Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.110
E Heffernan, K Ayling, C Ewart, S Smith, S Calvert, D Maru, J Straus, T Dening, H Henshaw
Introduction Hearing loss is a long-term, progressive condition that affects approximately 18 million UK adults. It is especially prevalent among older adults. It can substantially impair quality-of-life and is associated with an increased risk of depression, loneliness, falls, and dementia. Evidence suggests that hearing loss is a substantial, yet frequently overlooked, barrier to accessing healthcare. This research aimed to examine the challenges experienced by adults living with hearing loss in UK primary care services and to develop recommendations for overcoming these challenges. Method The participants (N = 413) included adults living with hearing loss and health professionals. They were recruited from an internal participant database, professional societies and networks, and charities. Their experiences were examined via a survey (n = 400) and individual and group interviews (n = 45). Recommendations for improving access to primary care were developed through a series of co-design workshops with an expert panel (n = 18). Results Adults living with hearing loss can experience challenges (e.g. communication barriers, lack of awareness, facilities, or interpreters) at every stage of accessing and using primary care services (e.g. booking appointments, obtaining referrals and interventions, adhering to care plans). This can impact physical, mental, and social functioning, as well as privacy and safety. Recommendations for overcoming these challenges included staff training, hearing loss champions, standardised communication protocols, addressing the psychosocial impact of hearing loss (e.g. counselling, support groups), and utilising technology (e.g. speech-to-text applications). Perceived impediments to implementing these recommendations included time and financial constraints and prioritisation of other health conditions. Conclusions This study provides novel insights on the experiences of adults living with hearing loss in UK primary care services and has key implications for health professionals and policymakers. The findings suggest that, despite legal requirements (e.g. Accessible Information Standard) and efforts to raise awareness, many people living with hearing loss remain under-served in primary care.
{"title":"3726 Navigating primary care with hearing loss: a mixed methods study of lived and professional experiences in the UK","authors":"E Heffernan, K Ayling, C Ewart, S Smith, S Calvert, D Maru, J Straus, T Dening, H Henshaw","doi":"10.1093/ageing/afaf368.110","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.110","url":null,"abstract":"Introduction Hearing loss is a long-term, progressive condition that affects approximately 18 million UK adults. It is especially prevalent among older adults. It can substantially impair quality-of-life and is associated with an increased risk of depression, loneliness, falls, and dementia. Evidence suggests that hearing loss is a substantial, yet frequently overlooked, barrier to accessing healthcare. This research aimed to examine the challenges experienced by adults living with hearing loss in UK primary care services and to develop recommendations for overcoming these challenges. Method The participants (N = 413) included adults living with hearing loss and health professionals. They were recruited from an internal participant database, professional societies and networks, and charities. Their experiences were examined via a survey (n = 400) and individual and group interviews (n = 45). Recommendations for improving access to primary care were developed through a series of co-design workshops with an expert panel (n = 18). Results Adults living with hearing loss can experience challenges (e.g. communication barriers, lack of awareness, facilities, or interpreters) at every stage of accessing and using primary care services (e.g. booking appointments, obtaining referrals and interventions, adhering to care plans). This can impact physical, mental, and social functioning, as well as privacy and safety. Recommendations for overcoming these challenges included staff training, hearing loss champions, standardised communication protocols, addressing the psychosocial impact of hearing loss (e.g. counselling, support groups), and utilising technology (e.g. speech-to-text applications). Perceived impediments to implementing these recommendations included time and financial constraints and prioritisation of other health conditions. Conclusions This study provides novel insights on the experiences of adults living with hearing loss in UK primary care services and has key implications for health professionals and policymakers. The findings suggest that, despite legal requirements (e.g. Accessible Information Standard) and efforts to raise awareness, many people living with hearing loss remain under-served in primary care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"42 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.151
D Cengiz, A O Bas, Y Özturk, C Kayabasi, M Pehlivan, Ö Özgun, O Turhan, M Esme, C Balcı, B B Dogu, M Cankurtaran, M G Halil
Rationale Sarcopenia, the progressive loss of muscle mass and strength, increases the risk of falls, disability, and mortality in older adults. The SARC-F questionnaire is commonly used to screen for probable sarcopenia, though the optimal cut-off remains debated. This study aimed to identify the most appropriate SARC-F threshold by examining its association with measures of muscle strength and physical performance. Methods Individuals aged ≥65 years who presented to a tertiary university hospital geriatric outpatient clinic between January 2022 and May 2024, were evaluated in this cross-sectional study. Patients with active inflammatory conditions, malignancy, or incomplete datasets were excluded. SARC-F scores were analysed against established performance tests: handgrip strength (HGS; <16 kg for females, <27 kg for males), sit-to-stand (STST >15 seconds), 4-meter gait speed(>5 seconds), and the Timed Up and Go (TUG >20 seconds). Receiver operating characteristic (ROC) analyses were performed to determine diagnostic accuracy. Results Among the 3583 individuals screened, 1355 met the inclusion criteria (mean age: 74.0 ± 6.0 years; 64.9% female). A SARC-F score ≥ 4 was identified in 22.2% of participants. Using a cut-off of ≥2, sensitivity and specificity were 68.9% and 63.6% for HGS (AUC = 0.705), and 68.6% and 68.3% for STST (AUC = 0.735), respectively. A threshold of ≥3 was optimal for detecting slow gait speed (sensitivity 63.75%, specificity 83.4%, AUC = 0.788), while a cut-off of ≥4 yielded the greatest diagnostic accuracy for TUG (sensitivity 85.2%, specificity: 82.5%, AUC = 0.881). Conclusion This study, involving one of the largest single-centre geriatric outpatient cohorts, supports a lower SARC-F threshold for improved early detection of sarcopenia. A novel perspective is introduced by proposing the SARC-F as a gradational marker of sarcopenia severity and functional decline, rather than a binary outcome.
