Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.016
H Kingston, R Podmore
Introduction Frailty is a strong prognostic predictor. By incorporation routine frailty scoring as part of routine primary care this can help as guide to clinical teams. Method In 2021 we recognised that our we needed to improve identification of frailty. We undertook whole team training of nurse, GPs and Health Care Assistants, and incorporated scoring the Rockwood Clinical Scale as a routine part of regular chronic disease reviews and template for those over 80. An alert was added on the clinical system to highlight last Rockwood score or where this remained outstanding. Results In May 2020 we have proactively recorded frailty status as mild moderate or severe frailty or a Rockwood score in only 22% patients and 27% patients in May 2021 and 33% in May 2022. With implementation of a systematic approach the completeness of our data has improved from to 66% by May 2023 and has since steadily increased to 81% in May 2024 and 90% in May 2025. Comparison with neighbouring practices in Mendip where this change was not implemented shows a smaller incremental rise in completeness of recording from 33% in 2020 to 47% in May 2025. Conclusion Although in 2021 our proactive coding for frailty lagged behind the performance of other Mendip practices, we have been able to make improvements from coding 24.3% of those over 80 to now having coded 90.1% of this group through a systematic approach. Working as a whole practice team it has been possible to identify those living with frailty using Rockwood scoring. The coding of those at advanced age who are not frail can also help ensure this group continue to have full medical interventions and are not subject to age discrimination.
{"title":"3683 Improving frailty coding through a systems approach in primary care","authors":"H Kingston, R Podmore","doi":"10.1093/ageing/afaf368.016","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.016","url":null,"abstract":"Introduction Frailty is a strong prognostic predictor. By incorporation routine frailty scoring as part of routine primary care this can help as guide to clinical teams. Method In 2021 we recognised that our we needed to improve identification of frailty. We undertook whole team training of nurse, GPs and Health Care Assistants, and incorporated scoring the Rockwood Clinical Scale as a routine part of regular chronic disease reviews and template for those over 80. An alert was added on the clinical system to highlight last Rockwood score or where this remained outstanding. Results In May 2020 we have proactively recorded frailty status as mild moderate or severe frailty or a Rockwood score in only 22% patients and 27% patients in May 2021 and 33% in May 2022. With implementation of a systematic approach the completeness of our data has improved from to 66% by May 2023 and has since steadily increased to 81% in May 2024 and 90% in May 2025. Comparison with neighbouring practices in Mendip where this change was not implemented shows a smaller incremental rise in completeness of recording from 33% in 2020 to 47% in May 2025. Conclusion Although in 2021 our proactive coding for frailty lagged behind the performance of other Mendip practices, we have been able to make improvements from coding 24.3% of those over 80 to now having coded 90.1% of this group through a systematic approach. Working as a whole practice team it has been possible to identify those living with frailty using Rockwood scoring. The coding of those at advanced age who are not frail can also help ensure this group continue to have full medical interventions and are not subject to age discrimination.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"110 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122380","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/afaf368.163
K Ali, E Mensah, J M Stevenson, S Nyangoma, V Hamer, N Parekh, C Rajkumar, J G Davies, M Touray, H Gage, S Fowler-Davis
Introduction Medication-related harm (MRH) is a challenge for older adults in the period following hospital discharge. NHS Discharge Medicines Service (DMS), within the Community Pharmacy Contractual Framework, aims to reduce post-discharge MRH through improved communication between hospital, community pharmacists, and patients. The aim of the study was to investigate the effectiveness of an individualised medicine management plan (MMP) plus DMS in reducing medication-related harm compared to DMS only. Method Older adults ≥65 years were recruited from 8 hospitals in England and randomised to intervention (MMP of patient education about medicines and discussion around medication risk plus DMS) or control (DMS only). Baseline data included patients’ clinical and social demographics and medication risk calculated using a risk-prediction tool at the point of discharge. At 8-weeks post-discharge, trained study pharmacists or doctors verified MRH via triangulation of outcome data obtained from telephone interview with study participants and/or carers, review of GP records and identifying cause of readmission if it occurred. A process evaluation assessed the acceptability of study methods by hospital pharmacists. Results A total of 274 patients were included (140 control, 134 intervention), mean age of 80.1 years (range 65–100), 151 (55.1%) females. In both study arms, MRH was strongly associated with hospital readmission (OR = 5.29, 95% CI: 1.57–17.77) and use of A&E services (OR = 4.21, 95% CI: 1.33–13.31). Although not statistically significant, there was a consistent trend towards reduced odds of adverse outcomes in the intervention group, OR = 0.52 (95% CI: 0.16–1.68). The process evaluation showed that the study strengths were a standardised medicine management plan, objectively assessing medications risk, and identifying opportunities for pharmacist-led interventions. Conclusion MRH after leaving hospital has a substantial impact on healthcare utilisation. The study intervention has the potential to deliver clinically important benefits through reducing MRH.
