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Editor’s view
Terry Quinn
doi : 10.1093/ageing/afac082
Age and Ageing, Volume 51, Issue 3, March 2022, afac082
Geriatric medicine and health care for older people in Australia
David G Le Couteur, Leon Flicker, Sarah N Hilmer
doi : 10.1093/ageing/afac001
Age and Ageing, Volume 51, Issue 3, March 2022, afac001
Aged care coverage in Australia is universal but fragmented and has been challenged by government policy to deregulate aged care and open it up to market forces. A recent inquiry into aged care (Royal Commission into Aged Care Quality and Safety) documented the outcome of this policy—substandard care at most levels. The provision of services to older Aboriginal and Torres Strait Islander peoples, who have high prevalence of frailty and cognitive impairment, was also identified as inadequate. The effects of yet to be implemented changes in policy and funding in response to this report remain to be seen. Despite this policy backdrop, geriatricians have contributed to a steady growth in medical services and interventions focussed on specific geriatric issues such as dementia, falls, polypharmacy and orthogeriatrics. These are often driven by, or in collaboration with researchers, and aim to generate research data as well as provide patient care. The numbers of academic geriatricians and other aged care health professionals is increasing, and the training of specialist geriatricians now includes a significant research component.
Geriatric emergency medicine—a model for frailty friendly healthcare
Simon P Mooijaart, Christopher R Carpenter, Simon P Conroy
doi : 10.1093/ageing/afab280
Age and Ageing, Volume 51, Issue 3, March 2022, afab280
As the world’s population continues to age over the decades ahead, medical educators and researchers in every adult medical and surgical specialty will need to ‘geriatricise’ their clinical science. Many have already engaged with geriatrics. Here we describe the progress that has been made and the opportunities ahead in the field of Geriatric Emergency Medicine (GEM), a field that has taken large steps in integrating holistic care. Future opportunities exist in the three domains of evidence-based medicine: including patient preferences and needs, generating scientific evidence, and improving physician knowledge and expertise. Implementation requires new innovations also in the organisation of care. Similar strategies may be useful in other fields of medicine, in making holistic care the standard for older people.
What’s good for the heart is good for the mind. . .
Terence J Quinn
doi : 10.1093/ageing/afac021
Age and Ageing, Volume 51, Issue 3, March 2022, afac021
‘Don’t let the trial kill the intervention’: how can researchers and care home teams implement complex intervention trials in care homes?
Susan D Shenkin, Adam L Gordon, Lucy Johnston, Cheryl Henderson, Wilco P Achterberg
doi : 10.1093/ageing/afac068
Age and Ageing, Volume 51, Issue 3, March 2022, afac068
Using linked health and social care data to understand service delivery and planning and improve outcomes
Ann-Marie Towers
doi : 10.1093/ageing/afac070
Age and Ageing, Volume 51, Issue 3, March 2022, afac070
The COVID-19 pandemic has highlighted the need to invest in care home research infrastructure
Adam L Gordon, Caroline Rick, Ed Juszczak, Alan Montgomery, Rob Howard, Bruce Guthrie, Wei Shen Lim, Susan Shenkin, Paul Leighton, Philip M Bath, the PROTECT-CH Triallists
doi : 10.1093/ageing/afac052
Age and Ageing, Volume 51, Issue 3, March 2022, afac052
The COVID-19 pandemic resulted in catastrophic levels of morbidity and mortality for care home residents. Despite this, research platforms for COVID-19 in care homes arrived late in the pandemic compared with other care settings. The Prophylactic Therapy in Care Homes Trial (PROTECT-CH) was established to provide a platform to deliver multi-centre cluster-randomized clinical trials of investigational medicinal products for COVID-19 prophylaxis in UK care homes. Commencing set-up in January 2021, this involved the design and development of novel infrastructure for contracting and recruitment, remote consent, staff training, research insurance, eligibility screening, prescribing, dispensing and adverse event reporting; such infrastructure being previously absent. By the time this infrastructure was in place, the widespread uptake of vaccination in care homes had changed the epidemiology of COVID-19 rendering the trial unfeasible. While some of the resources developed through PROTECT-CH will enable the future establishment of care home platform research, the near absence of care home trial infrastructure and nationally linked databases involving the care home sector will continue to significantly hamper progress. These issues are replicated in most other countries. Beyond COVID-19, there are many other research questions that require addressing to provide better care to people living in care homes. PROTECT-CH has exposed a clear need for research funders to invest in, and legislate for, an effective care home research infrastructure as part of national pandemic preparedness planning. Doing so would also invigorate care home research in the interim, leading to improved healthcare delivery specific to those living in this sector.
Fragility fractures of the pelvis in the older population
Dhanupriya Sivapathasuntharam, Gillian Smith, Mohammed-Ashraf Master, Peter Bates
doi : 10.1093/ageing/afac063
Age and Ageing, Volume 51, Issue 3, March 2022, afac063
Pelvic fractures are an increasingly common injury seen in the older population and represent a significant burden of morbidity and mortality in this age group, as well as a large financial burden on the health service. It is well established that early fixation of femoral neck and acetabular fractures improves outcomes and increases the chances of patients returning close to their premorbid functional baseline. However, fixation of fragility fractures of the pelvis is less well established in current practice. There has been recent development of novel stabilisation techniques for unstable pelvic fractures, designed to tackle the difficulties associated with fixation in poor bone quality, along with medical trials of parathyroid hormone analogue treatment. However, it is still current practice to manage nearly all fragility fractures of the pelvis conservatively. In this article, we consider whether the development of surgical stabilisation techniques for pelvic fragility fractures may have the potential to improve the well-described morbidity and mortality associated with them.
Palliative care for older people with dementia—we need a paradigm shift in our approach
Suzanne Timmons, Siobhan Fox, Jonathan Drennan, Suzanne Guerin, W George Kernohan
doi : 10.1093/ageing/afac066
Age and Ageing, Volume 51, Issue 3, March 2022, afac066
Older people with dementia have multiple palliative care needs, with pain, agitation, dyspnoea, aspiration and pressure ulcers being common and persistent in advanced dementia. Anticipating the person’s possible symptoms requires knowledge of the whole person, including the type of dementia, which is problematic when the dementia type is often not documented.A palliative care approach to dementia should look at symptoms across the four pillars of palliative care, but in reality, we tend to over-focus on physical and psychological symptoms, while spiritual and emotional needs can be overlooked, especially around the time of diagnosis, where such needs may be significant.Advance care planning (ACP) is a central tenet of good dementia palliative care, as the person may lose their ability to communicate and make complex decisions over time. Despite this, care planning is often approached too late, and with the person’s family rather than with the person; much of the literature on ACP in dementia is based on proxy decision-making for people in residential care.Thus, we need a paradigm shift in how we approach dementia, beginning with timely diagnosis that includes the dementia type, and with services able to assess and meet emotional and spiritual needs especially around the time of diagnosis, and with timely ACP as an integral part of our overall approach.
The value of qualitative data in Quality Improvement Projects in the care of older adults: the case of frailty scores in the emergency department
Paul Pascall Jones, Louise Tomkow
doi : 10.1093/ageing/afac057
Age and Ageing, Volume 51, Issue 3, March 2022, afac057
This commentary discusses the role and value of qualitative data when undertaking quality improvement (QI) focussing on the care of older adults. To illustrate this, we reflect on our own experiences of planning a QI project to improve the documentation of Clinical Frailty Scale (CFS) scores in the emergency department (ED) during the coronavirus disease of 2019 (COVID-19) pandemic. National clinical guidance for COVID-19 states that all adults over the age of 65 should be given a CFS at the first point of contact during hospital admission. Therefore, there is a need to improve CFS documentation, specifically in acute care settings.We describe how qualitative methods facilitated an understanding of the barriers to CFS documentation in ED. Staff see the CFS as a useful tool for inter-professional communication, though there are tensions between clinical guidance and their beliefs. Staff had moral concerns about how an ED-allocated CFS might limit available treatment options for older adults. Our findings demonstrate how qualitative methods can illuminate the important social and moral dimensions of why improvement does or does not occur.
Detecting depression in persons living in long-term care: a systematic review and meta-analysis of diagnostic test accuracy studies
Bria Mele, Jennifer Watt, Pauline Wu, Feeha Azeem, Grace Lew, Jayna Holroyd–Leduc, Zahra Goodarzi
doi : 10.1093/ageing/afac039
Age and Ageing, Volume 51, Issue 3, March 2022, afac039
Depressive disorders are common in long-term care (LTC), however, there is no one process used to detect depressive disorders in this setting. Our goal was to describe the diagnostic accuracy of depression detection tools used in LTC settings.
Bi-directional associations of epilepsy with dementia and Alzheimer’s disease: a systematic review and meta-analysis of longitudinal studies
Changchang Dun, Yaqi Zhang, Jiawei Yin, Binbin Su, Xiaobo Peng, Liegang Liu
doi : 10.1093/ageing/afac010
Age and Ageing, Volume 51, Issue 3, March 2022, afac010
To assess the bi-directional associations of epilepsy with dementia and Alzheimer's disease (AD).
Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis
Jennifer K Burton, Jennifer Stewart, Mairi Blair, Sinead Oxley, Amy Wass, Martin Taylor-Rowan, Terence J Quinn
doi : 10.1093/ageing/afac064
Age and Ageing, Volume 51, Issue 3, March 2022, afac064
frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes.
Assessment of coding-based frailty algorithms for long-term outcome prediction among older people in community settings: a cohort study from the Shizuoka Kokuho Database
Shiori Nishimura, Hiraku Kumamaru, Satoshi Shoji, Eiji Nakatani, Hiroyuki Yamamoto, Nao Ichihara, Yoshiki Miyachi, Alexander T Sandhu, Paul A Heidenreich, Keita Yamauchi, Michiko Watanabe, Hiroaki Miyata, Shun Kohsaka
doi : 10.1093/ageing/afac009
Age and Ageing, Volume 51, Issue 3, March 2022, afac009
To assess the applicability of Electronic Frailty Index (eFI) and Hospital Frailty Risk Score (HFRS) algorithms to Japanese administrative claims data and to evaluate their association with long-term outcomes.
Functional health index of intrinsic capacity: multi-domain operationalisation and validation in the Singapore Longitudinal Ageing Study (SLAS2)
Chin Yee Cheong, Philip Yap, Ma Shwe Zin Nyunt, Gao Qi, Xinyi Gwee, Shiou Liang Wee, Keng Bee Yap, Tze Pin Ng
doi : 10.1093/ageing/afac011
Age and Ageing, Volume 51, Issue 3, March 2022, afac011
ad hoc approaches are used to create composite indexes of intrinsic capacity (IC) based on five domains recommended by the World Health Organization for healthy ageing. We examined how combinations of domain-specific measures determine measurement performances of composite IC indexes.
Analysis of blood pressure and blood pressure variability pattern among older patients in long-term care hospitals: an observational study analysing the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) dataset
Jung-Yeon Choi, Seungyeon Chun, Hongsoo Kim, Young-il Jung, Sooyoung Yoo, Kwang-il Kim
doi : 10.1093/ageing/afac018
Age and Ageing, Volume 51, Issue 3, March 2022, afac018
There are limited data regarding blood pressure (BP) variability among older adults living in long-term care hospitals (LTCHs). We aimed to collect data from LTCH and analyse BP characteristics and its variability among these patients using a novel platform.
The lack of opportunity to eat together is associated with an increased risk of weight loss among independent older adults: a prospective cohort study based on the JAGES
Taro Kusama, Sakura Kiuchi, Yukako Tani, Jun Aida, Katsunori Kondo, Ken Osaka
doi : 10.1093/ageing/afac022
Age and Ageing, Volume 51, Issue 3, March 2022, afac022
the present study aimed to investigate the relationship between the frequency of eating together and the risk of weight loss in older adults.