{"title":"3837 Diagnostic ability of SARC-F according to muscle strength and physical performance tests","authors":"D Cengiz, A O Bas, Y Özturk, C Kayabasi, M Pehlivan, Ö Özgun, O Turhan, M Esme, C Balcı, B B Dogu, M Cankurtaran, M G Halil","doi":"10.1093/ageing/afaf368.151","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.151","url":null,"abstract":"Rationale Sarcopenia, the progressive loss of muscle mass and strength, increases the risk of falls, disability, and mortality in older adults. The SARC-F questionnaire is commonly used to screen for probable sarcopenia, though the optimal cut-off remains debated. This study aimed to identify the most appropriate SARC-F threshold by examining its association with measures of muscle strength and physical performance. Methods Individuals aged ≥65 years who presented to a tertiary university hospital geriatric outpatient clinic between January 2022 and May 2024, were evaluated in this cross-sectional study. Patients with active inflammatory conditions, malignancy, or incomplete datasets were excluded. SARC-F scores were analysed against established performance tests: handgrip strength (HGS; &lt;16 kg for females, &lt;27 kg for males), sit-to-stand (STST &gt;15 seconds), 4-meter gait speed(&gt;5 seconds), and the Timed Up and Go (TUG &gt;20 seconds). Receiver operating characteristic (ROC) analyses were performed to determine diagnostic accuracy. Results Among the 3583 individuals screened, 1355 met the inclusion criteria (mean age: 74.0 ± 6.0 years; 64.9% female). A SARC-F score ≥ 4 was identified in 22.2% of participants. Using a cut-off of ≥2, sensitivity and specificity were 68.9% and 63.6% for HGS (AUC = 0.705), and 68.6% and 68.3% for STST (AUC = 0.735), respectively. A threshold of ≥3 was optimal for detecting slow gait speed (sensitivity 63.75%, specificity 83.4%, AUC = 0.788), while a cut-off of ≥4 yielded the greatest diagnostic accuracy for TUG (sensitivity 85.2%, specificity: 82.5%, AUC = 0.881). Conclusion This study, involving one of the largest single-centre geriatric outpatient cohorts, supports a lower SARC-F threshold for improved early detection of sarcopenia. A novel perspective is introduced by proposing the SARC-F as a gradational marker of sarcopenia severity and functional decline, rather than a binary outcome.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"30 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.136
A Seeley, R Brettel, A Wang, R Barnes, G Hayward
Introduction Out-of-hours (OOH) services provide emergency primary care outside normal GP hours, serving patients with higher health needs. Delirium affects 25% of hospitalised older adults, causes distress to patients and carers, and leads to poor outcomes. However, little is known about delirium presentations and prevalence in OOH services. We aimed to investigate delirium occurrence and management using case records from an OOH service in South-West England. Methods The OPEN database contains 33,345 consultations of patients ≥65 attending the OOH service between April 2019–March 2020. We screened consultations for delirium symptoms during April and July 2019, and January 2020. Records were reviewed by two GPs independently using DSM-V criteria to identify probable or possible delirium. We validated our search strategy by reviewing a random sample of 100 consultations initially classified as ‘search-negative’ and assessed inter-rater reliability. Patient characteristics were compared using Chi-squared tests. Results Of 4288 consultations with patients ≥65 in the study periods, 394 (9.2%) involved possible or probable delirium. A further 76 (1.8%) had end-of-life delirium and were excluded from further analysis. Patients with delirium were similar in age to those without, but more likely to live in residential care (29% vs. 14%, p < 0.001) and have dementia (46% vs. 11%, p < 0.001). 67% of delirious patients required home visits, compared to 22% without delirium (p < 0.001). Delirium was not available as a coded diagnosis; only 6% of cases were coded as ‘Acute Confusion,’ whilst 20.9% were coded ‘Urinary Tract Infection.’ Patients with delirium were admitted to hospital twice as often as those without (21% vs 10%, p < 0.001). Conclusions Delirium is a common OOH presentation, representing ~10% of consultations with patients ≥65. These patients often have cognitive impairment, require home visits, and are more likely to be hospitalised. Improved recognition and coding could support better management and service planning.