{"title":"3767 Results of a randomised controlled study to reduce medication-related harm in older adults after hospital discharge","authors":"K Ali, E Mensah, J M Stevenson, S Nyangoma, V Hamer, N Parekh, C Rajkumar, J G Davies, M Touray, H Gage, S Fowler-Davis","doi":"10.1093/ageing/afaf368.163","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.163","url":null,"abstract":"Introduction Medication-related harm (MRH) is a challenge for older adults in the period following hospital discharge. NHS Discharge Medicines Service (DMS), within the Community Pharmacy Contractual Framework, aims to reduce post-discharge MRH through improved communication between hospital, community pharmacists, and patients. The aim of the study was to investigate the effectiveness of an individualised medicine management plan (MMP) plus DMS in reducing medication-related harm compared to DMS only. Method Older adults ≥65 years were recruited from 8 hospitals in England and randomised to intervention (MMP of patient education about medicines and discussion around medication risk plus DMS) or control (DMS only). Baseline data included patients’ clinical and social demographics and medication risk calculated using a risk-prediction tool at the point of discharge. At 8-weeks post-discharge, trained study pharmacists or doctors verified MRH via triangulation of outcome data obtained from telephone interview with study participants and/or carers, review of GP records and identifying cause of readmission if it occurred. A process evaluation assessed the acceptability of study methods by hospital pharmacists. Results A total of 274 patients were included (140 control, 134 intervention), mean age of 80.1 years (range 65–100), 151 (55.1%) females. In both study arms, MRH was strongly associated with hospital readmission (OR = 5.29, 95% CI: 1.57–17.77) and use of A&E services (OR = 4.21, 95% CI: 1.33–13.31). Although not statistically significant, there was a consistent trend towards reduced odds of adverse outcomes in the intervention group, OR = 0.52 (95% CI: 0.16–1.68). The process evaluation showed that the study strengths were a standardised medicine management plan, objectively assessing medications risk, and identifying opportunities for pharmacist-led interventions. Conclusion MRH after leaving hospital has a substantial impact on healthcare utilisation. The study intervention has the potential to deliver clinically important benefits through reducing MRH.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"235 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122142","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/afaf368.028
A Turna, E Lines
Introduction Elderly patients undergoing surgery for neck of femur (NOF) fractures are at high risk of post-operative hypotension due to reduced physiological reserve. Hypotension in this context is associated with an increased risk of cardiovascular events and impaired recovery. Therefore, senior clinicians often pre-emptively hold angiotensin-converting enzyme inhibitors (ACE-Is) and calcium channel blockers (CCBs) for 48 hours post-operatively, but this practice is inconsistently followed by resident doctors. We audited the prevalence and impact of this practice and introduced an intervention to improve consistency. Methods A two-cycle audit was conducted on an orthogeriatric ward. Inclusion criteria were patients aged >65 requiring surgery for NOF fractures. Data collected included antihypertensive use on admission, whether antihypertensives were held post-operatively, systolic blood pressure on post-operative days (POD) 1–3, episodes of moderate (90–100 mmHg) and severe (<90 mmHg) systolic hypotension, and potential confounders (haemoglobin drop, fluid resuscitation, age). Ethical approval was waived. After the first cycle, an intervention was introduced: (1) an induction teaching session for resident doctors and (2) a revised post-op proforma prompting holding of ACE-Is and CCBs. Results Twenty-four patients were included pre-intervention, and 25 post-intervention. 75% of patients were taking at least one antihypertensive on admission. Already in the first cycle, patients in whom antihypertensives were held pre-emptively had significantly fewer days of severe hypotension in POD 1–3 (0.36 vs. 0.64 days, p = 0.03). Prior to the intervention, antihypertensives were appropriately held in 40% of cases. Post-intervention, this rose to 88% (p = 0.04). The average number of days with severe hypotension decreased from 0.62 to 0.28 (p = 0.03), and hypotension incidence fell from 35% to 28% (p = 0.01). Conclusion Pre-emptively withholding ACE-Is and CCBs post-operatively for 48 hours in elderly patients reduces the incidence and duration of hypotension. Teaching and documentation prompts can embed this practice into routine care and improve post-operative outcomes.