Effectiveness of a multicomponent exercise program to reverse pre-frailty in community-dwelling Chinese older adults: a randomised controlled trial
Yaoshan Dun, Peng Hu, Jeffrey W Ripley-Gonzalez, Nanjiang Zhou, Hui Li, Wenliang Zhang, Meijuan Chen, Qingsong Zheng, Ni Cui, Shaoping Wu, Suixin Liu
doi : 10.1093/ageing/afac026
Age and Ageing, Volume 51, Issue 3, March 2022, afac026
the Xiangya Hospital circuit training (X-CircuiT), was developed to reverse pre-frailty in Chinese older adults and determine potential mechanisms through which pre-frailty is reversed.
A vulnerable residential environment is associated with higher risk of mortality and early transition to permanent residential aged care for community dwelling older South Australians
Danielle Taylor, Azmeraw T Amare, Suzanne Edwards, Maria Inacio, Renuka Visvanathan
doi : 10.1093/ageing/afac029
Age and Ageing, Volume 51, Issue 3, March 2022, afac029
This study examined the impact of the residential environment, measured by the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, on risk of mortality or entry into Permanent Residential Aged Care (PRAC).
Factors associated with accessing long-term adult social care in people aged 75 and over: a retrospective cohort study
Mable Nakubulwa, Cornelia Junghans, Vesselin Novov, Clare Lyons-Amos, Derryn Lovett, Azeem Majeed, Paul Aylin, Thomas Woodcock
doi : 10.1093/ageing/afac038
Age and Ageing, Volume 51, Issue 3, March 2022, afac038
An ageing population and limited resources have put strain on state provision of adult social care (ASC) in England. With social care needs predicted to double over the next 20Â years, there is a need for new approaches to inform service planning and development, including through predictive models of demand.
Family carer perspectives on the language of behaviour change in dementia: an online mixed methods survey
Emma Wolverson, Esme Moniz-Cook, Rosie Dunn, Rebecca Dunning
doi : 10.1093/ageing/afac047
Age and Ageing, Volume 51, Issue 3, March 2022, afac047
following the #BanBPSD campaign there has been critical interest in common terminology used for ‘changes in behaviour’ associated with dementia. However, commentaries and emerging studies have not fully considered family carer perspectives. This study explores the views of family carers on terminology and language for this paradigm.
Characteristics and outcomes of older patients hospitalised for COVID-19 in the first and second wave of the pandemic in The Netherlands: the COVID-OLD study
Rosalinde A L Smits, Stella Trompet, Carolien M J van der Linden, Jessica M van der Bol, Steffy W M Jansen, Harmke A Polinder-Bos, Hanna C Willems, Dennis G Barten, Laura C Blomaard, Mark G J de Boer, Floor J A van Deudekom, Jacobien L J Ellerbroek, Jan Festen, Esther M M van de Glind, Linda M Kampschreur, Ouafae Karimi, Bart Kroon, Marc G J A van Lanen, Jacinta A Lucke, Huub A A M Maas, Francesco U S Mattace-Raso, Barbara C van Munster, Lisette Reijerse, Sarah H M Robben, Rikje Ruiter, Henrike J Schouten, Petra E Spies, Anna Wassenburg, Marjolein A Wijngaarden, Simon P Mooijaart
doi : 10.1093/ageing/afac048
Age and Ageing, Volume 51, Issue 3, March 2022, afac048
as the coronavirus disease of 2019 (COVID-19) pandemic progressed diagnostics and treatment changed.
Perceptions, knowledge and attitudes about COVID-19 vaccine hesitancy in older Portuguese adults
Tânia Magalhães Silva, Marta Estrela, VÃtor Roque, Eva Rebelo Gomes, Adolfo Figueiras, Fátima Roque, Maria Teresa Herdeiro
doi : 10.1093/ageing/afac013
Age and Ageing, Volume 51, Issue 3, March 2022, afac013
Coronavirus 2019 (COVID-19) has become a public-health emergency of international concern. Most efforts to contain the spread and transmission of the virus rely on campaigns and interventions targeted to reduce Vaccine Hesitancy and Refusal (VHR).
A clinical tool to identify older women with back pain at high risk of osteoporotic vertebral fractures (Vfrac): a population-based cohort study with exploratory economic evaluation
Tarnjit K Khera, Linda P Hunt, Sarah Davis, Rachael Gooberman-Hill, Howard Thom, Yixin Xu, Zoe Paskins, Tim J Peters, Jon H Tobias, Emma M Clark
doi : 10.1093/ageing/afac031
Age and Ageing, Volume 51, Issue 3, March 2022, afac031
osteoporotic vertebral fractures (OVFs) identify people at high risk of future fractures, but despite this, less than a third come to clinical attention. The objective of this study was to develop a clinical tool to aid health care professionals decide which older women with back pain should have a spinal radiograph.
Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions
Atul Anand, Michael Cheng, Temi Ibitoye, Alasdair M J Maclullich, Emma R L C Vardy
doi : 10.1093/ageing/afac051
Age and Ageing, Volume 51, Issue 3, March 2022, afac051
Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 ‘A’s Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission).
Longitudinal associations between falls and future risk of cognitive decline, the Motoric Cognitive Risk syndrome and dementia: the Einstein Ageing Study
Oshadi Jayakody, Helena M Blumen, Monique Breslin, Emmeline Ayers, Richard B Lipton, Joe Verghese, Michele L Callisaya
doi : 10.1093/ageing/afac058
Age and Ageing, Volume 51, Issue 3, March 2022, afac058
falls share risk factors with cognitive decline but whether falls predict cognitive decline, pre-dementia syndromes and dementia is poorly understood.
Non-inferiority of a home-based videoconference physical training program in comparison with the same program administered face-to-face in healthy older adults: the MOTION randomised controlled trial
Antoine Langeard, Lucile Bigot, Nicola A Maffiuletti, Sébastien Moussay, Bruno Sesboüé, Gaélle Quarck, Antoine Gauthier
doi : 10.1093/ageing/afac059
Age and Ageing, Volume 51, Issue 3, March 2022, afac059
older adults often fail to reach the recommended amount of physical activity to prevent the age-related decline in metabolic, cardiorespiratory and muscular function. Effective home-based physical training programs could neutralise barriers preventing older adults from being active, and administration/supervision through videoconference may be an optimal solution. The present randomised controlled trial aimed to test the non-inferiority of training program administered through videoconference against the same program administered face-to-face in healthy older adults.
Circadian rhythm of postural control, sleepiness and verticality perception in older adults
Antoine Langeard, Amira Zouabi, Tristan Martin, GaËlle Quarck, Antoine Gauthier
doi : 10.1093/ageing/afac061
Age and Ageing, Volume 51, Issue 3, March 2022, afac061
with ageing, the risk of falling increases. It has been reported that fall frequency may depend on the time of the day, suggesting a possible circadian rhythm of postural control. The objective was to test whether postural control in older adults followed a circadian rhythm. Then, in order to examine the possible functions involved in circadian variations in balance performances, circadian rhythm of sleepiness and vertical perception were also tested.
BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
Allan Garland, Heather Keller, Patrick Quail, Veronique Boscart, Michelle Heyer, Clare Ramsey, Vanessa Vucea, Nora Choi, Ikdip Bains, Seema King, Tatiana Oshchepkova, Tatiana Kalashnikova, Brittany Kroetsch, Jessica Steer, George Heckman
doi : 10.1093/ageing/afac049
Age and Ageing, Volume 51, Issue 3, March 2022, afac049
Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal.
Potential determinants of unfavourable healthcare utilisation trajectories during the last year of life of people with incident Alzheimer Disease or Related Syndromes: a nationwide cohort study using administrative data
Antoine Elyn, Virginie Gardette, Axel Renoux, Sandrine Sourdet, Fati Nourhashemi, Brigitte Sanou, Michel Dutech, Philippe Muller, Adeline Gallini
doi : 10.1093/ageing/afac053
Age and Ageing, Volume 51, Issue 3, March 2022, afac053
people approaching the end-of-life frequently face inappropriate care. With Alzheimer Disease or Related Syndromes (ADRS), end-of-life is characterised by progressive decline, but this period remains difficult to identify. This leads to a lack of anticipation and sometimes with unfavourable healthcare utilisation trajectories (HUTs).
A multi-centre cohort study on healthcare use due to medication-related harm: the role of frailty and polypharmacy
Jennifer M Stevenson, Nikesh Parekh, Kia-Chong Chua, J Graham Davies, Rebekah Schiff, Chakravarthi Rajkumar, Khalid Ali
doi : 10.1093/ageing/afac054
Age and Ageing, Volume 51, Issue 3, March 2022, afac054
To determine the association between frailty and medication-related harm requiring healthcare utilisation.
Retinal age gap as a predictive biomarker of future risk of Parkinson’s disease
Wenyi Hu, Wei Wang, Yueye Wang, Yifan Chen, Xianwen Shang, Huan Liao, Yu Huang, Gabriella Bulloch, Shiran Zhang, Katerina Kiburg, Xueli Zhang, Shulin Tang, Honghua Yu, Xiaohong Yang, Mingguang He, Zhuoting Zhu
doi : 10.1093/ageing/afac062
Age and Ageing, Volume 51, Issue 3, March 2022, afac062
retinal age derived from fundus images using deep learning has been verified as a novel biomarker of ageing. We aim to investigate the association between retinal age gap (retinal age–chronological age) and incident Parkinson’s disease (PD).
Advance care plans in UK care home residents: a service evaluation using a stepped wedge design
Gill Garden, Adeela Usman, Donna Readman, Lesley Storey, Lindsey Wilkinson, Graham Wilson, Tom Dening, Adam L Gordon, John R F Gladman
doi : 10.1093/ageing/afac069
Age and Ageing, Volume 51, Issue 3, March 2022, afac069
advance care planning (ACP) in care homes has high acceptance, increases the proportion of residents dying in place and reduces hospital admissions in research. We investigated whether ACP had similar outcomes when introduced during real-world service implementation.
Long-term physical activity participation trajectories were associated with subsequent cognitive decline, risk of dementia and all-cause mortality among adults aged ≥50 years: a population-based cohort study
Chenglong Li, Yanjun Ma, Rong Hua, Fanfan Zheng, Wuxiang Xie
doi : 10.1093/ageing/afac071
Age and Ageing, Volume 51, Issue 3, March 2022, afac071
to evaluate self-reported physical activity (PA) participation trajectories over a 6-year span and to assess associations with subsequent cognitive decline, incident dementia and all-cause mortality.
Non-inferiority of intranasal ketamine compared to intravenous morphine for musculoskeletal pain relief among older adults in an emergency department: a randomised controlled trial
Suchada Tongbua, Jiraporn Sri-on, Kwannapa Thong-on, Thitiwan Paksophis
doi : 10.1093/ageing/afac073
Age and Ageing, Volume 51, Issue 3, March 2022, afac073
ketamine has potential advantages over morphine for musculoskeletal pain relief. The aim of this study was to compare the analgesic efficacy and safety of intranasal (IN) ketamine to intravenous (IV) morphine for older adults with musculoskeletal pain in the emergency department (ED).
Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis
Guy Peryer, Sarah Kelly, Jessica Blake, Jennifer K Burton, Lisa Irvine, Andy Cowan, Gizdem Akdur, Anne Killett, Sarah L Brand, Massirfufulay Kpehe Musa, Julienne Meyer, Adam L Gordon, Claire Goodman
doi : 10.1093/ageing/afac014
Age and Ageing, Volume 51, Issue 3, March 2022, afac014
Care homes are complex settings to undertake intervention research. Barriers to research implementation processes can threaten studies’ validity, reducing the value to residents, staff, researchers and funders. We aimed to (i) identify and categorise contextual factors that may mediate outcomes of complex intervention studies in care homes and (ii) provide recommendations to minimise the risk of expensive research implementation failures.