介绍非工作时间（OOH）服务提供普通家庭医生正常工作时间以外的紧急初级保健，为有更高健康需求的患者提供服务。25%的住院老年人患有谵妄，给患者和护理人员带来痛苦，并导致不良后果。然而，人们对户外服务中谵妄的表现和流行程度知之甚少。我们的目的是调查谵妄的发生和管理使用来自英格兰西南部户外服务的病例记录。OPEN数据库包含2019年4月至2020年3月期间参加户外医疗服务的≥65名患者的33,345次咨询。我们在2019年4月和7月以及2020年1月筛选了谵妄症状的咨询。记录由两名全科医生使用DSM-V标准独立审查，以确定可能或可能的谵妄。我们通过审查最初被归类为“搜索阴性”的100个咨询的随机样本来验证我们的搜索策略，并评估了评级者之间的可靠性。采用卡方检验比较患者特征。结果在4288例≥65例患者的咨询中，394例（9.2%）涉及可能或可能的谵妄。另有76人（1.8%）患有临终谵妄，被排除在进一步分析之外。谵妄患者的年龄与非谵妄患者相似，但更有可能住在养老院（29%对14%，p < 0.001），并有痴呆（46%对11%，p < 0.001）。67%的谵妄患者需要家访，而22%的非谵妄患者需要家访（p < 0.001）。谵妄不能作为编码诊断；只有6%的病例被编码为“急性意识不清”，而20.9%的病例被编码为“尿路感染”。谵妄患者入院的次数是无谵妄患者的两倍（21% vs 10%, p < 0.001）。结论：谵妄是一种常见的户外活动表现，约占就诊≥65岁患者的10%。这些患者通常有认知障碍，需要家访，而且更有可能住院。改进识别和编码可以支持更好的管理和服务规划。
{"title":"3833 Ascertainment of delirium in older adults presenting to a primary care out of hours (OOH) service: a retrospective cohort study","authors":"A Seeley, R Brettel, A Wang, R Barnes, G Hayward","doi":"10.1093/ageing/afaf368.136","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.136","url":null,"abstract":"Introduction Out-of-hours (OOH) services provide emergency primary care outside normal GP hours, serving patients with higher health needs. Delirium affects 25% of hospitalised older adults, causes distress to patients and carers, and leads to poor outcomes. However, little is known about delirium presentations and prevalence in OOH services. We aimed to investigate delirium occurrence and management using case records from an OOH service in South-West England. Methods The OPEN database contains 33,345 consultations of patients ≥65 attending the OOH service between April 2019–March 2020. We screened consultations for delirium symptoms during April and July 2019, and January 2020. Records were reviewed by two GPs independently using DSM-V criteria to identify probable or possible delirium. We validated our search strategy by reviewing a random sample of 100 consultations initially classified as ‘search-negative’ and assessed inter-rater reliability. Patient characteristics were compared using Chi-squared tests. Results Of 4288 consultations with patients ≥65 in the study periods, 394 (9.2%) involved possible or probable delirium. A further 76 (1.8%) had end-of-life delirium and were excluded from further analysis. Patients with delirium were similar in age to those without, but more likely to live in residential care (29% vs. 14%, p &lt; 0.001) and have dementia (46% vs. 11%, p &lt; 0.001). 67% of delirious patients required home visits, compared to 22% without delirium (p &lt; 0.001). Delirium was not available as a coded diagnosis; only 6% of cases were coded as ‘Acute Confusion,’ whilst 20.9% were coded ‘Urinary Tract Infection.’ Patients with delirium were admitted to hospital twice as often as those without (21% vs 10%, p &lt; 0.001). Conclusions Delirium is a common OOH presentation, representing ~10% of consultations with patients ≥65. These patients often have cognitive impairment, require home visits, and are more likely to be hospitalised. Improved recognition and coding could support better management and service planning.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"91 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.079
T Parkin, S Lewis
Introduction The older population are more likely to suffer from chronic diseases, requiring more frequent hospital admissions, therefore, in University Hospital of Wales there is a dedicated Older Persons Acute Medical Unit (OPAMU). The OPAMU, opened in 2023, admits frail patients directly from the Emergency (ED) and Acute Medicine (AM) Departments for comprehensive geriatric assessment before discharge or onward hospital stay. Main objective: To understand how our patients felt throughout different steps of their journey to the OPAMU. Secondary objective To assess how the patient experience has changed since the last time feedback was collected in 2022. Methods We designed a questionnaire tailored to reveal patient experience across a variety of aspects of their journey on the OPAMU. This included broad questions about their assessment in ED/AM, comfort, and treatment, and detailed questions about their pain needs, discharge planning and communication on the ward. Results We received 18 responses and participants answered very positively. 100% felt comfortable on the ward, 94% felt listened to and informed on their treatment plan; 89% felt their pain needs were met, found staff respectful, and felt appropriately prepared for discharge, by answering ‘agree’ or ‘strongly agree.’ There was a statistically significant increase in positive responses to participant comfort (78% vs 53%), patient admission (44% vs 16%), and being prepared for discharge (89% vs 39%), compared to the study in 2022 (all p < 0.05). Additionally, there was an increased positive response to participant experience of treatment (72% vs 68%) and communication with staff (72% vs 53%). Conclusions Our study revealed that the OPAMU is an overwhelmingly positive experience for older persons requiring specialist geriatric care. Whilst understanding the limitations of this study, the best steps moving forward would be to identify aspects of care needing improvement, then incorporate changes, and repeat the study in 6 months.