{"title":"3761 Pre-emptive holding of antihypertensives after neck of femur fracture surgery: a PDSA audit in an orthogeriatric ward","authors":"A Turna, E Lines","doi":"10.1093/ageing/afaf368.028","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.028","url":null,"abstract":"Introduction Elderly patients undergoing surgery for neck of femur (NOF) fractures are at high risk of post-operative hypotension due to reduced physiological reserve. Hypotension in this context is associated with an increased risk of cardiovascular events and impaired recovery. Therefore, senior clinicians often pre-emptively hold angiotensin-converting enzyme inhibitors (ACE-Is) and calcium channel blockers (CCBs) for 48 hours post-operatively, but this practice is inconsistently followed by resident doctors. We audited the prevalence and impact of this practice and introduced an intervention to improve consistency. Methods A two-cycle audit was conducted on an orthogeriatric ward. Inclusion criteria were patients aged &gt;65 requiring surgery for NOF fractures. Data collected included antihypertensive use on admission, whether antihypertensives were held post-operatively, systolic blood pressure on post-operative days (POD) 1–3, episodes of moderate (90–100 mmHg) and severe (&lt;90 mmHg) systolic hypotension, and potential confounders (haemoglobin drop, fluid resuscitation, age). Ethical approval was waived. After the first cycle, an intervention was introduced: (1) an induction teaching session for resident doctors and (2) a revised post-op proforma prompting holding of ACE-Is and CCBs. Results Twenty-four patients were included pre-intervention, and 25 post-intervention. 75% of patients were taking at least one antihypertensive on admission. Already in the first cycle, patients in whom antihypertensives were held pre-emptively had significantly fewer days of severe hypotension in POD 1–3 (0.36 vs. 0.64 days, p = 0.03). Prior to the intervention, antihypertensives were appropriately held in 40% of cases. Post-intervention, this rose to 88% (p = 0.04). The average number of days with severe hypotension decreased from 0.62 to 0.28 (p = 0.03), and hypotension incidence fell from 35% to 28% (p = 0.01). Conclusion Pre-emptively withholding ACE-Is and CCBs post-operatively for 48 hours in elderly patients reduces the incidence and duration of hypotension. Teaching and documentation prompts can embed this practice into routine care and improve post-operative outcomes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"87 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122198","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/afaf368.024
F Bako, M Myint
Introduction Controlling BP minimises the rate of ICH and reperfusion to promote adequate cerebral perfusion (2). Antiplatelets reduce the risk of recurrent stroke and other vascular events (3). Cholesterol reduction reduces the risk of stroke by reducing harming lipids (4). Diet and exercise are independent stroke reducers and positively impacts both weight and blood pressure (5). Smoking cessation can greatly reduce your risk of stroke (7) (8) (9). If carotid endarterectomy takes place sooner the absolute risk reduction (ARR) is increased and the outcome for the patient is much better (1). Standards and Ethics National Clinical Guideline for Stroke and it is under the section Acute Care Criteria for Carotid Doppler Ultrasound Scan (CDUS) include: Short lived symptoms (TIA), Minor non debilitating symptoms so that they can have further surgery (in this audit we have defined this as NIHSS score < 5) and has to be anterior stroke. Ethic approval was not needed as it is focused on improving the quality of care within routine clinical practice and do not involve interventions or data collection beyond standard acre. The audit was registered with the audit department and the audit registration number is Ca11032. Methods A re-evaluation of 49 patients with an (National Institutes of Health Stroke Scale) NIHSS score admitted to E58 in Sunderland Royal Hospital between 21st June 2024- 67th August 2024 were analysed. Aims and Objectives. Aim Complete cycle 2 of an audit investigating if ward E58 have improved their management of patients appropriate for CDUS. Objectives Document how many patients had their carotid doppler ultrasound scans. Log how many were seen within 24 hours. Establish how many patients undergo vascular surgery. Calculate how long patients were seen between CDUS report and surgery. Demonstrate how many patients were treated correct with pharmacological therapy including: Correct statin treatment; Correct antiplatelet treatment. Demonstrate how many patients had non-pharmacological treatment explored. Diet, Lifestyle and Smoking cessation. Results 100% success rate in all strokes reviewed receiving the correct antiplatelet therapy. 25/30 (83.3%) patients were started on cholesterol lowering therapy. This is a three percent increase from last time. 4/30 patients (13.3%) were talked to about diet and exercise/lifestyle measures. This is a 2% increase from last time. The doctors did well in this study and were better at commenting on blood pressure. 18/30 (60%) of patients which is a great improvement as there were only 3% of cases commented on previously. Only one patient received vascular surgery and they did not have it within seven days. There were multiple factors leading to delay in surgery—they had their CDUS as an outpatient and there was a delay in the aorta CTa being ordered. Then the surgery was booked for 3 weeks after the aorta CTA was reported. Conclusion What we excel at: Prescribing antiplatelet medications and stat