‘You need to be healthy to be sick’: exploring older people’s experiences with medication packaging at home
Giana Carli Lorenzini, Alison Bell, Annika Olsson
doi : 10.1093/ageing/afac050
Age and Ageing, Volume 51, Issue 3, March 2022, afac050
the ageing global population is living longer with complex health conditions addressed by multiple medications. Little is known about how older people manage these medications and associated packaging at home.
‘Unprepared for the depth of my feelings’ - Capturing grief in older people through research poetry
Katrin Gerber, Bianca Brijnath, Kayla Lock, Christina Bryant, Danny Hills, Larissa Hjorth
doi : 10.1093/ageing/afac030
Age and Ageing, Volume 51, Issue 3, March 2022, afac030
Older people are more likely to experience bereavements than any other age group. However, in healthcare and society, their grief experiences and support needs receive limited attention. Through innovative, arts-based research poetry, this study aimed to capture older people’s bereavement stories and the effects of grief on their physical and mental health.
Stakeholders’ views on the use of psychotropic medication in older people: a systematic review
Eliza Bednarczyk, Sarah Cook, Ruth Brauer, Sara Garfield
doi : 10.1093/ageing/afac060
Age and Ageing, Volume 51, Issue 3, March 2022, afac060
psychotropic medication use has been shown to increase with age and has been associated with increased risk of falls, strokes and mortality. Various guidelines, regulations and tools have been developed to reduce inappropriate prescribing, but this remains high. In order to understand the reasons for this, we aimed to systematically review healthcare professionals’, patients’ and family caregivers’ attitudes towards the use of psychotropic medication in older people.
Towards an approach of disability along a continuum from robustness, pre-frailty, frailty to disability
Alfonso Zamudio-RodrÃguez, José Alberto Avila-Funes, Maturin Tabue-Teguo, Jean-François Dartigues, Hélène Amieva, Karine Pérès
doi : 10.1093/ageing/afac025
Age and Ageing, Volume 51, Issue 3, March 2022, afac025
frailty and disability are very prevalent in older age and although both are distinct clinical entities, they are commonly used indistinctly in order to identify vulnerable older adults.
Learning about sites of care for older adults: a jigsaw educational session for medical students
Ashley Goreshnik, Matthew T Corey, Jennifer Rhodes Kropf, Andrea Wershof Schwartz
doi : 10.1093/ageing/afac032
Age and Ageing, Volume 51, Issue 3, March 2022, afac032
Choosing the appropriate site of care for patients is a vital clinical skill when caring for older adults. For better patient safety and smoother transitions of care, we need improved curricula to train clinicians about the system of sites and services where older adults receive care. Here we present an innovative introduction for medical trainees to the complexities of long-term and post-acute care for geriatric patients. Students participated in a team-based ‘jigsaw’ learning activity, in which each team researched a particular site of care and then taught a larger group of their peers about that site. It was subsequently converted to a virtual format due to COVID-19. The activity was assessed using students’ written feedback and satisfaction scores. Students enjoyed the interactivity and hands-on approach, giving the activity an average score of 3.9 out of 5 (1 = ‘poor’; 5 = ‘excellent’). The jigsaw provided an engaging, case-based foundation for learning about sites of care and was well-received by students.
Describing transitions in residential status over 10Â years in the very old: results from the Newcastle 85+ Study
Laurie E Davies, Katie Brittain, Heather Wilkinson, Sue Lewis, Louise Robinson, Andrew Kingston Author Notes
doi : 10.1093/ageing/afac056
Age and Ageing, Volume 51, Issue 3, March 2022, afac056
the very old (aged ≥ 85) are the fastest growing subpopulation of many developed countries but little is known about how their place of residence changes over time. We investigated transitions in residential status in an inception cohort of 85-year-olds over 10 years.
Characterising older adults’ risk of harm from blood-pressure lowering medications: a sub-analysis from the PRIME study
Ahmed Hussain, Khalid Ali, Nikesh Parekh, Jennifer M Stevenson, J Graham Davies, Stephen Bremner, Chakravarthi Rajkumar, PRIME study group
doi : 10.1093/ageing/afac045
Age and Ageing, Volume 51, Issue 3, March 2022, afac045
Cardiovascular disease (CVD) is common amongst frail older people. The evidence base for CVD commonly excludes older adults with multimorbidity or chronic conditions. Most cardiovascular drugs have the potential to lower blood pressure (BP) and therefore cause medication-related harm (MRH). We aimed to identify key clinical and sociodemographic characteristics associated with MRH in older people taking BP-lowering drugs for whatever indication they were prescribed.
Fat embolism syndrome in a patient with a right undisplaced femoral neck fracture
Junta Ishikawa, Nobuhiro Sato, Naho Ishigame, Ayaka Ono, Ikumi Yamagishi, Atsushi Sakagami, Yoshinori Sakai, Yasuo Hirose, Masahiro Yabe
doi : 10.1093/ageing/afac046
Age and Ageing, Volume 51, Issue 3, March 2022, afac046
Fat embolism syndrome (FES) is a rare condition characterised by the classic triad of respiratory distress, neurologic symptoms and petechial rash. Here, we encountered a case of FES in a patient with an asymptomatic right undisplaced femoral neck fracture (Garden Stage II). FES was diagnosed based on the Gurd and Willson’s diagnostic criteria and brain magnetic resonance imaging features. To the best of our knowledge, this is the first case of FES in a patient with an undisplaced femoral neck fracture. This study highlights the importance of considering the possibility of FES even in patients with undisplaced femoral neck fractures.
Insulinoma: an uncommon cause of delirium
Katie McComb, Gary Roulston, Lynne Armstrong Author Notes
doi : 10.1093/ageing/afac055
Age and Ageing, Volume 51, Issue 3, March 2022, afac055
We present the case of an 83-year-old woman with recurrent episodes of delirium occurring overnight, associated with hypoglycaemia. Other causes for delirium were excluded. Laboratory findings were in keeping with endogenous insulin production. Computerised tomography imaging revealed a small mass in the pancreas supporting a presumed diagnosis of an insulinoma. Given the patient’s frailty and cognitive impairment, a conservative management approach was taken. Diazoxide was commenced with resolution of episodes of delirium. This case highlights hypoglycaemia, and insulinoma, as a rare, but treatable cause of delirium. It demonstrates the importance of blood sugar screening in delirium. It emphasises the holistic modifications to management, which must be taken to ensure patient-centred care when caring for an older adult living with frailty, who may have cognitive impairment.
Corrigendum to: Perceptions and experiences of residents and relatives of emergencies in care homes: a systematic review and metasynthesis of qualitative research
Ffion Curtis, Withanage Iresha Udayangani Jayawickrama, Despina Laparidou, Dedunu Weligamage, Weerapperuma Kankanamge Wijaya Sarathchandra Kumarawansha, Marishona Ortega, Aloysius Niroshan Siriwardena
doi : 10.1093/ageing/afab238
Age and Ageing, Volume 51, Issue 3, March 2022, afab238
Corrigendum to: Care-home outbreaks of COVID-19 in Scotland March to May 2020: National linked data cohort analysis
Jennifer Kirsty Burton, Megan McMinn, James E Vaughan, Jacques Fleuriot, Bruce Guthrie Author Notes
doi : 10.1093/ageing/afac041
Age and Ageing, Volume 51, Issue 3, March 2022, afac041
Erratum to: 435 The Impact of Comprehensive Geriatric Assessment in the Outcomes of Older Acute Neurosurgical Patients
L Soutter, S Yordanov, C Uff, D Sivapathasuntharam
doi : 10.1093/ageing/afab255
Age and Ageing, Volume 51, Issue 3, March 2022, afab255
Erratum to: Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial
Lorène Zerah, Séverine Henrard, Stefanie Thevelin, Martin Feller, Carla Meyer-Masetti, Wilma Knol, Ingeborg Wilting, Denis O’Mahony, Erin Crowley, Olivia Dalleur, Anne Spinewine
doi : 10.1093/ageing/afac043
Age and Ageing, Volume 51, Issue 3, March 2022, afac043
659 PATIENT PERSPECTIVES OF RECOVERY AFTER HIP FRACTURE: A SYSTEMATIC REVIEW AND QUALITATIVE SYNTHESIS
N Beer, A Riffat, B Volkmer, D Wyatt, K Lambe
doi : 10.1093/ageing/afac035.659
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.659
Recovery is multidimensional highlighted by a wealth of qualitative evidence published on patient perspectives of recovery after hip fracture. The purpose of the current review is to synthesize this evidence of patients’ perspectives of recovery after hip fracture across the care continuum.
661 PROGNOSTIC FACTORS OF DEPRESSION AFTER HIP FRACTURE SURGERY: SYSTEMATIC REVIEW
R Milton-Cole, S Ayis, K Lambe, M D L O’Connell, C Sackley, K J Sheehan
doi : 10.1093/ageing/afac035.661
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.661
Patients with hip fracture and depression are less likely to recover. This review aimed to identify prognostic factors of depression up to one year after hip fracture surgery in adults. Secondary aims were to determine whether identified factors are modifiable or non-modifiable and describe proposed underlying mechanisms for their association with depression.
678 THE MENTAL HEALTH NURSE EXPERIENCE OF PROVIDING CARE FOR PEOPLE WITH DELIRIUM SUPERIMPOSED ON DEMENTIA
C Pryor
doi : 10.1093/ageing/afac035.678
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.678
People with severe dementia are frequently cared for by registered mental health nurses due to their often complex cognitive or psychological care needs. This study aimed to explore and describe the experiences of mental health nurses who provide care for people with delirium superimposed on dementia.
683 UNDERSTANDING HOW DISCHARGE SERVICES FOR OLDER PATIENTS CAN BRIDGE THE GAP BETWEEN HOSPITAL, COMMUNITY AND SOCIAL CARE
E O’Connell Francischetto, J Jones, K Allen, G Combes, S Damery
doi : 10.1093/ageing/afac035.683
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.683
UK policy recommends that discharge support is provided by hospital, community and social care staff. However, there is a lack of understanding regarding how these multiagency hospital discharge services work in practice, how they can be sustained and what service stakeholder experiences of them are. This research aimed to understand how integrated discharge services work and the views and experiences of stakeholders.
705 CHARACTERISING OLDER ADULTS’ RISK OF HARM FROM BLOOD-PRESSURE LOWERING MEDICATIONS: A SUB-ANALYSIS FROM THE PRIME STUDY
A S Hussain, K Ali, N Parekh, J M Stevenson, J G Davies, S Bremner, C Rajkumar
doi : 10.1093/ageing/afac035.705
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.705
Hypertension is a major risk factor for cardiovascular disease and death. Randomised trials in older adults with relatively few co-morbidities recommend treatment of their hypertension [1]. However, blood-pressure lowering medications increase the risk of medication-related harm (MRH) from adverse drug reactions (ADRs), non-adherence, medication errors and drug–drug interactions. We aimed to identify characteristics associated with MRH in older people on blood-pressure lowering medications.
709 IMPACT ON HEALTHCARE UTILISATION OF A GENERAL PRACTITIONER-LED MODEL OF CARE FOR PATIENTS WITH FRAILTY
H E Jones, I Morrison, S Hurding, S Wild, A Anand, S D Shenkin
doi : 10.1093/ageing/afac035.709
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.709
Primary care has a significant role to play in the identification and management of frailty. MidMed is a new dedicated GP-led service developed by a large practice in Midlothian for patients living at home with moderate or severe frailty. MidMed comprises a full-time GP performing a comprehensive geriatric assessment (CGA) adapted for primary care. Patients receive direct access to all appointments with the named GP. The aim of this study was to assess the impact of MidMed on healthcare utilisation in this patient group.