{"title":"3854 Understanding patient experience on the older person’s acute medical unit (OPAMU) and the acute frailty pathway at UHW","authors":"T Parkin, S Lewis","doi":"10.1093/ageing/afaf368.079","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.079","url":null,"abstract":"Introduction The older population are more likely to suffer from chronic diseases, requiring more frequent hospital admissions, therefore, in University Hospital of Wales there is a dedicated Older Persons Acute Medical Unit (OPAMU). The OPAMU, opened in 2023, admits frail patients directly from the Emergency (ED) and Acute Medicine (AM) Departments for comprehensive geriatric assessment before discharge or onward hospital stay. Main objective: To understand how our patients felt throughout different steps of their journey to the OPAMU. Secondary objective To assess how the patient experience has changed since the last time feedback was collected in 2022. Methods We designed a questionnaire tailored to reveal patient experience across a variety of aspects of their journey on the OPAMU. This included broad questions about their assessment in ED/AM, comfort, and treatment, and detailed questions about their pain needs, discharge planning and communication on the ward. Results We received 18 responses and participants answered very positively. 100% felt comfortable on the ward, 94% felt listened to and informed on their treatment plan; 89% felt their pain needs were met, found staff respectful, and felt appropriately prepared for discharge, by answering ‘agree’ or ‘strongly agree.’ There was a statistically significant increase in positive responses to participant comfort (78% vs 53%), patient admission (44% vs 16%), and being prepared for discharge (89% vs 39%), compared to the study in 2022 (all p &lt; 0.05). Additionally, there was an increased positive response to participant experience of treatment (72% vs 68%) and communication with staff (72% vs 53%). Conclusions Our study revealed that the OPAMU is an overwhelmingly positive experience for older persons requiring specialist geriatric care. Whilst understanding the limitations of this study, the best steps moving forward would be to identify aspects of care needing improvement, then incorporate changes, and repeat the study in 6 months.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"39 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.138
R E Carroll, C Goodman, N Smith, A L Gordon
Introduction Standardising data collection and collation in care homes is a policy priority. The DACHA study piloted and tested a care home Minimum Dataset This follow-up study aimed to understand how care homes deploy data to improve care. Methods Interviews with care home staff, residents, relatives and other stakeholders (n = 22) from three care homes, explored data usage. Interview data were synthesised and thematically analysed with findings used to inform worked examples of how data informs care. These exemplars were presented at workshop with commissioners, healthcare providers and Electronic Care Record (ECR) vendors to test their relevance and resonance for services working in and with care homes. Results Exemplars developed from the findings focused on systematically using data for predicting unwellness/agitation, the importance of valuing soft data to support individualised care and supporting relatives’ involvement in and understanding of the care being provided. Discussing the data they needed for care and developing exemplars led staff to refine and change ECR data fields and include quality of life outcome measures. The process also supported an exploration of day-to-day decisions staff made about what is important to document, how systematic this was, and if what mattered to the residents was always captured. The findings highlighted the importance of peer support and training to build staff confidence in using data and ensure data collected were meaningful and the basis for decision making. Conclusion Staff and relatives already use data in multiple ways to understand and support care delivery. Discussion about how data collection could inform care decisions led staff to develop skills in data literacy to appraise care delivered and value the process of data capture as an aid to practice.