{"title":"3479 Re-evaluation of stroke patients with NIHSS score < 5 at Sunderland Royal Hospital","authors":"F Bako, M Myint","doi":"10.1093/ageing/afaf368.024","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.024","url":null,"abstract":"Introduction Controlling BP minimises the rate of ICH and reperfusion to promote adequate cerebral perfusion (2). Antiplatelets reduce the risk of recurrent stroke and other vascular events (3). Cholesterol reduction reduces the risk of stroke by reducing harming lipids (4). Diet and exercise are independent stroke reducers and positively impacts both weight and blood pressure (5). Smoking cessation can greatly reduce your risk of stroke (7) (8) (9). If carotid endarterectomy takes place sooner the absolute risk reduction (ARR) is increased and the outcome for the patient is much better (1). Standards and Ethics National Clinical Guideline for Stroke and it is under the section Acute Care Criteria for Carotid Doppler Ultrasound Scan (CDUS) include: Short lived symptoms (TIA), Minor non debilitating symptoms so that they can have further surgery (in this audit we have defined this as NIHSS score &lt; 5) and has to be anterior stroke. Ethic approval was not needed as it is focused on improving the quality of care within routine clinical practice and do not involve interventions or data collection beyond standard acre. The audit was registered with the audit department and the audit registration number is Ca11032. Methods A re-evaluation of 49 patients with an (National Institutes of Health Stroke Scale) NIHSS score admitted to E58 in Sunderland Royal Hospital between 21st June 2024- 67th August 2024 were analysed. Aims and Objectives. Aim Complete cycle 2 of an audit investigating if ward E58 have improved their management of patients appropriate for CDUS. Objectives Document how many patients had their carotid doppler ultrasound scans. Log how many were seen within 24 hours. Establish how many patients undergo vascular surgery. Calculate how long patients were seen between CDUS report and surgery. Demonstrate how many patients were treated correct with pharmacological therapy including: Correct statin treatment; Correct antiplatelet treatment. Demonstrate how many patients had non-pharmacological treatment explored. Diet, Lifestyle and Smoking cessation. Results 100% success rate in all strokes reviewed receiving the correct antiplatelet therapy. 25/30 (83.3%) patients were started on cholesterol lowering therapy. This is a three percent increase from last time. 4/30 patients (13.3%) were talked to about diet and exercise/lifestyle measures. This is a 2% increase from last time. The doctors did well in this study and were better at commenting on blood pressure. 18/30 (60%) of patients which is a great improvement as there were only 3% of cases commented on previously. Only one patient received vascular surgery and they did not have it within seven days. There were multiple factors leading to delay in surgery—they had their CDUS as an outpatient and there was a delay in the aorta CTa being ordered. Then the surgery was booked for 3 weeks after the aorta CTA was reported. Conclusion What we excel at: Prescribing antiplatelet medications and stat","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"17 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121870","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/afaf368.146
T Tay, F Chen, H Amin, B Maan, S Dryden, M Fertleman, L Shepherd, K Grailey, A Darzi
Introduction Frailty is defined as a clinically recognised state of increased vulnerability, reflecting a decline in an individual’s psychological and physical reserves. Digital interventions, such as smartwatches, are increasingly utilised to monitor and support the health of older adults. Evidence on the effectiveness of digital interventions in reducing or reversing frailty is limited. This systematic review aimed to investigate the types of digital interventions tested and the resulting outcomes. Method The following databases: Medline, CINAHL, Scopus, PsychInfo and Embase were searched from time of origin until July 2024. A search strategy was designed to identify randomised controlled trials assessing the impact of digital interventions on older adults. Outcome measures explored include frailty, wellbeing and quality of life. Narrative synthesis was performed for all studies and meta-analysis was performed for outcomes reported in four or more studies. Risk of bias was conducted using Cochrane Risk of Bias-2 tool. Results From 4476 titles and abstracts screened, 17 studies were included following full text review. Overall, 12 studies included exercises as a component or the sole form of intervention. The mean duration of intervention was 4.04 (SD 2.56) months. Mean adherence to the intervention was 59%. The most reported frailty-specific outcome was walking speed (n = 8), while the least reported outcome was self-reported exhaustion level (n = 2). Meta-analysis showed non-exercise-based interventions showed significant improvements in SPPB. There was no statistically significant change in TUG and handgrip strength. Narrative synthesis indicates there was insufficient evidence to evaluate the impact of digital interventions on frailty, cognition, wellbeing, activities of daily living and health-related quality of life. Conclusions The findings suggest low technological readiness and adherence among digital interventions for older adults. Narrative synthesis of overall frailty and outcome measures showed mixed results and insufficient evidence on the impact of digital interventions on frailty and outcomes reviewed.