734 ACUTE CARE PATHWAYS FOR OLDER MAJOR TRAUMA PATIENTS: A SURVEY OF UK PRACTICE
H Jarman, E Cole, R Crouch, M Halter, G Peck
doi : 10.1093/ageing/afac035.734
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.734
Major trauma is a significant health burden for older patients, with worse clinical outcomes when compared to younger people. Various clinical models exist however it is not clear which have most benefit for older patients. This study aimed to map the current provision of clinical pathways and services for older people with major trauma in the United Kingdom (UK).
736 REAL-TIME MOBILITY DATA FROM WEARABLE DEVICES PREDICTING FALLS RISK IN OLDER ADULTS
K Hewage, S Lee, S Fosker, T Hardcastle, K Ali
doi : 10.1093/ageing/afac035.736
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.736
Falls are a common cause of injuries in people over 65 years, usually resulting in life-threatening or life-altering sequalae for affected individuals. Falls risk assessment typically requires a face-to-face evaluation delivered by a trained professional in a clinical setting, thus limiting their application for many older people with falls. Therefore, there is a need for a remote monitoring system (RMS) that captures mobility data to assess comprehensively an older individual’s true falls risk undertaking their everyday activities in their usual environment.
743 THE THIRD NATIONAL SURVEY OF UNDERGRADUATE TEACHING IN AGEING AND GERIATRIC MEDICINE AND ITS IMPACT ON STUDENTS’ ATTITUDES
G M E Pearson, A G Blundell, A L Gordon, T Masud, Y Ben-Shlomo, E J Henderson
doi : 10.1093/ageing/afac035.743
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.743
The British Geriatrics Society’s (BGS) recommended undergraduate curriculum was conceived in 2008 and mapped to the General Medical Council’s (GMC) standards [1]. Subsequently, two national surveys have described how geriatric medicine is taught in the UK and both identified areas for improvement [2,3]. In 2018, the GMC updated their statutory learning outcomes, therefore it is timely that the BGS remap their curriculum to this new guidance, with repeat surveys of UK institutions and students.
765 EFFECTIVENESS OF AROMATHERAPY IN MANAGING BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: A MIXED METHODS: SYSTEMATIC REVIEW
B S Y Li, C W H Chan, I K Y Wong, Y H U Yu, M Li
doi : 10.1093/ageing/afac035.765
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.765
Over 90% older persons with dementia (PWD) exhibit behavioural and psychological symptoms of dementia (BPSD) during their illness, which is the most prominent and distressing manifestation for PWD and caregivers. Aromatherapy has demonstrated its effectiveness in BPSD management in previous studies. However, previous studies and systematic reviews have shown inconsistent findings, and no review has been done on qualitative studies. The aim of this review was to identify and review the evidence from quantitative and qualitative studies of the effectiveness of aromatherapy on BPSD management, for PWD and caregivers.
775 IMPROVING ADVANCE CARE PLANNING DISCUSSIONS AND COMMUNICATION WITH PRIMARY CARE IN GERIATRIC MEDICINE IN A DISTRICT GENERAL
M Twigg, D Robins-Piotrowski, R Jenkin
doi : 10.1093/ageing/afac035.775
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.775
Advance care planning and Respect forms are useful tools in the care of patients in geriatric medicine. Prior projects locally in acute medicine identified gaps in engaging appropriate patients in advance care planning. This quality improvement project aims to improve the identification and completion of Respect forms and how this information is passed on to primary care. NICEQS13 states there must be evidence to support conversations and care planning with relevant care agencies to ensure coordinated care.
776 INTRODUCING TREATMENT ESCALATION PLANS (TEP) FOR OLDER PERSONS: RESPONSE TO THE COVID-19 PANDEMIC
S J Woolford, H P Patel
doi : 10.1093/ageing/afac035.776
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.776
TEP detail appropriate ceilings of care and guide treatment of patients based on shared decision making. TEP documentation was not standard within our trust up to 2018. We aimed to design and introduce a standardised TEP proforma and evaluate its use in older persons aged ≥80.
805 UPPER LIMB FRACTURE PATHWAYS IN FRAILTY ENABLE EARLIER RETURN TO FUNCTION WITH ASSOCIATED REDUCED LENGTH OF HOSPITAL STAY
L Shaw, T Maggs, P Braude, D Shipway, S Srivastava, M Kelly Author Notes
doi : 10.1093/ageing/afac035.805
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.805
Upper limb fractures are the second most common fracture requiring admission to hospital after hip fracture [Jennison, 2019]. At 1-year 20.5% have died, compared to 29.5% in hip fracture [Wiedl, 2021]. Local Problems: At North Bristol Trust most patients with upper limb fractures and a Clinical Frailty Score ≥ 5 are managed non-operatively on medical wards. Local service evaluation identified a long length of stay of 23 days. Case note review revealed: • Delayed transfers of care (DTOCs) had been managed non-weight bearing in slings for 4–6 weeks. • Non-weight bearing status resulted in DTOC due to declined access to social care and rehabilitation due to perceived health needs. • A high rate of hospital-acquired complications and failure to rehabilitate. • Breakdown in interdisciplinary communication and ownership across the pathway.
809 USE OF NEW MOBILITY SCORE AND A TRANS-DISCIPLINARY APPROACH TO REDUCE HOSPITAL LOS, RETURN TO ORIGINAL RESIDENCE, AND MORTALITY
D Leong, P Ng, A Brien, K Law, C Potter, S Sampson, S De Silva
doi : 10.1093/ageing/afac035.809
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.809
The National Hip Fracture Database indicated Guy’s and St Thomas’ Trust ranked in the fourth quartile nationally with reference to hospital length of stay (LOS), return to original residence (ROR), and mortality in hip fracture patients in 2018. This quality improvement project aimed to improve and maintain these key factors via a two-stage process.
825 DEVELOPMENT OF THE ANTICHOLINERGIC MEDICATION INDEX (ACMI)
K Best, S Alderson, D Alldred, L Bonnet, I Buchan, O Butters, A Farrin, R Foy, O Johnson, C McInerney,D Mehdizadeh, T Lawton, R Lawton, S Rodgers, E Teale, L Walker, R West, B Young, M Pirmohamed, A Clegg
doi : 10.1093/ageing/afac035.825
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac035.825
Medications with Anticholinergic (AC) properties, are prescribed to treat a range of conditions. Older people are increasingly likely to be prescribed multiple AC medications, but are also more likely to experience unwanted adverse effects, such as falls and delirium. The risks of adverse outcomes increase with the number and potency of AC medications prescribed. The aim of this study was to use a prognostic modelling approach to develop an AC Medication Index (ACMI) that identifies patients at high risk of AC medication side effects.
658 THE RISK OF ANTICOAGULATION IN ELDERLY FALLERS WITH ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
P P Sarathy, F Cruces
doi : 10.1093/ageing/afac036.658
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.658
Anticoagulation of elderly patients with Atrial Fibrillation (AF) and falls remains a domain of contention amongst clinicians. There is limited evidence to guide long-term anticoagulation decision in such patients. We performed a systematic-review and meta-analysis to guide anticoagulation decision.
663 BEHAVIOUR CHANGE INTERVENTIONS TO INCREASE PHYSICAL ACTIVITY IN HOSPITALISED PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
V A Goodwin, K E Harding, A M Dennett, S Febrey, K Warmoth, A J Hall, L A Prendergast, N F Taylor
doi : 10.1093/ageing/afac036.663
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.663
Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients.
666 EFFECT OF PERINDOPRIL ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA: RESULTS: FROM THE
M D Witham, S Adamson, A Avenell, M M Band, P T Donnan, J George, A Hapca, C Hume, P Kemp, E McKenzie, K Pilvinyte, K Smith, A D Struthers, D Sumukadas, for the LACE study group
doi : 10.1093/ageing/afac036.666
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.666
Angiotensin-converting enzyme inhibitors such as perindopril have been proposed as treatments to improve muscle mass and physical performance but have not been tested in randomised controlled trials enrolling patients with sarcopenia.
667 EFFECT OF LEUCINE SUPPLEMENTATION ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA
M D Witham, S Adamson, A Avenell, M M Band, P T Donnan, J George, A Hapca, C Hume, P Kemp, E McKenzie, K Pilvinyte, K Smith, A D Struthers, D Sumukadas, for the LACE study group
doi : 10.1093/ageing/afac036.667
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.667
Leucine supplementation improves muscle protein synthesis in physiological studies and has been proposed as a treatment to improve muscle mass and physical performance. We tested the effects of leucine supplementation in a randomised controlled trial enrolling patients with sarcopenia.
676 OPTIMISING ENGAGEMENT OF OLDER ADULTS IN AN ONLINE PHYSICAL ACTIVITY PROGRAMME TO IMPROVE COGNITION: A QUALITATIVE STUDY
S Ritchie, V Lawrence, J Jones, A Corbett
doi : 10.1093/ageing/afac036.676
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.676
Maintaining physical activity is a modifiable risk factor for cognitive impairment. However, despite numerous public health interventions, older adults do not routinely meet activity guidelines. Online interventions offer an alternative means of engaging with this group. The role of an online intervention holds particular value in the context of a global pandemic where people have become accustomed to digital living. Furthermore, such an intervention negates barriers frequently faced by older adults in attending face to face interventions, whilst providing an economically viable option. This study explored the factors which maximise engagement in an online programme to promote physical activity.
682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS
E O’Connell Francischetto, J Jones, S Davies, K Allen, G Combes, S Damery
doi : 10.1093/ageing/afac036.682
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.682
The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital.
684 LONG-TERM CONDITIONS, MULTIMORBIDITY, LIFESTYLE FACTORS AND GRIP STRENGTH CHANGE OVER 9Â YEARS IN 44,315 UK BIOBANK PARTICIPANTS
C Hurst, J C Murray, A Granic, S J Hillman, R Cooper, A A Sayer, S M Robinson, R M Dodds
doi : 10.1093/ageing/afac036.684
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.684
Weak grip strength is associated with a range of adverse health outcomes, and an accelerated decline in grip strength confers an even greater risk. To date there has been limited research into the factors associated with change in grip strength in mid-life. Using data from UK Biobank our aim was to investigate the associations of long-term conditions (LTCs), multimorbidity and lifestyle factors with patterns of change in grip strength.
707 RESEARCH PRIORITIES FOR PREHOSPITAL CARE OF OLDER PATIENTS WITH INJURIES: SCOPING REVIEW
N Harthi, S Goodacre, F Sampson, R Alharbi
doi : 10.1093/ageing/afac036.707
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.707
The use of ambulance services by older patients with injuries increases within the impacts of ageing-related changes leading to adverse patient outcomes. There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature.
768 PREDICTORS OF INDEPENDENCE IN COMMUNITY-DWELLING OLDER PEOPLE
E Taylor, V Goodwin, A Clegg, J Frost, S Ball
doi : 10.1093/ageing/afac036.768
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.768
Many people wish to retain their independence as they age. Therefore, identifying factors that can predict sustainability of independence for older people over time are essential for preventing functional decline and maintaining quality of life.
799 FRAILTY MATTERS PROJECT
F J R Duffy, C Papadopolou, J Barrie, A Hendry, M Andrew, J Martin
doi : 10.1093/ageing/afac036.799
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac036.799
Preventing and managing frailty is a new area for many community practitioners yet frailty specific education remains limited. We aimed to understand and strengthen the capability of District Nurses (DNs) in leading personalised care for older people with frailty.