{"title":"3855 How do care home staff use data to improve care in care homes for older people?","authors":"R E Carroll, C Goodman, N Smith, A L Gordon","doi":"10.1093/ageing/afaf368.138","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.138","url":null,"abstract":"Introduction Standardising data collection and collation in care homes is a policy priority. The DACHA study piloted and tested a care home Minimum Dataset This follow-up study aimed to understand how care homes deploy data to improve care. Methods Interviews with care home staff, residents, relatives and other stakeholders (n = 22) from three care homes, explored data usage. Interview data were synthesised and thematically analysed with findings used to inform worked examples of how data informs care. These exemplars were presented at workshop with commissioners, healthcare providers and Electronic Care Record (ECR) vendors to test their relevance and resonance for services working in and with care homes. Results Exemplars developed from the findings focused on systematically using data for predicting unwellness/agitation, the importance of valuing soft data to support individualised care and supporting relatives’ involvement in and understanding of the care being provided. Discussing the data they needed for care and developing exemplars led staff to refine and change ECR data fields and include quality of life outcome measures. The process also supported an exploration of day-to-day decisions staff made about what is important to document, how systematic this was, and if what mattered to the residents was always captured. The findings highlighted the importance of peer support and training to build staff confidence in using data and ensure data collected were meaningful and the basis for decision making. Conclusion Staff and relatives already use data in multiple ways to understand and support care delivery. Discussion about how data collection could inform care decisions led staff to develop skills in data literacy to appraise care delivered and value the process of data capture as an aid to practice.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"2 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.071
S Jamil, F Kirkham, P Xenofontos, R Techache, L Tomkow
Background Frailty is a poor prognostic indicator following cardiopulmonary resuscitation (CPR). Discussions about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are often contentious. While existing research focuses on patients’ and relatives’ perspectives, there is a lack of in-depth studies exploring clinicians’ experiences of DNACPR discussions. This study aims to explore how clinicians’ personal and professional beliefs and experiences influence their approach to DNACPR conversations with frail, older adults. Methods Ninety clinicians from primary and secondary care across the UK, all experienced in resuscitation discussions with frail older patients, participated in either semi-structured interviews (n = 45) or focus groups (n = 5). Participants included doctors of various grades, nurses, and advanced practitioners. Data were analysed using thematic analysis. Results Four key clinician-related themes emerged: professional experience, specialty culture, emotional response, and personal values. Some junior clinicians reported a lack of confidence in leading DNACPR discussions. Participants described how specialty culture shaped approaches, with geriatricians and palliative care teams most likely to initiate discussions. Some clinicians reported agreeing to CPR decisions that contradicted their medical judgement to avoid conflict with patients or families. Many expressed a personal preference for non-resuscitation in similar circumstances, influenced by professional exposure. A lack of formal training and a reliance on an informal ‘apprenticeship model’ were also commonly reported. Conclusion Clinician-specific factors appear to be important in DNACPR conversations with frail older adults. Addressing the personal and emotional aspects of these discussions is essential to improving clinician confidence and the overall quality of resuscitation decision-making.
{"title":"3792 Improving discussions about resuscitation with frail older adults: clinicians’ perspectives","authors":"S Jamil, F Kirkham, P Xenofontos, R Techache, L Tomkow","doi":"10.1093/ageing/afaf368.071","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.071","url":null,"abstract":"Background Frailty is a poor prognostic indicator following cardiopulmonary resuscitation (CPR). Discussions about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are often contentious. While existing research focuses on patients’ and relatives’ perspectives, there is a lack of in-depth studies exploring clinicians’ experiences of DNACPR discussions. This study aims to explore how clinicians’ personal and professional beliefs and experiences influence their approach to DNACPR conversations with frail, older adults. Methods Ninety clinicians from primary and secondary care across the UK, all experienced in resuscitation discussions with frail older patients, participated in either semi-structured interviews (n = 45) or focus groups (n = 5). Participants included doctors of various grades, nurses, and advanced practitioners. Data were analysed using thematic analysis. Results Four key clinician-related themes emerged: professional experience, specialty culture, emotional response, and personal values. Some junior clinicians reported a lack of confidence in leading DNACPR discussions. Participants described how specialty culture shaped approaches, with geriatricians and palliative care teams most likely to initiate discussions. Some clinicians reported agreeing to CPR decisions that contradicted their medical judgement to avoid conflict with patients or families. Many expressed a personal preference for non-resuscitation in similar circumstances, influenced by professional exposure. A lack of formal training and a reliance on an informal ‘apprenticeship model’ were also commonly reported. Conclusion Clinician-specific factors appear to be important in DNACPR conversations with frail older adults. Addressing the personal and emotional aspects of these discussions is essential to improving clinician confidence and the overall quality of resuscitation decision-making.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"69 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.121
C Carter, S Guerra, L Clothier, S Barlow, R Axenciuc, R Milton-Cole, X L Griffin, K J Sheehan
Introduction To synthesise the evidence available on components of reported rehabilitation interventions following pelvic fragility fracture in older adults and describe outcomes measured. Methods: A scoping review reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. A systematic search of Cochrane CENTRAL, Embase, MEDLINE and PEDr for studies of rehabilitation among patients 60 years and older with non-pathological pelvic fragility fracture, published up to May 2024. Single case studies were excluded. Screening and study selection were completed in duplicate by four independent reviewers. One reviewer completed extraction with accuracy checked by a second reviewer. A narrative synthesis approach was employed with text and tables. Results 17 studies reporting on rehabilitation after pelvic fragility fracture were identified. For 13 studies, descriptors were limited to mobilisation strategies with 9 citing unrestricted mobilisation as the first prescription. Three studies reporting multicomponent, multidisciplinary (physiotherapy-led), rehabilitation interventions across inpatient and community settings, incorporating exercise, psychological components, and education/advice were identified. 31 outcome domains were identified with key domains including pain, mobility, activities of daily living, quality of life, and mortality. There was an absence of consensus on which patient reported outcome instruments to use to measure relevant domains. Conclusions There is overall limited evidence to guide rehabilitation for older adults following fragility fracture of the pelvis. A standardised approach to rehabilitation should be designed which improves outcomes which matter most to those people affected.