虚弱被定义为一种临床公认的脆弱性增加的状态，反映了个人心理和身体储备的下降。智能手表等数字干预措施越来越多地用于监测和支持老年人的健康。关于数字干预措施在减少或扭转脆弱性方面的有效性的证据有限。本系统综述旨在调查所测试的数字干预措施的类型及其结果。方法检索自文献来源时间至2024年7月的Medline、CINAHL、Scopus、PsychInfo和Embase数据库。设计了一种搜索策略，以确定评估数字干预对老年人影响的随机对照试验。研究结果包括虚弱、健康和生活质量。对所有研究进行叙事综合，并对四项或更多研究报告的结果进行荟萃分析。偏倚风险采用Cochrane Risk of bias -2工具进行。结果从筛选的4476篇标题和摘要中，纳入了17项研究。总的来说，有12项研究将锻炼作为干预的组成部分或唯一形式。平均干预时间为4.04个月（SD 2.56）。干预的平均依从性为59%。报告最多的虚弱特异性结果是步行速度（n = 8），而报告最少的结果是自我报告的疲劳水平（n = 2）。荟萃分析显示，非运动干预对SPPB有显著改善。TUG和握力没有统计学上的显著变化。叙述性综合表明，没有足够的证据来评估数字干预措施对脆弱性、认知、福祉、日常生活活动和与健康相关的生活质量的影响。结论：研究结果表明，老年人数字干预的技术准备程度和依从性较低。对总体脆弱性和结果测量的叙述性综合结果显示，数字干预措施对脆弱性和结果的影响结果好坏参半，证据不足。
{"title":"3734 The impact of digital interventions to reverse frailty—systematic review and meta-analysis","authors":"T Tay, F Chen, H Amin, B Maan, S Dryden, M Fertleman, L Shepherd, K Grailey, A Darzi","doi":"10.1093/ageing/afaf368.146","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.146","url":null,"abstract":"Introduction Frailty is defined as a clinically recognised state of increased vulnerability, reflecting a decline in an individual’s psychological and physical reserves. Digital interventions, such as smartwatches, are increasingly utilised to monitor and support the health of older adults. Evidence on the effectiveness of digital interventions in reducing or reversing frailty is limited. This systematic review aimed to investigate the types of digital interventions tested and the resulting outcomes. Method The following databases: Medline, CINAHL, Scopus, PsychInfo and Embase were searched from time of origin until July 2024. A search strategy was designed to identify randomised controlled trials assessing the impact of digital interventions on older adults. Outcome measures explored include frailty, wellbeing and quality of life. Narrative synthesis was performed for all studies and meta-analysis was performed for outcomes reported in four or more studies. Risk of bias was conducted using Cochrane Risk of Bias-2 tool. Results From 4476 titles and abstracts screened, 17 studies were included following full text review. Overall, 12 studies included exercises as a component or the sole form of intervention. The mean duration of intervention was 4.04 (SD 2.56) months. Mean adherence to the intervention was 59%. The most reported frailty-specific outcome was walking speed (n = 8), while the least reported outcome was self-reported exhaustion level (n = 2). Meta-analysis showed non-exercise-based interventions showed significant improvements in SPPB. There was no statistically significant change in TUG and handgrip strength. Narrative synthesis indicates there was insufficient evidence to evaluate the impact of digital interventions on frailty, cognition, wellbeing, activities of daily living and health-related quality of life. Conclusions The findings suggest low technological readiness and adherence among digital interventions for older adults. Narrative synthesis of overall frailty and outcome measures showed mixed results and insufficient evidence on the impact of digital interventions on frailty and outcomes reviewed.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"48 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121876","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/afaf368.081
M R Jamal, M Tariq, S Kandel, M Ali, H Patel
Background Hip fractures represent a significant global health burden, leading to substantial morbidity, mortality, and healthcare costs. Delays in surgical intervention are consistently linked to poorer patient outcomes. This audit aimed to evaluate and enhance hip fracture management at Southampton General Hospital (SGH) through targeted quality improvement initiatives. Methods An interventional clinical audit was conducted at SGH, a Major Trauma Centre, comparing a pre-intervention period (December 2023—March 2024; n = 272 patients) with a post-intervention period (September 2024—December 2024; n = 291 patients). The methodology adhered to NICE guidelines. Data were collected via consecutive sampling from the National Hip Fracture Database (NHFD), Pathpoint eTrauma, and CHARTS/EDMS. Interventions focused on increasing surgical capacity (e.g. additional theatre allocation, dedicated hip fracture team), implementing comprehensive multidisciplinary medical evaluation, optimising imaging, addressing pre-existing conditions, standardising anticoagulation reversal, and improving overall patient care. Mean operating times, 30-day mortality rates, and length of hospital stay (LOS) were assessed and compared between cycles. Results The overall average patient age was 84 years. In the pre-intervention cycle, the mean operating time was 80 hours, with a 30-day mortality rate of 4.7%. Surgical delays affected 57.4% of patients. Post-intervention, the mean operating time significantly decreased to 55 hours, and the 30-day mortality rate reduced to 3.0%, notably lower than the national average of 5.9% for the same period. Despite these improvements, the proportion of delayed surgeries increased slightly to 63.9%. A key finding was that in the post-intervention cycle, an equal number of patients (n = 6) died in both the non-delayed (5.7%) and delayed (3.2%) groups, suggesting that enhanced medical optimisation during delays contributed to improved outcomes. Delays consistently correlated with prolonged LOS in both cycles. Conclusion Targeted quality improvement initiatives at SGH significantly reduced the average time to hip fracture surgery and improved overall mortality rates. The crucial role of comprehensive medical stabilisation in mitigating mortality risks, even when leading to surgical delays, was evident. Despite systemic challenges inherent to a major trauma centre, these interventions demonstrate a positive impact on patient outcomes. Ongoing efforts should focus on sustainable theatre capacity, streamlined diagnostic pathways, and continuous auditing to optimise patient care.