662 ENHANCING CARE BY IMPROVING DISCHARGE SUMMARIES
C Davidson, M K Zaw, R Loh, C Grout
doi : 10.1093/ageing/afac034.662
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.662
Within the Geriatric Medicine department at the Lister Hospital, Stevenage, the timeliness and quality of discharge summaries had become a source of complaints. Both primary care practitioners and families reported documentation was inadequate or incorrect. This project aimed to improve the quality of these discharge summaries in accordance with standards generated from previous audit data. Through improving communication it was clear that patient care could be enhanced.
665 NECK OF FEMUR FRACTURE: POST OPERATIVE DELIRIUM SCREENING
F Hammett, S Asmar, T Taggart
doi : 10.1093/ageing/afac034.665
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.665
Delirium is common yet preventable in hip fracture patients. Adverse implications include: increased length of admission, hospital acquired infection, functional decline and mortality. NICE/NHFD guidance recommends early assessment using the 4AT tool. We aim to assess compliance with this guidance and to identify and initiate changes to improve screening and patient outcomes.
668 IMPROVING ACCESS TO CALL BELLS: LESSONS FROM THE PANDEMIC
A Morrow, A Knighton
doi : 10.1093/ageing/afac034.668
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.668
Call bells are a simple safety measure linked to prevention of falls. The National Audit of Inpatient falls 2017 highlighted that access to call bells was highly variable across trusts and recommended regular auditing. The national average of access to call bells was 81%. The winter covid pandemic posed a significant burden on staffing levels due to absence and redeployment. Experienced nursing staff are essential to maintaining good quality care to elderly patients.
672 ASSESSMENT OF THERAPEUTIC RESPONSE TO MELATONIN IN PARKINSON’S DISEASE PATIENTS WITH SLEEP DISORDERS, A QI PROJECT
R Melrose, C Kershaw, E Jones
doi : 10.1093/ageing/afac034.672
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.672
Holistic care of patients with Parkinson’s Disease (PD) addresses motor and non-motor features. With prevalence of around two-thirds of patients, sleep disorders; including REM Sleep behaviour Disorder (RBD); can have significant negative impact on quality of life. The naturally occurring neuro-hormone, melatonin plays a role in circadian rhythm; a process disrupted in PD. In 2017, NICE suggested to ‘consider clonazepam or melatonin to treat RBD.’ Melatonin has a more favourable side effect profile than clonazepam. This QI project qualitatively evaluates a geographical subset of PD patients treated with melatonin, assessing the clinical effect of treatment and whether this medication is being used optimally. PDSA methodology identified potential for introducing a sleep scale to allow more Objective future assessment.
675 IMPROVING RECOGNITION OF DELIRIUM IN CRITICAL CARE PATIENTS
O Meakin, N Young, S Woods, T Sherwin
doi : 10.1093/ageing/afac034.675
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.675
Delirium is more prevalent in patients admitted to the critical care environment, those over 65Â years old and living with frailty. By increasing the recognition of delirium we can improve management of patients and therefore reduce associated morbidity. Initial audit of this patient group highlighted that we are missing opportunities to screen for, diagnose and document the presence of delirium. This Quality Improvement project aimed to improve delirium screening, and therefore recognition, on the critical care unit at The Royal Bolton Hospital.
680 IMPROVING COMMUNICATION IN THE TIME OF COVID-19 - USING A DEDICATED COMMUNICATION SHEET
O Misquitta, G Angeles, D Overin, L Green
doi : 10.1093/ageing/afac034.680
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.680
Title Improving ease and consistency of communication with Next of Kin (NoK) on an Acute Frailty Ward.A dedicated Communication Sheet was introduced on an Acute Frailty ward at the Royal Surrey County Hospital (by a Nurse-in-Charge and foundation doctors under the supervision of a Consultant Geriatrician) to improve communication between the Multidisciplinary team(MDT) and patients’ NoK/families.
685 HOSPITAL @HOME: TREATING SEVERE COVID-19 IN THE COMMUNITY
M Quinn, S Walters, P McEnhill, M Oyston, R Schiff
doi : 10.1093/ageing/afac034.685
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.685
Patient numbers during the second wave of COVID-19 threatened to overwhelm hospital capacity. Hospital @home services bring the ward to the patient; providing acute care in the home, delivered by a specialised multi-disciplinary team. Our Hospital @home was ideally placed to adapt to support the care of COVID patients in the community who would otherwise have required hospitalisation yet were unlikely to benefit from level 2/3 care. Here we report on the process and 30Â day outcomes.
687 FLUID MANAGEMENT OF PATIENT ADMITTED IN ACUTE ELDERLY CARE MEDICINE WARD: A RE - AUDIT AND COMPARISON TO STANDARD RECOMMENDATION
T Farhana, J Noble
doi : 10.1093/ageing/afac034.687
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.687
There is considerable pressure for monitoring and recording of fluid intake in the elderly care unit We conducted a re-audit of our practice measured against standard recommended fluid intake and implemented measures following initial audit to determine an improvement of the patient care in our unit.
691 ‘ARE YOU CONCERNED ABOUT ME TODAY’ - AN MDT APPROACH TO IMPROVING DELIRIUM RECOGNITION
L Bennett, A Boswell, H Huet, M Whitsey
doi : 10.1093/ageing/afac034.691
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.691
Delirium is a common neuropsychiatric syndrome that increases the likelihood of adverse outcomes for patients admitted to hospital. Delirium is preventable and treatable. Recognition of the syndrome is challenging. Our aim was to increase this recognition through robust inpatient screening, utilising a multi-disciplinary team (MDT) approach.
694 IMPROVING OPIATE PRESCRIBING IN OLDER ADULTS WITH HIP FRACTURES TO COMBAT THE IATROGENIC FALLOUT
M A J Hudson, J Atkin, G Lumley, S Singh, S Varma, D Shenoy, C Morgan, G Peck, M Fertleman, L Koizia
doi : 10.1093/ageing/afac034.694
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.694
The number of opioid prescriptions in older patients has increased dramatically and it is recognised that opioids are the fourth most likely drug to cause preventable hospital admissions. The adverse effects of opioids occur more frequently in the geriatric population. Little is known about the impact of postoperative pain in older adults. NICE recommends paracetamol with additional opioids if there is insufficient postoperative pain relief. Multidisciplinary management with early and then daily physiotherapy is critical. We have assessed pre-morbid, immediate and prolonged use of opioids in patients following hip fracture. Local problem Pre-intervention analysis identified 79% (57/72) of all patients being discharged on opiates. At 4-months, 37% (17/46) of those were still using them. This represents 28% (17/61) of all patients.
695 QUALITY IMPROVEMENT PROJECT ON TRANSFER TIMES OF ACUTE HIP FRACTURE PATIENTS FROM ED TO INPATIENT BED POST SIMULATION TRAINING
C Clancy, R Mahony, M Donegan, V Meighan
doi : 10.1093/ageing/afac034.695
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.695
The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard (IHFS) 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4Â hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90Â minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of covid-19, the training was available in person and online via zoom.
699 EMBEDDING A FRAILTY TEAM AND UNIT INTO WYTHENSHAWE HOSPITAL’S EMERGENCY DEPARTMENT
S S Bruce, D Saunders, E Mallouppa
doi : 10.1093/ageing/afac034.699
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.699
Evaluation of Wythenshawe Hospital’s Acute Frailty Service in January–June 2019 demonstrated slow referrals times and poor identification of frail patients due to inaccurate Clinical Frailty Scoring (CFS) at emergency department triage. This project presents the results of ongoing quality assessment of our service between June 2019–January 2021, following two quality improvement (QI) interventions.
702 COMMUNICATION CHALLENGES BETWEEN DOCTORS & RELATIVES DURING THE COVID-19 PANDEMIC: SIMPLE INTERVENTIONS WITH MEANINGFUL IMPACT
B Patani, M Hudson, M Khan, N Head, S Long
doi : 10.1093/ageing/afac034.702
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.702
& Aims Visiting restrictions during the COVID-19 pandemic resulted in reduced and inconsistent communication with the next-of-kin of elderly inpatients. This project aimed to improve communication between doctors and patients’ relatives in accordance with the GMC Good Medical Practice guidelines which outline that doctors ‘must be considerate to those close to the patient and be sensitive and responsive in giving them information and support’.
706 IMPROVING PRESCRIPTION OF PARKINSON’S DISEASE MEDICATIONS FOR PATIENTS ON ELDERLY CARE WARDS AT ROYAL STOKE UNIVERSITY HOSPITAL
O T Alonge, N Sultana, Y T Aung
doi : 10.1093/ageing/afac034.706
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.706
Patients with Parkinson’s disease (PD) are commonly admitted into hospital with various acute medical conditions. Inaccurate prescription can result in adverse effects, increased hospital stay, and increased morbidity and mortality. We present a QIP conducted to improve PD medication prescription pattern among doctors and medication delivery from the nursing staff.
710 IPC STOCKINGS FOR VTE PREVENTION IN STROKE: BENEFITS OF INTRODUCING ELECTRONIC PRESCRIPTIONS AND WARD ROUND PROMPTS
K Ross, F Kattakayam, E Hall, J R Barker
doi : 10.1093/ageing/afac034.710
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.710
A fully completed audit cycle, performed by doctors on the Stroke Unit at Royal Lancaster Infirmary (RLI) which is a combined acute and rehabilitation ward in a university teaching hospital.
712 EVALUATING AN ‘ACUTE FRAILTY TEAM’ MODEL OF CARE IN IMPROVING OUTCOMES FOR PATIENTS WITH FRAILTY ACUTELY ADMITTED TO HOSPITAL
J Thompson, V Gusev, P Dervin, E Tevendale
doi : 10.1093/ageing/afac034.712
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.712
In frailty, Comprehensive geriatric assessment (CGA) has benefit in improving patient outcomes, including hospital readmissions and institutionalisation. We looked to evaluate the effectiveness of our newly initiated multi-disciplinary, acute frailty team (AFT) in improving acute care. This team works on the Acute Medical Unit (AMU), delivering early CGA alongside the existing acute medical care.
715 REDUCING OVERTREATMENT OF TYPE 2 DIABETES IN OLDER PEOPLE LIVING IN CARE HOMES
N Samarasekara, E Dinsdale, S Taylor, M Sulaiman, A Gittens, E Ahmed, A Jain, M Tang, S Ninan
doi : 10.1093/ageing/afac034.715
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.715
Older people in care homes living with frailty are less likely to benefit from tight glycaemic control in the management of type 2 diabetes with increased risk of adverse effects for example hypoglycaemia, falls and hospital admission. We wished to ascertain the scale of the problem and reduce overtreatment. We defined overtreatment based on American Diabetes Association guidelines as being on an agent that can cause hypoglycaemia and having an HBA1C of ≤53 mmol/mol or, an HbA1c 53–64 mmol/mol with either three or more co-morbidities.
716 A MULTIDISCIPLINARY SIMULATED TEACHING PROGRAMME ON TREATMENT ESCALATION PLANNING IN THE CONTEXT OF FRAILTY
C Corson, K Fair
doi : 10.1093/ageing/afac034.716
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.716
We designed a simulated teaching session to enable participants to learn more about Treatment Escalation Planning (TEP) and do not attempt resuscitation (DNACPR) orders in the context of frailty and to simulate communication of these decisions with the patient/relative.
717 FLUSHI- AN INTERVENTION TO IMPROVE CATHETER CARE AND REDUCE UNNECESSARY CATHETERISATION DAYS
N Anwyll, K Hyde, J Powell
doi : 10.1093/ageing/afac034.717
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.717
Catheter-Associated Urinary Tract Infections (CAUTIs) are a common and preventable healthcare-associated infection that cost NHS hospitals an estimated £54.4 M per year. The risk of developing a CAUTI is intrinsically linked to the duration of an indwelling catheter. Our project was created in response to a clinical incident where a patient was mislabelled as having a long-term catheter (LTC) and discharged, subsequently enduring several unnecessary catheter days. We have created interventions with the primary aim of reducing the number of Short-term Catheters (STC) mislabelled as LTCs by 100%, and secondary aims of reducing the number of unnecessary catheter days, increasing the number of discharge summaries with correct catheter information and reducing the number of inappropriate catheterisations.