{"title":"3551 Rehabilitation after pelvic fragility fracture in older adults: a scoping review","authors":"C Carter, S Guerra, L Clothier, S Barlow, R Axenciuc, R Milton-Cole, X L Griffin, K J Sheehan","doi":"10.1093/ageing/afaf368.121","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.121","url":null,"abstract":"Introduction To synthesise the evidence available on components of reported rehabilitation interventions following pelvic fragility fracture in older adults and describe outcomes measured. Methods: A scoping review reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. A systematic search of Cochrane CENTRAL, Embase, MEDLINE and PEDr for studies of rehabilitation among patients 60 years and older with non-pathological pelvic fragility fracture, published up to May 2024. Single case studies were excluded. Screening and study selection were completed in duplicate by four independent reviewers. One reviewer completed extraction with accuracy checked by a second reviewer. A narrative synthesis approach was employed with text and tables. Results 17 studies reporting on rehabilitation after pelvic fragility fracture were identified. For 13 studies, descriptors were limited to mobilisation strategies with 9 citing unrestricted mobilisation as the first prescription. Three studies reporting multicomponent, multidisciplinary (physiotherapy-led), rehabilitation interventions across inpatient and community settings, incorporating exercise, psychological components, and education/advice were identified. 31 outcome domains were identified with key domains including pain, mobility, activities of daily living, quality of life, and mortality. There was an absence of consensus on which patient reported outcome instruments to use to measure relevant domains. Conclusions There is overall limited evidence to guide rehabilitation for older adults following fragility fracture of the pelvis. A standardised approach to rehabilitation should be designed which improves outcomes which matter most to those people affected.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.004
A Soma, L Jones, E Clift
Introduction Falls are a common presentation comprising 17% of all ED attendances in older people and can result in harm including fragility fractures (FFs). FFs lead to pain, functional decline, deconditioning, and high mortality. Validated tools such as FRAX can increase prescribing of antiresorptive medications (ARM), reducing harm. Comprehensive geriatric assessment (CGA) is the gold standard for assessing and managing geriatric syndromes including falls and can include fragility fracture risk assessment. Method: An audit was conducted of all inpatients over one day on Colwell Ward at Isle of Wight NHS Trust. Patients were screened meeting NICE criteria for Bone Health Assessment (BHA). Notes were reviewed for evidence of FRAX scores or BHAs. Bloods were reviewed for vitamin D and calcium. Drg charts, medicine reconciliations, and GP records were screened to see if vitamin D, calcium, and anti-resorptive medications were prescribed previously. Following the audit FRAX scoring has been included in the CGA being piloted by the acute frailty team. Results Of 30 inpatients, 100% met NICE criteria for BHA. Mean and median age was 85 (72–96). 63.3% were female (19/30). 16.7% had a history of osteoporosis or osteopenia (5/30). 6.7% (2/30) had a note mentioning BHA in their medical notes, however zero patients had had a FRAX score calculated. 46.7% (14/30) had vitamin D checked and 93.3% (28/30) had had calcium checked. 6.7% (2/30) were already on ARM and the same percentage were started on ARM that admission. 56.7% (17/30) had vitamin D and calcium prescribed on their drug charts. Conclusion All patients met NICE criteria for BHA however few had FRAX scores completed. This may lead to avoidable fragility fractures. Reasons for few BHAs are likely multifactorial. Embedding FRAX within the CGA increases opportunities to identify at-risk patients. Re-audit is recommended after the CGA has been fully implemented locally.