{"title":"3484 Optimising neck of femur fractures surgical timing for improved patient outcomes: an excellence of service clinical audit","authors":"M R Jamal, M Tariq, S Kandel, M Ali, H Patel","doi":"10.1093/ageing/afaf368.081","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.081","url":null,"abstract":"Background Hip fractures represent a significant global health burden, leading to substantial morbidity, mortality, and healthcare costs. Delays in surgical intervention are consistently linked to poorer patient outcomes. This audit aimed to evaluate and enhance hip fracture management at Southampton General Hospital (SGH) through targeted quality improvement initiatives. Methods An interventional clinical audit was conducted at SGH, a Major Trauma Centre, comparing a pre-intervention period (December 2023—March 2024; n = 272 patients) with a post-intervention period (September 2024—December 2024; n = 291 patients). The methodology adhered to NICE guidelines. Data were collected via consecutive sampling from the National Hip Fracture Database (NHFD), Pathpoint eTrauma, and CHARTS/EDMS. Interventions focused on increasing surgical capacity (e.g. additional theatre allocation, dedicated hip fracture team), implementing comprehensive multidisciplinary medical evaluation, optimising imaging, addressing pre-existing conditions, standardising anticoagulation reversal, and improving overall patient care. Mean operating times, 30-day mortality rates, and length of hospital stay (LOS) were assessed and compared between cycles. Results The overall average patient age was 84 years. In the pre-intervention cycle, the mean operating time was 80 hours, with a 30-day mortality rate of 4.7%. Surgical delays affected 57.4% of patients. Post-intervention, the mean operating time significantly decreased to 55 hours, and the 30-day mortality rate reduced to 3.0%, notably lower than the national average of 5.9% for the same period. Despite these improvements, the proportion of delayed surgeries increased slightly to 63.9%. A key finding was that in the post-intervention cycle, an equal number of patients (n = 6) died in both the non-delayed (5.7%) and delayed (3.2%) groups, suggesting that enhanced medical optimisation during delays contributed to improved outcomes. Delays consistently correlated with prolonged LOS in both cycles. Conclusion Targeted quality improvement initiatives at SGH significantly reduced the average time to hip fracture surgery and improved overall mortality rates. The crucial role of comprehensive medical stabilisation in mitigating mortality risks, even when leading to surgical delays, was evident. Despite systemic challenges inherent to a major trauma centre, these interventions demonstrate a positive impact on patient outcomes. Ongoing efforts should focus on sustainable theatre capacity, streamlined diagnostic pathways, and continuous auditing to optimise patient care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"34 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121974","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/afaf368.005
K Giridharan, T Ngubor, E Chethri, C Uduma, C Jedidiah
Introduction Recommendations from the revised European Society of Cardiology (ESC) guidelines (2023) have changed how we manage decompensated heart failure (HF) in acute hospitals. Adherence to ESC guidelines is associated with reduced mortality, readmissions and improved quality of life (www.escardio.org, 2023). This audit was conducted to compare our practice against the above ESC guidelines. Method Two PDSA cycles were completed between July 2024 and April 2025 in the Acute Frailty Unit and two Elderly Care wards. Patients presenting with decompensated HF above 65 years were included. Data were collected from electronic health records on diagnosis of HF and its phenotype, initiation of appropriate guideline-directed medical therapy, and diagnosis and management of anaemia. Interventions post 1st PDSA cycle include departmental teaching, discussing HF phenotype and the management at the board rounds, teaching during ward rounds, presentation at the governance meeting and displaying posters. Results The first PDSA cycle included 28 patients, and the second one included 42 patients. Five out of 28 patients (18%) had their phenotype mentioned in the initial clerking, and 11 (39%) in their discharge notes in the first cycle, compared to 23 out of 42 (54.7%) and 27 out of 42 (64.3%) in the second cycle. The patients investigated for iron deficiency improved from 43% to 69%, post intervention. Out of 12 patients with iron deficiency, only 5 received iron infusion in the 1st cycle, whereas 14 out of 15 received in the 2nd cycle (42% to 93%). 10 out of 22 (45%) eligible patients were started on SGLT2i in 1st cycle as opposed to 22 out of 28 (79%) in 2nd cycle. Out of 9 appropriate patients, only 3 were commenced on ACE/ARB/ARNI in the first cycle, which improved to 17 out of 18 post-intervention (33% to 94%). 3 out of 9 (33%) eligible patients were started on MRAs in the 1st cycle, which improved to 13 out of 13 (100%) in the 2nd cycle. Conclusion A significant improvement was demonstrated in the management of acute HF, during the second PDSA cycle. The interventions implemented were effective and transferable to similar settings in the UK.