713 COLLABORATION WITH CARE HOMES TO PROVIDE APPROPRIATE MEDICAL CARE IN THE PANDEMIC
S Kelly, B Griffiths, A Davies, F Adenwalla
doi : 10.1093/ageing/afac034.713
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.713
The Acute Clinical Team (ACT) in Neath Port Talbot is a well-established hospital at home service that provides treatments in the community. During the COVID 19 outbreaks, the team proactively telephoned the care home managers on a regular basis to enquire about the residents wellbeing and establish if input was required. This proactive approach worked well with some homes. Where crises developed, we were able to provide hands on support to provide appropriate medical care.
722 IMPLEMENTATION OF TREATMENT ESCALATION PLANS IN A COMMUNITY PSYCHIATRIC HOSPITAL
A Y T Chua, S K Makh, A Ghanchi, J Grayston, N Yasmeen, S M Insigne, S Woolford, S Wijayaweera, H P Patel, J Amin
doi : 10.1093/ageing/afac034.722
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.722
Treatment Escalation Plans (TEP) detail appropriate ceilings of care and guide treatment of patients based on shared decision making. Whilst established in many acute trusts, TEP are not frequently used in community mental health hospitals. This is particularly concerning in organic mental health wards, where patients with severe dementia may be transferred to acute hospitals for treatment without consideration about whether this is appropriate. This quality improvement project aimed to develop and implement TEP within a community mental health hospital to support the management of our older patients with severe mental illness.
727 BOOSTING BONE HEALTH: IMPROVING JUNIOR DOCTORS’ CONFIDENCE IN ASSESSING AND MANAGING FRAGILITY FRACTURES
Y Ge, L M Dennis
doi : 10.1093/ageing/afac034.727
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.727
Fragility fractures are a major disease burden in the UK. With an ageing population and number of fragility fractures predicted to double in 50Â years, prevention in this high-risk population needs to be addressed. This audit aimed to examine the assessment of fracture risk in patients presenting with fragility fractures and improve awareness amongst trainee doctors through education.
729 INCORPORATING PATIENTS’ VIEWS IN THE DESIGN OF AN EDUCATIONAL LEAFLET FOR FRAIL, OLDER PATIENTS WITH KIDNEY DISEASE
L Ryan, J McNicholas, H Beckwith, Kidney Care UK, E A Brown
doi : 10.1093/ageing/afac034.729
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.729
There are an increasing number of older people live with advanced kidney disease. These individuals tend to have a higher number of co-morbidities, including frailty. This group experience multiple challenges in understanding and managing their co-existing conditions. This quality improvement project aimed to incorporate patient and carers views and experiences to improve their understanding and support self-management.
737 STOOLS FOR STOOLS - COMBINING MEDICAL AND CONSERVATIVE TREATMENTS TO REDUCE CONSTIPATION IN THE ELDERLY INPATIENT POPULATION
N Roth, N Khalil, C Moore-Gillon, D James, L Gilby, C Morgan
doi : 10.1093/ageing/afac034.737
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.737
Constipation is a common cause of morbidity in the elderly. Its management is particularly challenging in the inpatient population, where many factors exacerbate constipation. We describe a Quality Improvement Project to reduce the rates of constipation on a female Medicine for the Elderly ward.
740 ASSESSING THE IMPACT OF A DEDICATED FRAILTY MULTIDISCIPLINARY TEAM TO DELIVER A PROACTIVE VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENT
K Conlon, E Harris, E Spiers, H Coleman, R Gallifent, M Farnsworth, C S Chan
doi : 10.1093/ageing/afac034.740
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.740
Surrey Downs Health and Care (SDHC) is an innovative partnership between acute and community providers, local general practitioner (GP) federations and adult social care. The NHS Long Term Plan emphasises the importance of ageing well and supporting people living with frailty by improving integrated proactive services in the community. To achieve this, SDHC collaborated with local Primary Care Networks (PCNs) to develop a frailty multidisciplinary team (MDT) to deliver proactive virtual Comprehensive Geriatric Assessments (CGA).
744 3Â YEAR FOLLOW-UP OF SEDATIVE PRESCRIBING FOR RESPONSIVE BEHAVIOURS IN NURSING HOME RESIDENTS, AN IRISH STUDY
E Killeen, S Horan, A Pollock, A Lee, A Martin
doi : 10.1093/ageing/afac034.744
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.744
Sedative medications are commonly prescribed for older adults; these include neuroleptics, benzodiazepines, opioids, ‘z’ drugs and trazadone. The prevalence of sedative drug prescriptions is increasing (1). Nursing home residents are three times more likely to be prescribed benzodiazepines (2). Regular medication review and education have been shown to reduce rates of sedative use in nursing homes (3). We previously demonstrated a significant reduction in prescription of these target medications at an Irish nursing home with specific focus, within scheduled medication reviews, on reduction or discontinuation of the target drugs in combination with education on management of Behavioural and Psychological symptoms (BPSD). This audit examines the prescribing patterns 3 years on from the initial audit.
745 PROACTIVE INPUT FROM GERIATRICIAN LED SURGICAL LIAISON SERVICE FOR OLDER SURGICAL PATIENTS AT ROYAL BERKSHIRE HOSPITAL, READING
E Castaneda-Caicedo, M Khwaja, S Alam, S Warrior
doi : 10.1093/ageing/afac034.745
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.745
Need for a geriatrician in the peri operative care of older surgical patients is evident by the NCEPOD reports in 2010 and 2011. Funding for Consultant Geriatrician led surgical liaison service for RBH was approved in 2014.We present a comparative review of the service during 2019/2020.
747 THE DIAGNOSIS AND MANAGEMENT OF HYPERKALAEMIA IN MEDICAL AND ELDERLY CARE INPATIENTS AT A DISTRICT GENERAL HOSPITAL
C Broadhurst, K Thompson, W Tan
doi : 10.1093/ageing/afac034.747
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.747
Severe hyperkalaemia is a dangerous and potentially life-threatening condition. Despite this knowledge, the incidence of hyperkalaemia in hospital inpatients remains high. On review of the acute management of hyperkalaemia at Croydon University Hospital, only 50% of medical and elderly care inpatients were managed correctly in line with hospital guidelines, and 50% of surveyed doctors did not feel confident managing acute hyperkalaemia—highlighting an urgent requirement for improvement. The project objectives were to improve management in line with hospital guidelines, overall prescription accuracy and the confidence of junior doctors in managing acute hyperkalaemia.
748 HEARING AIDS AND GLASSES: BEDSIDE SIGNS PROMPT ASSESSMENT OF SENSORY NEEDS, AN AUDIT
E Laws, H Currie, R Batra
doi : 10.1093/ageing/afac034.748
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.748
It is widely acknowledged that older adults with hearing or visual impairment are at higher risk of developing delirium. The National Institute for Clinical Excellence (NICE) guideline for delirium prevention in the hospital setting emphasises the importance of considering sensory impairment in the clinical assessment of patients at risk of delirium, yet it is often overlooked. This audit aimed to determine doctors’ documentation of sensory needs in a geriatrics department and the effect of bedside signs on this documentation.
754 DEVELOPING A FRAILTY SERVICE IN ROYAL BOLTON HOSPITAL
A Connolly, A Kallat, M Cairns, R Oates
doi : 10.1093/ageing/afac034.754
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.754
Bolton NHS Trust has a busy Emergency Department (ED) in the North West. 21% of attendances are patients aged over 65. Early specialist input is recognised for frail older adults. The goal of this quality improvement project was to readdress the admission/discharge bias and to improve the quality of care for older patients in ED. A referral pathway would be implemented, and frailty team embedded into ED.
756 ORTHOPAEDIC SURGEONS CAN PRESCRIBE LAXATIVES & ANALGESICS TOO - A QUALITY IMPROVEMENT PROJECT SPANNING 7Â YEARS
K K B Kim, P Gibson
doi : 10.1093/ageing/afac034.756
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.756
Patients admitted with age 60Â years and over with a hip fracture admitted to a District General Hospital.
757 ASSESSING THE READMISSION RATES OF THE OLDER PERSON’S ASSESSMENT AND LIAISON ACUTE FRAILTY TEAM AT GOOD HOPE HOSPITAL
H G T Brice, S Sheikh, T Quigley
doi : 10.1093/ageing/afac034.757
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.757
The Older Person’s Assessment and Liaison (OPAL) team at Good Hope Hospital (GHH), part of the University Hospitals Birmingham NHS Foundation Trust, provides multidisciplinary, patient-centred comprehensive assessment to patients presenting to the hospital front door. The team takes a ‘home first’ approach and where possible aims to discharge patients home with support by community teams. The service is part of the Birmingham wide Early Intervention programme. A front door OPAL service therefore enables early discharge for frail patients who would otherwise be likely to have a prolonged hospital admission. This has to be balanced against ensuring readmission rates do not exceed that of a comparable hospital inpatient population.
760 IMPROVING THE MANAGEMENT AND DURATION OF RESOLUTION OF ACUTE KIDNEY INJURY IN THE ELDERLY
Y Ghaddar, A Stevens, M Pearl, T Sivagnanam, S P Sheriff
doi : 10.1093/ageing/afac034.760
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.760
Acute Kidney Injury (AKI) is prevalent in elderly populations due to several factors: polypharmacy, anatomic/physiologic changes of the kidneys associated with aging. AKI can contribute to increased length of stay, morbidity and mortality. This audit sets out to establish if the guidance established by NICE is being followed and how it may be better implemented.
763 QUALITY IMPROVEMENT PROJECT (QIP) ON IMPROVING THE USE OF THE CLINICAL FRAILTY SCALE (CFS) DURING THE COVID-19 PANDEMIC
P Wijayaratne, A Vijay, A Shah, M Ene
doi : 10.1093/ageing/afac034.763
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.763
Older people were disproportionally affected by the COVID-19 pandemic resulting in a surge in the demand for healthcare resources. The aim of this QIP was to assess and improve the compliance of using the CFS in patients over the age of 65 with COVID-19 to aid in establishing appropriate Treatment Escalation Plans (TEPs) during admission.
769 IMPROVING THE DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH COMMUNITY AND HOSPITAL ACQUIRED PNEUMONIA WITHIN ELDERLY CARE
Cv't Hoff, T Chopra, A Chatterjee
doi : 10.1093/ageing/afac034.769
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.769
In 2017 pneumonia was the most cited cause of death in elderly care at our hospital, and in 2019, we were shown to be an outlier in the incidence of hospital acquired pneumonia (HAP). Therefore, accurate diagnosis and management of pneumonia is paramount and an area for improvement in our trust. From 2017–20 we focussed on the care of elderly patients with pneumonia, aiming to improve the diagnosis and subsequent management plans.
773 BARRIERS TO RECOGNISING PAIN IN PATIENTS WITH DEMENTIA AND DELIRIUM ON A HEALTHCARE OF THE ELDERLY INPATIENT WARD
R Stokes, R Philpott
doi : 10.1093/ageing/afac034.773
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.773
Pain is often poorly recognised and remains under-treated in older patients, especially those who are unable to articulate their discomfort. In those with severe cognitive impairment or communication difficulties, recognition of the non-verbal manifestations of pain is needed to ensure patient comfort. Understanding how likely these patients are to have pain, how we improve recognition of the signs of discomfort, and encouraging doctors to think about prescribing analgesics will allow these patients to retain their dignity, and reduce their physical and psychological distress during their inpatient stays.
