Posters

Introduction The Covid19 pandemic represents an unprecedented challenge to global health and care services and necessitated a rapid shift towards healthcare being provided remotely. 1 A quality improvement project was conducted in Cardiff CRT to improve staff confidence in relation to remote-working to optimise the care of older patients in the community. Objectives To integrate the use of technology in intermediate care in Cardiff CRT Method A survey was sent to Cardiff CRT staff in May 2020. The plan-do-study-act (PDSA) model was used to implement improvement interventions whilst allowing

Introduction Parkinson’s Disease (PD) is recognised by the motor symptoms of tremor, rigidity and bradykinesia. However, the prevalence of psychiatric symptoms such as low mood, anxiety and memory problems in PD is also common (20-80%). We integrated one clinical session per week from a Parkinson’s specialist psychiatrist (PDSP) into our existing MDT service, and aimed to evaluate the impact of this model on care for patients with PD. Method We initiated a series of Plan Do Study Act (PDSA) cycles to establish a referral pathway to our PDSP. Using electronic clinical records we collected data

Background and aims: Frailty is a clinical syndrome of increased vulnerability to stressors, associated with adverse outcomes after stroke, but its impact on outcomes after transient ischaemic attack (TIA) remain unclear. Methods: Retrospective analysis of 1185 patients referred by the emergency department (ED) who attended TIA clinic with a Clinical Frailty Scale (CFS) within two weeks. Records were combined from two routinely collected databases, and prevalence of frailty was determined. Frailty was classified as CFS score >/=4. Data were collected on date of death, and hazard ratios (HR)

Introduction: Incontinence affects a significant proportion of older adults who reside in care homes. Incontinence symptoms have been linked to comorbidities, an increased risk of infection and reduced quality of life and mental wellbeing of residents. However, continence care provision can often be poor for residents, further compromising the health and wellbeing of this vulnerable population. Method: A systematic qualitative evidence synthesis and thematic analysis established the current evidence-base of barriers and facilitators for the provision of continence care in care homes. Results

Introduction In Scotland, more than 18,000 older people are admitted to hospital after a fall each year. One in three people over the age of 65 experience a fall at least once each year (1). Neurological examination is an essential part of the initial assessment of these patients in hospital and can determine the cause of falls such as stroke, peripheral neuropathies and Parkinson’s disease. Local anecdotal evidence suggested that this was often not carried out, with the potential for delayed diagnosis and treatment. Method Baseline data was collected from clinical notes of admissions to the

Introduction Delirium is prevalent in patients with idiopathic Parkinson’s disease (iPD) who are admitted to hospital. The hypoactive subtype of delirium is associated with poorer outcomes in hospitalised patients The aim of this study was to evaluate different outcomes across delirium subtypes in unplanned hospital admissions in patients living with iPD Methods Data was collated prospectively on all patients with idiopathic Parkinson’s disease admitted to our hospital’s medical wards between 1st January 2019 and 30th March 2020. Electronic case-note review and in-person assessments were used

Introduction In older adults, medicines non-adherence is prevalent and harmful. Current methods of identification have limitations with direct questioning often being met with a reluctance to “admit” non-adherence to healthcare professionals. The Making Medicines Work for You screener has been developed to support patients and clinicians identify and discuss adherence issues in a clinical setting. This study aimed to pilot the screener and identify barriers to medication adherence in an unspecified geriatric outpatient population. Method Patients attending the Older Person’ Assessment Unit at

Introduction The pathway for referral to elective perioperative clinic involves frailty screening patients at the point of referral1. This is adequate If waiting times are short. At Swansea Bay 6,458 patients>65 years are awaiting surgery with up to 5 year waits for cholecystectomies. Opportunity to medically optimise patients prior to surgery are lost using a traditional approach. We aimed to develop a screening tool to identify frailty in patients awaiting surgery. Method The cholecystectomy list (750 patients) of which 258 were> 65years. Older people were sent a postal questionnaire gaining

Introduction Stress and communication difficulties, both prone in people with dementia, are risk factors for challenging behaviour. Challenging behaviour negatively impacts the quality of life of people with dementia and their caregivers. Technology can help caregivers detect stress in people with dementia. However, implementation of these technologies is not always successful. The aim of this study is to explore the implementation opportunities for a garment-integrated sensor system that enables caregivers to identify early signs of stress in people with dementia. Methods A qualitative design

Introduction In the presence of multiple co-morbidities and frailty, older people undergoing emergency laparotomy warrant higher supportive care. It is evident that geriatrician input to perioperative care plays a crucial role to improve patient experience and outcomes ( 1, 2). Whilst we recognised the need for a surgical liaison service and increased compliance with NELA we had limited resources to give. We created an automatic email alert to enable us to see NELA patients and make the maximum use of our clinical time. Method An automated email alert was created in July 2022 to identify