{"title":"3436 A quality improvement initiative on the ‘diagnosis and management of acute heart failure in older adults’","authors":"K Giridharan, T Ngubor, E Chethri, C Uduma, C Jedidiah","doi":"10.1093/ageing/afaf368.005","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.005","url":null,"abstract":"Introduction Recommendations from the revised European Society of Cardiology (ESC) guidelines (2023) have changed how we manage decompensated heart failure (HF) in acute hospitals. Adherence to ESC guidelines is associated with reduced mortality, readmissions and improved quality of life (www.escardio.org, 2023). This audit was conducted to compare our practice against the above ESC guidelines. Method Two PDSA cycles were completed between July 2024 and April 2025 in the Acute Frailty Unit and two Elderly Care wards. Patients presenting with decompensated HF above 65 years were included. Data were collected from electronic health records on diagnosis of HF and its phenotype, initiation of appropriate guideline-directed medical therapy, and diagnosis and management of anaemia. Interventions post 1st PDSA cycle include departmental teaching, discussing HF phenotype and the management at the board rounds, teaching during ward rounds, presentation at the governance meeting and displaying posters. Results The first PDSA cycle included 28 patients, and the second one included 42 patients. Five out of 28 patients (18%) had their phenotype mentioned in the initial clerking, and 11 (39%) in their discharge notes in the first cycle, compared to 23 out of 42 (54.7%) and 27 out of 42 (64.3%) in the second cycle. The patients investigated for iron deficiency improved from 43% to 69%, post intervention. Out of 12 patients with iron deficiency, only 5 received iron infusion in the 1st cycle, whereas 14 out of 15 received in the 2nd cycle (42% to 93%). 10 out of 22 (45%) eligible patients were started on SGLT2i in 1st cycle as opposed to 22 out of 28 (79%) in 2nd cycle. Out of 9 appropriate patients, only 3 were commenced on ACE/ARB/ARNI in the first cycle, which improved to 17 out of 18 post-intervention (33% to 94%). 3 out of 9 (33%) eligible patients were started on MRAs in the 1st cycle, which improved to 13 out of 13 (100%) in the 2nd cycle. Conclusion A significant improvement was demonstrated in the management of acute HF, during the second PDSA cycle. The interventions implemented were effective and transferable to similar settings in the UK.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"21 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121978","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/afaf368.083
J Alvarez-Martin, C J Miller, S J Clark
Introduction The increasing prevalence of frailty in the ageing UK population poses significant challenges for healthcare systems, particularly in emergency departments (EDs). Frailty is a leading factor in hospital readmissions among individuals over 65 years old. This project aims to analyse readmissions of frail patients within 7 and 30 days of ED discharge following comprehensive geriatric assessments (CGAs). Method This retrospective audit aimed to identify 7-day and 30-day readmissions of patients discharged by the Frailty Emergency Service (FES) at Leicester Royal Infirmary over a six-month period (April–September 2021) and potential readmissions related to the first presentation. Data were collected using Electronic Health Records and anonymised by the ED audit team, with variables including age, gender, ethnicity, readmission status within 7 and 30 days, and reasons for readmission. Preventability of readmissions was assessed by comparing diagnosis from the first visit and the following admission to the hospital, considering positive if at least one diagnosis was repeated, a descriptive statistical analysis was performed. The scope of practice involves only patients older than 65 that have a CFS of 6 or above for any reason, or a CFS of 4 and above but have presented to ED with a geriatric syndrome. Results During the six-month period beginning April 1, 2021, the FES team in ED performed 749 discharges, including 705 primary visits and 34 revisits (4,6%). Of the 749 discharges, 110 patients required hospital readmission within 30 days, resulting in an overall readmission rate of 14,68%, increasing to 15,68% when adjusted for primary visits on the first 30 days and 52 on the first 7 days which represents 6,94% readmission rate in total. The potential preventable visits for the first 7 days after discharge was 40 (76,92%) and 68 (61,81%) in the first 30 days. The primary reasons for readmissions included falls, infections, delirium, and social problems. For patients with multiple visits, only data from the initial visit was included in the analysis. Conclusion(s) The overall results reveal FES readmission rates align with global CGA studies but highlight potential for improvement. Falls and infections were identified as primary causes of readmissions, with insufficient MDT involvement linked to higher rates. A multifactorial intervention, emphasising MDT collaboration, team expansion, and improved follow-up care, is proposed to reduce readmissions.
