Introduction Alcohol excess is a risk factor for falls in all ages. However, it is important to establish the relationship in older patients, who are at a greater risk of falling, to allow for appropriate risk management. Methods The Older Persons Assessment Service (OPAS) is an Emergency Department service which, accepting patients on the basis of the presence of frailty syndromes in patients aged >70 years (falls, confusion, care dependence, polypharmacy and poor mobility).The OPAS databank was retrospectively analysed for people with alcohol excess admitted with a fall between June 2020
Introduction - The POPS service (SOPAS) in Morriston Hospital receives over 300 referrals a year. However, many of these referrals did not meet service criteria. Inefficient direction of referrals has a negative impact on service efficiency and can result in poor patient experience and outcomes. This is a quality improvement initiative to increase the quality and suitability of referrals made to the service. Aim - To implement a referral system able to offer safe, rapid assessment for surgical patients who would benefit from geriatrician-led intervention. Method - We developed a list of
Introduction The NHS backlog in Elective Surgery are a subject of societal concern and political pressure. Over 6,400 patients >65 yrs are currently awaiting surgery at Swansea Bay. What role, if any, can geriatricians play in improving patient and organisational outcomes? Intervention We wrote to all 258 patients on the Cholecystectomy waiting list > 65 yrs with a letter explaining the project and a patient experience questionnaire. An attempt to contact all patients by telephone was made with an intention to ask questions about their health, activities of daily living and frailty and
Introduction As part of a planned care initiative undertaken with the Bevan Commission to improve surgical waiting lists in Swansea Bay we contacted patients on the waiting list for a cholecystectomy, undertook frailty screening and invited those with frailty markers to undergo clinic based geriatric assessment . Clinical governance requires patient input into the setup of any service (1). A patient satisfaction survey following clinic, along with a patient focus group were conducted. Methods 27 patients completed an online survey regarding their experience at clinic. 8 patients attended the
Introduction Many elderly patients presenting to ED with falls and suspected head injury are anticoagulated. The current National Institute for Health and Care Excellence (NICE) guideline recommends patients on anticoagulation should have a CT head scan within 8 hours of head injury. An updated guideline was drafted for consultation in November 2022. The indication for CT head scan has not changed for patients on anticoagulation. There is currently a lack of evidence to inform best practice in the management of anticoagulated older patients who present with falls and head injury. The Older
BACKGROUND A multidisciplinary (MDT) approach is increasingly recommended as the standard of care for patients with Parkinson’s disease (PD). Research has shown that an MDT approach can lead to better quality of life and improve patient outcomes in a number of domains depending on set up. We established an MDT clinic with a PD specialist physiotherapist and pharmacist to assess how this would improve patient outcomes at a DGH hospital. METHOD An MDT clinic led by a consultant geriatrician with a PD specialist pharmacist and a physiotherapist that could assess patients attending the clinic was
Introduction The term ‘frailty’ is increasingly being used in clinical practice. NHS services established to assess frail older people are described using various names including ‘Frailty Unit’ (FU). Little is known about patient’s self-perception on being frail and their views on the use of these terms and nomenclatures. Following the development of a new FU in the Emergency Quadrant of our DGH, this study was undertaken to assess how elderly in-patients in the unit perceive ‘frailty’ as a concept. Their views on the nomenclature of the unit and the service were also evaluated. Methods A semi
Introduction Training in the subspecialty of Movement Disorders (MD) has been previously identified to be lacking in geriatric medicine, through a survey in Northern and Yorkshire regions (2006). In anticipation of the new geriatric medicine curriculum, the MD Special Interest Group Committee of the British Geriatric Society (BGS) sought to evaluate current experiences of training and perspectives of trainees for their subspecialty training. Method An online survey was designed by trainees with input from supervisory clinicians. Alongside demographic details, a combination of multiple choice
Introduction The UK Parkinson's audit assesses whether patients with Parkinson's Disease (PD) are managed according to standards. Referring patients to physiotherapy (PT) and advising those with daytime sleepiness not to drive are two of these. In our clinic, patients identified as drivers are advised to inform the DVLA and will undergo a MOCA, sleep questionnaire and driving assessment. Project Aim Are we making early physiotherapy referrals and documenting driving status in newly diagnosed outpatients? Methods Online notes of newly diagnosed patients over a 12 month period were reviewed. A
Introduction: Sialorrhoea is a common non motor complication experienced by people with Parkinson’s disease (PD). Despite its prevalence there is conflicting evidence on how to effectively treat it. Our aim was to establish the efficacy and safety outcomes of pharmacological interventions used to treat sialorrhoea in people with idiopathic PD. Methods: We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42016042470). We searched 7 electronic databases from inception until July 2022. Quantitative synthesis was performed where data allowed using random effects models