774 KEEP SMILING! IMPROVING ORAL HEALTH ON AN ACUTE MEDICINE FOR THE ELDERLY WARD
V Livie, J Livie, A McCulloch
doi : 10.1093/ageing/afac034.774
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.774
Good oral health in older patients is important for numerous reasons including facilitating fluid and nutritional intake, communication and quality of life. It is an essential component of providing holistic care and should be a daily care requirement during a hospital admission. Poor oral health leads to adverse outcomes including periodontitis, tooth loss, pneumonia and cardiovascular disease. Frail, elderly and those with dementia are at increased risk of poor oral health. Our group decided to undertake quality improvement work to improve our patient’s oral health care during their hospital stay.
779 IMPROVING USE OF COORDINATE MY CARE USING A QUALITY IMPROVEMENT APPROACH FOR MEDICAL PATIENTS ADMITTED TO BARNET HOSPITAL
K Goffe, J Wilson, T Gluck, J Brady, A Burns, C Bergbaum, H Petra, M Stewart, E Wilson
doi : 10.1093/ageing/afac034.779
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.779
Coordinate My Care (CMC) is a digital care plan for communicating person-centred urgent and advance care planning. We recognised that it was not being consistently accessed on admission, nor updated on discharge, leading to a risk of ignoring patient wishes and previously clinician-agreed care plans. We used a quality improvement approach to increase use of CMC.
780 IMPROVING NUTRITIONAL SUPPORT FOR POST-SURGICAL FEMUR FRACTURE PATIENTS AT ST MARY’S HOSPITAL, LONDON
L Donnelly, S Sharpe, I Heber, C Morgan
doi : 10.1093/ageing/afac034.780
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.780
Malnutrition represents a common complication in femur fracture patients and is primarily caused by poor dietary intake. Malnutrition is associated with poor clinical outcomes, and is the strongest independent risk factor for recurrent femur fracture. High protein oral nutrition supplements (ONS) have been associated with improved clinical outcomes after femur fracture, including reduced complications, length of hospital stay, mortality and bone mineral density loss, and increases in functional status and quality of life (Volkert, Beck, Cederholm et al., Clinical Nutrition, 38, 10–47)). Accordingly, the European Society for Clinical Nutrition and Metabolism (ESPEN) advocates the use of ONS with all femur fracture patients in hospital.
781 IMPROVING THE QUALITY OF DO NOT ATTEMPT CARDIO-PULMONARY RESUSCITATION (DNACPR) FORM COMPLETION
M Rasquinha, K Ng, A Hillarious, L Pugh, H Ghobrial, D Emuss, K Shiel, M Vettasseri
doi : 10.1093/ageing/afac034.781
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.781
The completion of a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) form represents an important part of patient care. However, this can be a sensitive process that has gained national media interest. The aim of this Quality Improvement (QI) Project was to improve the quality of DNACPR form completion in a Care of the Elderly Department.
783 ADVANCE CARE PLANNING IN A LARGE TEACHING HOSPITAL EMERGING FROM THE COVID-19 PANDEMIC: A QUALITY IMPROVEMENT PROJECT
E Holdsworth, R Ryall, E Greenwood
doi : 10.1093/ageing/afac034.783
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.783
Advance care planning (ACP) is an ongoing conversation where healthcare professionals explore patients’ and families’ wishes in order to act within their best interests. The COVID19 pandemic continues to highlight the importance of timely ACP, namely while our patients have capacity. We noted that despite advancing age, accumulating co-morbidities and high clinical frailty scores (CFS); ACP discussions were not taking place within our elderly department. We aimed to increase ACP conversations and ensure documentation on ReSPECT forms to allow continuity within primary care.
787 THE PRUNE PROJECT: USING PRUNES AS A CONSTIPATION AID IN OLDER SURGICAL INPATIENTS
F Coath, C Morgan
doi : 10.1093/ageing/afac034.787
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.787
Constipation is a common and difficult issue in elderly surgical patients, often contributing to prolonged stay on inpatient wards (Sethi et al, Am J Gastroenterol. 2014;109:250–256). Increasing dietary fibre is a commonsense tactic to mitigate against constipation. However it is rarely formally employed on NHS wards. Prunes are beneficial in increasing fibre intake and are a natural source of sorbitol, which acts as an osmotic laxative (Stacewicz-Sapuntzakis et al, Crit Rev Food Sci Nutr. 2001;41:251–86.)
793 COLLATERAL HISTORY IN PATIENTS WITH CONFUSION
K Georgiou, J Mock, E Peter
doi : 10.1093/ageing/afac034.793
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.793
The aims of the project were to intervene early on admission, by taking a collateral history for patients with confusion; to improve the quality and detail of collateral history being taken to better establish certain clinically important specks of information. These include triggers for delirium, the patient’s baseline cognition, any patterns in the change of a patient’s cognition to help determine if a patient was displaying aspects of a certain type of dementia prior to admission, baseline mobility and housing situation, baseline continence, history of substance misuse and alcohol etc. Ultimately, this project aims to identify next of kin from which collateral history can be obtained, but also to establish a firm communication platform to facilitate future discussions on behalf of patients undergoing delirium. This will ultimately, improve care but also making sure family members are involved early on in admission, exploring their ideas, concerns, and expectations.
794 STANDARDISED SOCIAL HISTORY DOCUMENTATION IN MEDICAL CLERKING IMPROVES IDENTIFICATION OF FRAILTY
A McGinlay, L Munang
doi : 10.1093/ageing/afac034.794
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.794
Thorough social history is a crucial component of a medical admission. Understanding a patient’s functional status enables better assessment of their Frailty and better decisions about aims of treatment, rehabilitation, appropriate escalation and ceilings of care.
796 THE IMPORTANCE OF CHEST X RAYS AS AN INITIAL INVESTIGATION IN ROUTINE ACUTE ELDERLY CARE ADMISSIONS
M Tantoush, V Menon, N Ahmed
doi : 10.1093/ageing/afac034.796
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.796
The Chest X-Ray (CXR) is a common and central initial investigation for any patient that has been admitted via Accident and Emergency (A&E). In the context of elderly care, it is a useful measure of a patient’s baseline functional status as well as a tool for cancer surveillance and other aspects of clinical care. Accurate documentation of CXR review is also imperative for closed loop communication of clinical information amongst a multi-disciplinary team.
797 IMPROVING GERIATRIC CARE IN THE EMERGENCY DEPARTMENT; TREATT PROJECT: THE RAPID EARLY ASSESSMENT THERAPY TEAM
H Foxley, C Colby, J Swin, R Leyland
doi : 10.1093/ageing/afac034.797
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.797
At University Hospital Southampton (UHS) on average 400 elderly patients attend the emergency department (ED) each month following a fall with an estimated cost to the NHS of £2.3 billion a year. 50% of over 80’s fall at least once a year, after a first fall, 2/3 will fall again within the year. Since the creation of the Same Day Emergency Care (SDEC), treatment of those attending ED with frailty conditions has improved. However, the current therapy service cannot adequately assess these patients, leading to longer length of stay (LOS) and suboptimal functional outcomes. An initial 3-month pilot in ED identified those seen by a therapist had a reduced LOS compared with those who did not receive therapy (6.9 days vs 8.5 days). The data identified that 253 patients presenting later in the day received a substandard service.
798 SPOT DELIRIUM - IMPROVING DELIRIUM AWARENESS AND ASSESSMENT USING ELECTRONIC 4AT
S Kotecha, L M Dennis
doi : 10.1093/ageing/afac034.798
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.798
Delirium is a common medical emergency which is associated with adverse outcomes but often unrecognised in up to two thirds of patients in the acute care setting. The 4AT is a sensitive and rapid assessment tool that can be applied to assess for delirium in clinical practice.
812 GERIATRIC PERIOPERATIVE CARE IS ASSOCIATED WITH REDUCED LENGTH OF STAY IN UROLOGY PATIENTS
F Parry, A Rideway, S Ibitoye, R Nitharsan, R Grange, P Braude, K Warren, D Shipway
doi : 10.1093/ageing/afac034.812
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.812
Comprehensive Geriatric Assessment (CGA) is associated with reduced length of stay and perioperative complications in older orthopaedic, gastrointestinal and vascular surgical patients [1,2,3]. Limited published data from a single UK centre [4] reports reproducing these outcomes in a urological setting. It is unclear whether these outcomes can be repeated in other urological centres.
816 COORDINATE MY CARE: INCREASING STAFF ACCESS AND NUMBER OF PATIENT RECORDS CREATED IN A BUSY ACUTE HOSPITAL - A QI PROJECT
C King, J Arumugam, J Bichard
doi : 10.1093/ageing/afac034.816
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.816
The Royal College of Physicians have emphasised the need to provide good end of life care for patients in the acute care setting, with the publication of the Acute Care Resource (1) in February 2021. This follows on from their key recommendations in 2018, which proposed that ‘all healthcare professionals reviewing patients with chronic conditions,…more than one serious medical problem, or terminal illness, should initiate shared decision making including advance care planning in line with patient preferences’ (2). Coordinate My Care (CMC) is an electronic urgent care plan accessible to all relevant health and social care professionals caring for patients residing in London Boroughs, enabling communication of wishes and preferences, including those of resuscitation status and advance care plans.
817 AVOIDING THAT SINKING FEELING: A QIP TO IMPROVE THE IDENTIFICATION OF POSTURAL HYPOTENSION ON A MEDICINE FOR THE ELDERLY WARD
C G S Gilmartin, M Peacock, J Coultas, N Alavi, S Long
doi : 10.1093/ageing/afac034.817
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac034.817
Postural hypotension contributes significantly to falls in frail older people. The RCP recommend that all inpatients >65Â years have a lying and standing blood pressure (L&SBP) performed early. We recognised that there was a need to improve the understanding, measurement and consistency of documentation for L&SBP on our ward, a 20-bedded acute MFE ward with many patients at risk of falls.
660 PHYSIOTHERAPISTS PERCEPTIONS OF MECHANISMS FOR OBSERVED VARIATION IN PRACTICE DURING EARLY POSTOPERATIVE PHASE AFTER HIP FRACTURE
B Volkmer, E Sadler, K Lambe, F C Martin, S Ayis, L Beaupre, I D Cameron, C L Gregson, A Johansen, M T Kristensen, J Magaziner, C Sackley, T O Smith, B Sobolev
doi : 10.1093/ageing/afac037.660
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.660
To explore physiotherapists’ perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit.
664 EXPLORING THE FEASIBILITY OF THE INTERRAI CHECK-UP FORM (SELF-REPORTED) IN OLDER PEOPLE LIVING WITH FRAILTY IN THE COMMUNITY
M K Rajpara, C Wilson, A L Gordon, A Cowley
doi : 10.1093/ageing/afac037.664
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.664
Identifying the holistic needs of community dwelling older people is an essential component of clinical care. Current assessment instruments are limited by a narrow medical view and varied language use, referring to identical clinical concepts in different ways. The interRAI family of assessments have been designed to integrate health information across multiple settings. The interRAI Check-Up (Self-Reported) was designed to support the management of older adults with multi-morbidities in the community setting but has not yet been widely tested in clinical practice in the United Kingdom.
670 FACTORS ASSOCIATED WITH MORTALITY IN MULTI-ETHNIC HOSPITALISED COVID PATIENTS
I Omotade, M Bennett, S Chitson, F Asiedu, B Harrington, M Patel
doi : 10.1093/ageing/afac037.670
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.670
Whilst most patients during the COVID pandemic made an uneventful recovery, there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to evaluate independent risk factors for those who died of COVID compared to survivors and to identify any markers for improvement in future management.