{"title":"3589 Embedding FRAX scoring into the comprehensive geriatric assessment following an inpatient audit","authors":"A Soma, L Jones, E Clift","doi":"10.1093/ageing/afaf368.004","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.004","url":null,"abstract":"Introduction Falls are a common presentation comprising 17% of all ED attendances in older people and can result in harm including fragility fractures (FFs). FFs lead to pain, functional decline, deconditioning, and high mortality. Validated tools such as FRAX can increase prescribing of antiresorptive medications (ARM), reducing harm. Comprehensive geriatric assessment (CGA) is the gold standard for assessing and managing geriatric syndromes including falls and can include fragility fracture risk assessment. Method: An audit was conducted of all inpatients over one day on Colwell Ward at Isle of Wight NHS Trust. Patients were screened meeting NICE criteria for Bone Health Assessment (BHA). Notes were reviewed for evidence of FRAX scores or BHAs. Bloods were reviewed for vitamin D and calcium. Drg charts, medicine reconciliations, and GP records were screened to see if vitamin D, calcium, and anti-resorptive medications were prescribed previously. Following the audit FRAX scoring has been included in the CGA being piloted by the acute frailty team. Results Of 30 inpatients, 100% met NICE criteria for BHA. Mean and median age was 85 (72–96). 63.3% were female (19/30). 16.7% had a history of osteoporosis or osteopenia (5/30). 6.7% (2/30) had a note mentioning BHA in their medical notes, however zero patients had had a FRAX score calculated. 46.7% (14/30) had vitamin D checked and 93.3% (28/30) had had calcium checked. 6.7% (2/30) were already on ARM and the same percentage were started on ARM that admission. 56.7% (17/30) had vitamin D and calcium prescribed on their drug charts. Conclusion All patients met NICE criteria for BHA however few had FRAX scores completed. This may lead to avoidable fragility fractures. Reasons for few BHAs are likely multifactorial. Embedding FRAX within the CGA increases opportunities to identify at-risk patients. Re-audit is recommended after the CGA has been fully implemented locally.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"111 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.014
P Godage, L Forsyth, T Bell, H Hobbs, E Litto, B McCluskey-Mayes, C Meilak
Introduction Our perioperative service for older people undergoing surgery (POPS) commenced inpatient reviews in September 2024. Method Patients being considered for laparotomy aged 80 and over were prioritised as part of the national emergency laparotomy audit (NELA) recommendations. Other patients reviewed were multi-morbid and frail patients with other pathologies, aged between 65–80. All patients reviewed had a comprehensive geriatric assessment (CGA) and shared decision making (SDM) as required. Results In 3 months, 115 patients were seen. Median age 83, median clinical frailty score 4 (mild frailty: range 2–8). 22% had surgery, LOS range 2–96 days (2 longest were admitted pre-POPS), median LOS 7. 7% were readmitted within 30 days. 32% already had a DNA CPR/ReSPECT in place, POPS discussed treatment escalation with an additional 25% patients. End of life discussions and pathways instigated by POPS in 8 patients. SDM discussions regarding surgical treatment plans were undertaken in 11 patients. 18% did not need intervention, 55% chose not to have treatment and 27% chose to proceed with surgery after SDM. 53% of patients had medical complications, to which POPS gave input. For the laparotomy group aged 80 and over, 3 months pre and post POPS LOS analysis was undertaken. There was a reduction in LOS from 17 to 14.8 days. There were 4 patients readmitted within 30 days pre-POPS and none in the post-POPS group. Patient and colleague feedback were obtained. Patient feedback was adapted from experience-based design. Feedback on the POPS intervention was overwhelmingly positive. Conclusion The POPS intervention was well received by patients and colleagues. There was a trend in reduction in LOS (by 2.2 days) and readmission rates in the older laparotomy group. Quality of care was improved for all seen by virtue of medical input, SDM and escalation discussions.
