frailty” published in January 2024 identifies a need to shift our health and social care system from prioritising reactive crisis management to a ‘place-based’, community-focused approach that emphasises proactive identification and management of frailty. The CTMUHB
Introduction It is predicted that over 4,000,000 patients will be on an elective waiting list in England by 2030 (1) with increased demand, age and frailty following COVID (2). The importance of early assessment of frailty and geriatrician input to allow optimisation and shared decision making is key. A Geriatrician led perioperative clinic was established in Swansea Bay for patients on elective general surgical waiting lists in September 2023. Method Using an electronic Power Business Intelligence frailty flag, we highlighted patients and screened either electronically or via telephone using
Introduction In 2021, the Welsh Government launched the “All Wales Dementia Care Pathway of Standards”, which the Cardiff and Vale University Health Board (CVUHB) Memory Assessment Service (MAS) works under (1. Welsh Government, 2021). This service evaluation aims to evaluate the CVUHB MAS diagnostic pathway against these standards. Method This retrospective review analysed 299 referrals to the CVUHB MAS from August 2020-2023. Data was collected via referral and clinic letters, focusing on demographics, referral sources, diagnostic timelines and clinical outcomes. Results Patients had a mean
Pulmonary embolism (PE) is the third most common among acute cardiovascular diseases, after myocardial infarction and stroke, with a significant mortality rate. At Portsmouth University Hospital's acute medical and respiratory departments, inadequate understanding of pulmonary embolism diagnosis and management, which led to unnecessary investigations and medications putting the patients at risk of the side effects and complications of that, was the main impetus for initiating this audit. The hospital did not adhere to the NICE recommendation of regular interim anticoagulation for patients
Introduction Lakeside unit at the University Hospital of Wales is a rehabilitation and complex discharge planning facility for elderly patients. Recognising the importance of good sleep in rehabilitation, our quality improvement project aimed to assess the feasibility and evaluate the impact of introducing decaffeinated coffee and tea as alternatives to the standard caffeinated options routinely provided to patients. Caffeine is a diuretic and stimulant that disrupts sleep and increases urinary frequency, urgency, and volume. Reducing caffeine can reduce falls related to toileting. Addressing