Introduction People with Parkinson’s disease (PwP) are more likely to be admitted to hospital and have longer lengths of stay than those without Parkinson’s disease (PD). Parkinson’s UK and NICE have proposed standards of care for inpatients with PD, including that PD specialists are alerted when PwP are admitted to hospital. 66% of UK hospitals don’t have an alert system in place, including King’s Mill Hospital (KMH). Audit Over a 6 month period, referrals to the PD service in KMH were audited. 128 referrals were made; 5 per week on average. Hospital-wide, around 12 PwP are admitted weekly
Introduction From our observations and personal experience Parkinson’s Disease (PD) patients have complex medical needs and are often mismanaged during acute admissions. Medications are wrongly prescribed, particularly out of hours, leading to increased mortality and morbidity. 1 The aim of this project was to assess junior doctors’ understanding of managing the acutely unwell PD patient, with a particular focus on common prescribing errors. We addressed gaps in knowledge by providing teaching sessions and reassessing learning. Methods We designed a 9-point questionnaire which assessed
Introduction: Across the UK, emergency and assessment units are faced with the challenge of streamlining urgent care services which best meets the requirement of older frail patients. Method: Patient pathways were mapped using real-time and retrospective data collected from the notes of 30 frail patients over 75 admitted to ED under medicine. Frail patients were identified by the Frailty Intervention Team, and patient demographics were noted. Key touchpoints and the date/times of initial treatment and investigations were documented. Experience questionnaires produced by the Acute Frailty
Introduction Timely administration of medication for people living with Parkinson’s Disease (PwP) is critical. Missed or delayed Parkinson’s Disease (PD) medication can lead to motor complications, swallow impairment, and in some cases a neuroleptic malignant type syndrome. This can lead to morbidity and mortality and longer hospital stays. Our local policy on the nil by mouth (NBM) guidance for PwP is available on the intranet. We wanted to audit knowledge of, and adherence to this policy. Method An audit tool was used to collect responses from nursing and medical staff in the Clyde sector
Delirium is a condition characterised by an acute, fluctuating change in mental status, with features such as inattention and disorganised thinking. It is potentially life-threatening with a high morbidity and mortality. While it can affect up to 30% of all older medical patients, it is often under-recognised due to the fluctuating nature of symptoms. The 4AT assessment tool allows for early and rapid recognition of Delirium. AIM To improve the detection of patients with delirium using the 4AT assessment tool. METHODOLOGY Patients admitted to hospital with delirium or acute confusion were
Postural hypotension is defined as an abnormal fall in blood pressure upon standing and is an important cause of falls associated with significant morbidity and mortality. Screening for postural hypotension forms an integral aspect in the overall assessment of patients presenting with a fall and furthermore is non-invasive, inexpensive and reproducible. Aims To determine if a lying and standing blood pressure (LSBP) was requested and performed on patients aged >55 years presenting with a fall within three days of admission, and furthermore, to establish if staff could correctly perform and
Postural hypotension is defined as an abnormal fall in blood pressure upon standing and is an important cause of falls associated with significant morbidity and mortality. Screening for postural hypotension forms an integral aspect in the overall assessment of patients presenting with a fall and furthermore is non-invasive, inexpensive and reproducible. Aims To determine if a lying and standing blood pressure (LSBP) was requested and performed on patients aged >55 years presenting with a fall within three days of admission, and furthermore, to establish if staff could correctly perform and
The World’s population is ageing. It has been widely accepted in many countries to withhold medical therapy at the end-of-life based on medical grounds. Due to the lack of a policy, Do Not Resuscitate(DNR) orders are not currently implemented in our institute regardless of prognosis. In this study, we present the outcomes of the very old patients(80 years and above) who were admitted and underwent in-hospital CPR at our institute. This will allow for the discussion in the need to produce and apply a nationwide DNR policy in Bahrain Methods This retrospective study considered all patients
NICE TIA guidelines (2019) advise against performing CT unless there is suspicion of a relevant alternative diagnosis, instead recommending TIA clinic assessment to consider MRI (which should be on the same day as the assessment). This may be challenging in some trusts due to limited access to MRI. In a university teaching hospital, dedicated MRI slots for TIA clinic use were introduced to improve access to same-day scanning. This audit aimed to assess the timing of neuroimaging in TIA clinic, before and after the introduction of the dedicated MRI slots. Methods: We conducted a retrospective
Background: Sarcopenia is defined as the age-related progressive loss of skeletal muscle mass, strength, and function. Although many different interventions have been suggested for the management of sarcopenia, the effectiveness of such treatments is still uncertain. The objective of this review is to systematically assess the different intervention strategies currently reported and to evaluate their effects on muscle mass, muscle strength, and physical function outcomes in sarcopenic participants. Methods: Web of Science, ClinicalTrials.gov, and Scopus were systematically searched for