671 DEMOGRAPHIC VARIABILITY IN MORTALITY FROM COVID DURING THE TWO SURGES
M Patel, U Umasankar, E Aitken
doi : 10.1093/ageing/afac037.671
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.671
COVID-19 resulted in significant mortality over the last several months. This survey aims to evaluate demographic differences between those hospitalised patients who died of COVID during the first surge [until 31/08/2020] and those who died during the second [01/09/2020–15/03/2021].
677 UTILITY OF 24Â HOUR AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN PATIENTS WITH ORTHOSTATIC HYPOTENSION (OH) AT SYNCOPE CLINIC
A Arnott, G Reid, J Godwin, L Anderton, L Mitchell
doi : 10.1093/ageing/afac037.677
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.677
OH is a disabling condition resulting from a sustained reduction in blood pressure (>20 systolic or 10 diastolic) within 3 minutes of standing. It is a common cause of syncope. Patients with concurrent hypertension experiencing syncope present a complex management dilemma where a balance must be established between symptom burden and risk of cardiovascular disease. Current guidance on ABPM use in syncope is limited. European society of cardiology syncope guidelines suggest ABPM in patients with ‘autonomic failure’ to assess nocturnal hypertension or drug-induced hypotension. Could this be improved with further explicit criteria on which patients to assess and how to act on results? The objective of this study is to review the use of 24 hour ABPM in OH within a tertiary referral syncope clinic.
696 UNDERSTANDING INDEPENDENCE—OLDER PEOPLE’S PERSPECTIVES
E Taylor, V Goodwin, A Clegg, S Ball, J Frost
doi : 10.1093/ageing/afac037.696
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.696
Independence is an important personal goal for many older people. Achieving this goal in practice requires a shared-understanding of independence between older people and those supporting them, but a consensus of understanding remains elusive. This study aims to provide a basis for a person-centred understanding of independence by identifying which factors are important to the meaning, and experience, of independence for older people.
697 PATIENTS WITH PARKINSONISM AND THEIR CAREGIVERS: A PROTOCOL FOR THE PRIME-UK CROSS-SECTIONAL STUDY
E Tenison, F E Lithander, D Brazier, M Smith, Y Ben-Shlomo, E J Henderson
doi : 10.1093/ageing/afac037.697
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.697
People with parkinsonism (PwP) are a highly heterogeneous group and the condition encompasses a spectrum of motor and nonmotor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. Whilst parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe a broad range of PwP in relation to their symptomatology, disability, health needs, disease stage, comorbidities and sociodemographics.
719 THE EFFECT OF LOCKDOWN ON THE INCIDENCE OF VTE IN HIP FRACTURE PATIENTS DURING THE COVID-19 PANDEMIC
S Huque, A Robinson, N Singh
doi : 10.1093/ageing/afac037.719
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.719
COVID-19 is associated with an increased risk of venous thromboembolism (VTE). We compared the incidence of VTE on a busy hip fracture unit during 2020 with previous years to identify factors that may have played a role in its development.
738 DETERMINANTS OF MUSCLE DENSITY IN OLDER PEOPLE: FINDINGS FROM THE HERTFORDSHIRE COHORT STUDY (HCS)
F Laskou, L D Westbury, N Fuggle, N C Harvey, H P Patel, C Cooper, K Ward, E M Dennison
doi : 10.1093/ageing/afac037.738
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.738
Lower calf muscle density (CMD) as assessed by peripheral quantitative computed tomography (pQCT) is associated with greater hip fracture risk, independent of FRAX, falls and bone mineral density. To date, muscle density has been little studied, and its determinants are unknown. In this study, we examine the lifestyle and anthropometric determinants of future muscle density (MD) in the HCS.
746 VALIDITY OF THE CARER DIRECTED NEEDS ASSESSMENT IN DEMENTIA (CANDID) FOR USE IN ADVANCED STAGE DEMENTIA CARE
M O’Connor, A Glenn, C Elissa
doi : 10.1093/ageing/afac037.746
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.746
End of life care for people dying of dementia and their carer/s is a growing area of importance. Unmet needs are coming amongst this group. A tool to identify the needs of this person-carer dyad is a necessary component for providing this care. The aim of this project was to determine the validity of a new tool, the CArer directed NeeDs assessment In Dementia (CANDID), which was developed for use in a randomised trial of end of life dementia care.
759 RELATIONSHIP BETWEEN G8 AND CFS IN A COHORT OF LUNG CANCER PATIENTS REFERRED TO A SPECIALISED ONCO-GERIATRIC CLINIC
V Dunnett-Kane, L Ayrton, C Ng
doi : 10.1093/ageing/afac037.759
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.759
The International Society of Geriatric Oncology recommends using screening tools to identify cancer patients who would benefit from a comprehensive geriatric assessment. G8, a tool specifically designed for oncology, has been well validated in this setting (1). Rockwood Clinical frailty score (CFS) is a widely used tool to assess frailty, and has been adopted into standard assessments at many sites (2). However, this tool is less well validated in patients with cancer.
764 ROCKWOOD CLINICAL FRAILTY SCALE TO PREDICT LENGTH OF STAY,INPATIENT MORTALITY & READMISSION RATE IN A COMMUNITY HOSPITAL SETTING
D Daly, A McSorley
doi : 10.1093/ageing/afac037.764
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.764
Frailty is prevalent in elderly patients in acute medical wards. It is recognised that length of stay (LOS), inpatient mortality and readmission rates rise with increasing frailty. (Reference: Specialised Clinical Frailty Network: Clinical frailty Scale. 2018. https://www.scfn.org.uk/clinical-frailty-scale) The Rockwood clinical frailty scale (CFS) is a well-recognised and validated tool, which can be easily incorporated into the comprehensive geriatric assessment to identify the frailest patients and aid in clinical decision making. We collected data on elderly patients in a non-acute community setting to assess the relationship between degree of frailty and outcomes, in this subset of inpatients.
771 LET’S TALK ABOUT RESUS. DO WE DO IT? WHO DOES IT? WHAT ARE THE OUTCOMES?
S Gilmore, S Murray, S Taylor, S Ninan
doi : 10.1093/ageing/afac037.771
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.771
Discussing preferences around cardiopulmonary resuscitation (CPR) is recommended to patients who wish to discuss this, or where there is foreseeable risk of life-threatening clinical deterioration. Our team felt that we discussed this routinely for our inpatients but wished to investigate how we did this, when we did this, why decisions were made and who led these discussions.
778 THE IMPACT OF MUSCULOSKELETAL CONDITIONS AND FRAILTY ON THE ABILITY TO SELF-CARE OR BE IN RECEIPT OF CARE: A STUDY OF COMMUNITY-
G Bevilacqua, F Laskou, K Jameson, N Fuggle, C Cooper, E M Dennison, H P Patel
doi : 10.1093/ageing/afac037.778
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.778
Musculoskeletal conditions (MSC) and frailty lead to a significant burden of disease in later life. Living independently remains the aim of older adults but ability to self-care or access care at home may hamper this. Our aim was to consider whether MSC (osteoporosis, sarcopenia, osteoarthritis) and frailty were associated with ability to self-care or influence access to formal/informal care among community-dwelling older adults.
795 A POSITIVE 4AT DELIRIUM ASSESSMENT TOOL SCORE ON HOSPITAL ADMISSION IS LINKED TO MORTALITY, LENGTH OF STAY AND ‘HOME TIME’: A STUDY OF 82,770 HOSPITAL ADMISSIONS IN EDINBURGH AND SALFORD
E R L C Vardy, A Anand, M Cheng, T Ibitoye, A M J MacLullich
doi : 10.1093/ageing/afac037.795
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.795
Delirium is linked with poor outcomes but studies using large-scale routine data are scarce. The 4AT (www.the4AT.com) is a brief (~2 minutes), well-validated tool for detection of delirium and cognitive impairment. We performed a two-centre study (Edinburgh and Salford) of Electronic Health Record (EHR) 4AT scores and outcomes in 82,770 non-elective hospital admissions in patients aged ≥65. We determined relationships between 4AT scores 0 (no impairment), 1–3 (cognitive impairment but no delirium) and ≥ 4 (delirium), in relation to 30-day inpatient mortality, length of stay, and time at home (‘home time’) in the year following index admission.
801 EFFECTIVENESS OF HEARING REHABILITATION FOR CARE HOME RESIDENTS WITH DEMENTIA: A SYSTEMATIC REVIEW
H Cross, P Dawes, E Hooper, C J Armitage, I Leroi, R E Millman
doi : 10.1093/ageing/afac037.801
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.801
Hearing loss is common among people with dementia living in long-term care homes, leading to poorer quality of life, communication difficulties and exacerbated dementia-related symptoms. Hearing rehabilitation may improve outcomes; however, evidence suggests hearing is poorly managed in care homes.
802 CONCURRENT PATHOLOGIES OBSERVED IN OLDER ADULTS WITH COVID-19 INFECTION
C Murphy, K Hartop, K Aggrey, J Bilan, J Lumsden, K Colquhoun, T Quinn
doi : 10.1093/ageing/afac037.802
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.802
This study aimed to look at the effect of frailty and multi morbidity on short-term outcomes in patients diagnosed with COVID-19 in a hospital setting, looking specifically at the variety of concurrent pathologies diagnosed during their admission and how these affected the course of their illness and mortality.
803 QUALITY OF LIFE IN OLDER TRAUMA PATIENTS AFTER INJURY: FINDINGS FROM THE FRAILTY IN MAJOR TRAUMA STUDY (FRAIL-T)
H Jarman, R Crouch, M Baxter, C Wang, E Cole
doi : 10.1093/ageing/afac037.803
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.803
Major trauma is a substantial health burden for older patients with a significant proportion having ongoing functional and psychological difficulties long after their injury. Frailty impacts adversely on outcome after trauma but the longer term effects are unknown. This study aimed to determine differences in health related quality of life (HRQoL) and change in dependence for frail and non-frail patients aged 65 or over discharged from Major Trauma Centres (MTCs) following injury.
811 DELIRIUM IN COVID-19: COMMON AND CLINICALLY SIGNIFICANT: EXPERIENCES FROM THE NIGHTINGALE HOSPITAL EXETER
W Reed, C Fearnley, A Tregarthen, J Hubbard, J Griffiths, T Whitehead, J Hacon, L Anning
doi : 10.1093/ageing/afac037.811
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.811
Delirium is an independent predictor of mortality in patients admitted with community-acquired pneumonia (Pieralli, 2014), but significance and incidence in Covid-19 infection has not been established. The Nightingale Hospital Exeter (NHE) as a multidisciplinary team model, managed 242 patients with Covid-19 from November 2020 to February 2021. This study identifies the delirium incidence, outcome, premorbid function and demographics of this cohort.
814 GENERAL INTERNAL MEDICINE AND THE GERIATRIC MEDICINE WORKFORCE: RESULTS: OF THE RCP CENSUS AND WELLBEING SURVEY
C Welch, C Copeland
doi : 10.1093/ageing/afac037.814
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.814
In the UK, most geriatric medicine consultants also contribute to general internal medicine (‘acute take’) services. However, impact on workforce was unclear.
815 FRAILTY AND MULTIMORBIDITY ARE ASSOCIATED WITH LONGER LENGTH OF STAY IN OLDER UROLOGY PATIENTS
S Ibitoye, F Parry, A Rideway, R Nitharsan, R Grange, P Braude, K Warren, D Shipway
doi : 10.1093/ageing/afac037.815
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac037.815
Frailty and geriatric syndromes are becoming common place in surgical services. In general surgery, frailty has been shown to be associated with longer length of hospital stay. The effect of frailty on outcomes in Urology patients is not well described. We aimed to evaluate the effect of frailty and multimorbidity on length of stay in older patients admitted for emergency Urology care.
Author Index
doi : 10.1093/ageing/afac033
Age and Ageing, Volume 51, Issue Supplement_1, March 2022, afac033