Can use of sensor technology prevent hospitalisations in frail older people at high risk of hospital admissions? Background There has been significant developments, investment and ambition to use modern technology in admission avoidance in hospitals. Sensor technology has been one area of development. We used My Sense to improve outcomes for a cohort of High Intensity Users (HIU) frail older patients, and compared hospitalisation rates before and after employing Sensor technology. HIU patient consent criteria is 3 Admissions with 40 days Length of Stay. Introduction MySENSE 8 Sensors placed

Background: This Quality Improvement project was undertaken at University Hospitals of Derby and Burton. The team comprised a speciality doctor and improvement fellow previously employed as an operating department practitioner (ODP). Senior sponsors comprised a consultant geriatrician and Divisional Nurse Director. Introduction: Delirium impacts up to 40% of older hospital inpatients and is associated with mortality, institutionalisation and deconditioning. We aimed to increase diagnosis and management of delirium to reduce complications, length of stay and readmissions. Method: An initial

Introduction: The administration of melatonin and melatonin receptor agonists (MRA) may result in a small improvement in sleep quality among middle-aged and older adults living with neurocognitive disorders, but debate remains as to whether effects are clinically meaningful. The purpose of this PROSPERO-registered systematic review and meta-analysis (CRD42022373972) was to synthesise evidence from randomized controlled trials (RCTs) of melatonin or MRA against placebo and other interventions for the treatment of sleep disturbances in adults with neurocognitive disorders. Method: CENTRAL

Introduction Older people are the fastest growing group of hospitalised trauma patients, most commonly due to falls from standing height. The Scottish Trauma Audit Group (STAG) collect extensive national data, but this does not currently include frailty and longer-term dependency. Method We retrospectively reviewed consecutive cases in the STAG database for the Royal Infirmary of Edinburgh between September 2018 and February 2019. Casenote review was used to calculate baseline Charleston Comorbidity Index (CCI) and frailty status using the Clinical Frailty Scale (CFS). Outcomes of residence

Background: With advancing age comes the increasing prevalence of frailty and increased risk of adverse outcomes (e.g. hospitalisation). Internationally, models of Comprehensive Geriatric Assessment (CGA) delivery in primary care/community settings vary, and effectiveness is uncertain. CGA is a complex intervention and improving the effectiveness and efficiency of it first requires exploration of how individual components may work and how the intervention can be strengthened. Aims: To explore how to enhance current CGA, the conditions needed to implement enhanced CGA and the outcomes that

Improving the quality of teaching for junior Doctors within the Ageing and Complex Medicine Department; introducing a novel teaching and training programme. Introduction Feedback from the National Training Survey (NTS) in 2018 showed suboptimal satisfaction levels within our department, particularly for local teaching and clinical supervision. A novel dedicated teaching and training programme was designed and implemented. National and local feedback from trainees highlights significant improvement in satisfaction levels across all domains. Method The new programme includes scheduled weekly

Introduction Our perioperative service for older people undergoing surgery (POPS) commenced preoperative assessment of co-morbid and frail patients undergoing elective orthopaedic surgery in 2021. As part of the comprehensive geriatric assessment (CGA) and shared-decision-making process (SDM), we wanted to analyse the decisions our patients made around surgery and how many regretted having surgery. Methods Review of all orthopaedic patients seen by POPS between September 2021-December 2022 Intervention CGA and SDM on all patients Data collected: comorbidities, Clinical Frailty Scale (CFS), SDM

Introduction Sarcopenia is common in patients with hip fracture, but few studies have examined whether assessment of sarcopenia improves prediction of adverse post-operative outcomes. We examined whether sarcopenia, diagnosed using handgrip strength (HGS), could predict outcomes after hip fracture. Methods Routinely collected data from the National Hip Fracture Database were combined with locally collected HGS data from a high-volume orthopaedic trauma unit. Patients aged ≥65years with surgically managed, non-pathological hip fracture with grip strength measured on admission were included. The

Introduction Teaching and Research in Care Homes (ToRCH) is a living labs partnership between University of Nottingham and three nursing homes in Derbyshire and Nottinghamshire. We aim to engage care home teams in research, including knowledge exchange and co-designing research proposals. Methods We conducted 7 workshops / focus groups with 10 staff members. These were supplemented by site visits, where the researcher observed staff meetings and met with residents and relatives (for patient and public involvement). We elicited discussion by appreciative inquiry method and recorded findings

Introduction Sustaining independence is important for older people, but there is insufficient guidance about which community services to implement. Methods Systematic review and network meta-analysis (NMA; PROSPERO CRD42019162195) to synthesise effectiveness evidence from randomised or cluster-randomised controlled trials of community-based complex interventions to sustain independence for older people (mean age 65+) living at home, grouped according to their intervention components. Main outcomes: Living at home, activities of daily living (ADL), care-home placement, and service/economic