{"title":"3670 The role of comprehensive geriatric assessment and shared decision making in general surgical inpatients","authors":"P Godage, L Forsyth, T Bell, H Hobbs, E Litto, B McCluskey-Mayes, C Meilak","doi":"10.1093/ageing/afaf368.014","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.014","url":null,"abstract":"Introduction Our perioperative service for older people undergoing surgery (POPS) commenced inpatient reviews in September 2024. Method Patients being considered for laparotomy aged 80 and over were prioritised as part of the national emergency laparotomy audit (NELA) recommendations. Other patients reviewed were multi-morbid and frail patients with other pathologies, aged between 65–80. All patients reviewed had a comprehensive geriatric assessment (CGA) and shared decision making (SDM) as required. Results In 3 months, 115 patients were seen. Median age 83, median clinical frailty score 4 (mild frailty: range 2–8). 22% had surgery, LOS range 2–96 days (2 longest were admitted pre-POPS), median LOS 7. 7% were readmitted within 30 days. 32% already had a DNA CPR/ReSPECT in place, POPS discussed treatment escalation with an additional 25% patients. End of life discussions and pathways instigated by POPS in 8 patients. SDM discussions regarding surgical treatment plans were undertaken in 11 patients. 18% did not need intervention, 55% chose not to have treatment and 27% chose to proceed with surgery after SDM. 53% of patients had medical complications, to which POPS gave input. For the laparotomy group aged 80 and over, 3 months pre and post POPS LOS analysis was undertaken. There was a reduction in LOS from 17 to 14.8 days. There were 4 patients readmitted within 30 days pre-POPS and none in the post-POPS group. Patient and colleague feedback were obtained. Patient feedback was adapted from experience-based design. Feedback on the POPS intervention was overwhelmingly positive. Conclusion The POPS intervention was well received by patients and colleagues. There was a trend in reduction in LOS (by 2.2 days) and readmission rates in the older laparotomy group. Quality of care was improved for all seen by virtue of medical input, SDM and escalation discussions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"6 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.088
N Malik, S Salman, K Ng, N Tan
* Both authors contributed equally to this work. Introduction Polypharmacy is a major risk for older patients aged 65 and above. Commonly prescribed medications may have anticholinergic properties causing dry mouth, constipation, and urinary retention which can exacerbate delirium in older adults1. ACB scores help quantify the cumulative effect of these medications. ACB scores of three or more are associated with confusion, falls and death2. Aim To evaluate whether automated alerts of ACB scores help reduce scores and encourage medication reviews in older patients. Method Over two weeks, automated alerts were set up within the hospital’s online noting system, which is simulated to flag high ACB scores based on inpatient drug charts. The alert identified the total ACB score and highlighted offending medications. Data was collected from 40 patients across four elderly care wards over two weeks, on alternate days. ACB scores were calculated using an online ACB calculator. ACB scores collected before and after two simulated alerts were analysed and compared. Results Out of 40 patients, 12 had an ACB score of 3 or more before the simulated alerts. Following two automated alerts, this reduced to 9 patients, which equates to a 25% reduction. However, in 31 patients, the ACB score remained unchanged. The ACB scores increased in 8 of the 40 patients. Furthermore, lansoprazole was the most common offending drug, followed by tricyclic antidepressants. Conclusion Our study demonstrated that automated reminders could facilitate regular medical reviews and reduce anticholinergic burden in elderly patients. However, this would work better in combination with regular teaching sessions to increase awareness. Importantly, proton pump inhibitors (PPIs) were prescribed to over a quarter of patients. This raises questions about the necessity of these medications in this age group and a potential QIP looking at deprescribing PPIs as per the deprescribing algorithm.
{"title":"3765 Reducing anticholinergic burden (ACB) within the elderly care wards through implementation of automated alerts","authors":"N Malik, S Salman, K Ng, N Tan","doi":"10.1093/ageing/afaf368.088","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.088","url":null,"abstract":"* Both authors contributed equally to this work. Introduction Polypharmacy is a major risk for older patients aged 65 and above. Commonly prescribed medications may have anticholinergic properties causing dry mouth, constipation, and urinary retention which can exacerbate delirium in older adults1. ACB scores help quantify the cumulative effect of these medications. ACB scores of three or more are associated with confusion, falls and death2. Aim To evaluate whether automated alerts of ACB scores help reduce scores and encourage medication reviews in older patients. Method Over two weeks, automated alerts were set up within the hospital’s online noting system, which is simulated to flag high ACB scores based on inpatient drug charts. The alert identified the total ACB score and highlighted offending medications. Data was collected from 40 patients across four elderly care wards over two weeks, on alternate days. ACB scores were calculated using an online ACB calculator. ACB scores collected before and after two simulated alerts were analysed and compared. Results Out of 40 patients, 12 had an ACB score of 3 or more before the simulated alerts. Following two automated alerts, this reduced to 9 patients, which equates to a 25% reduction. However, in 31 patients, the ACB score remained unchanged. The ACB scores increased in 8 of the 40 patients. Furthermore, lansoprazole was the most common offending drug, followed by tricyclic antidepressants. Conclusion Our study demonstrated that automated reminders could facilitate regular medical reviews and reduce anticholinergic burden in elderly patients. However, this would work better in combination with regular teaching sessions to increase awareness. Importantly, proton pump inhibitors (PPIs) were prescribed to over a quarter of patients. This raises questions about the necessity of these medications in this age group and a potential QIP looking at deprescribing PPIs as per the deprescribing algorithm.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"68 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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