{"title":"3681 Readmissions after frailty emergency squad discharge in the emergency department","authors":"J Alvarez-Martin, C J Miller, S J Clark","doi":"10.1093/ageing/afaf368.083","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.083","url":null,"abstract":"Introduction The increasing prevalence of frailty in the ageing UK population poses significant challenges for healthcare systems, particularly in emergency departments (EDs). Frailty is a leading factor in hospital readmissions among individuals over 65 years old. This project aims to analyse readmissions of frail patients within 7 and 30 days of ED discharge following comprehensive geriatric assessments (CGAs). Method This retrospective audit aimed to identify 7-day and 30-day readmissions of patients discharged by the Frailty Emergency Service (FES) at Leicester Royal Infirmary over a six-month period (April–September 2021) and potential readmissions related to the first presentation. Data were collected using Electronic Health Records and anonymised by the ED audit team, with variables including age, gender, ethnicity, readmission status within 7 and 30 days, and reasons for readmission. Preventability of readmissions was assessed by comparing diagnosis from the first visit and the following admission to the hospital, considering positive if at least one diagnosis was repeated, a descriptive statistical analysis was performed. The scope of practice involves only patients older than 65 that have a CFS of 6 or above for any reason, or a CFS of 4 and above but have presented to ED with a geriatric syndrome. Results During the six-month period beginning April 1, 2021, the FES team in ED performed 749 discharges, including 705 primary visits and 34 revisits (4,6%). Of the 749 discharges, 110 patients required hospital readmission within 30 days, resulting in an overall readmission rate of 14,68%, increasing to 15,68% when adjusted for primary visits on the first 30 days and 52 on the first 7 days which represents 6,94% readmission rate in total. The potential preventable visits for the first 7 days after discharge was 40 (76,92%) and 68 (61,81%) in the first 30 days. The primary reasons for readmissions included falls, infections, delirium, and social problems. For patients with multiple visits, only data from the initial visit was included in the analysis. Conclusion(s) The overall results reveal FES readmission rates align with global CGA studies but highlight potential for improvement. Falls and infections were identified as primary causes of readmissions, with insufficient MDT involvement linked to higher rates. A multifactorial intervention, emphasising MDT collaboration, team expansion, and improved follow-up care, is proposed to reduce readmissions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"24 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122145","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/afaf368.053
L Scanlon, J Coffey, C Thomas, A Edwards, G Rose, I Singh
Introduction Fracture liaison services (FLS) aim to prevent secondary fractures by promptly identifying patients above 50 years with fragility fractures. The standard recommendation by FLS Database (FLS-DB) is to identify 80% expected fragility fractures, commencing treatment for 50% and monitor 80% at 52 weeks. Methods A quality improvement methodology based on the model of improvement; Plan-Do-Study-Act (PDSA) cycles was introduced in 2022. The fragility fracture case identification increased from 22.7% (2021) to 41.1% (2022) and 58.4% in 2023, a 149% increase. Process mapping for the Aneurin Bevan FLS (AB-FLS) showed that follow-up clinics were only ad-hoc and not formalised. A separate clinic code for annual review of patients, led by Speciality Geriatric Trainee was tested in 2023. One-year follow-up clinic streamlined service and improved performance to 25.9% (360 cases) in 2023, just above the national benchmark (24.2%). Our objective is to introduce multi-stakeholder involvement to further improve and sustain 52-weeks follow-up improvement to meet the service demand and national target. Results Multiple PDSA cycles led to AB-FLS Quality Assurance group including clinicians, Pharmacist, Primary Care General Practitioner as Influencers and three Patient Representatives. Team met formally every 3 months to review interventions and introduce changes. Challenges were overcome by providing a dedicated 52-weeks follow-up clinic. In addition, engagement with Primary Care for longer-term osteoporosis care unless requiring specialist bone health reviews is ongoing. In 2024, AB-FLS identified 2620 cases (70%; National benchmark = 39.9%) and commenced bone treatment for 1611 cases (61.5%; National Benchmark = 56.4%). The 52-weeks follow-up improved from 25.9% (360 cases) in 2023 to 62.7% (1010 cases) in 2024, which is more than double the national benchmark (24.2%). Conclusion This work is aligned with Welsh Prudent Healthcare principles of evidence-based medicine, partnership working with patients and meeting the unmet needs of the most vulnerable. Collaborative efforts with diverse stakeholders including primary care and patient representative have improved 52-week follow-up in 62% fracture patients. The success of this multi-stakeholder quality initiatives offers compelling evidence that this model is scalable across Wales, providing a sustainable and impactful solution to managing osteoporosis and preventing secondary fractures.
{"title":"3788 Multi-stakeholder approach: building on existing quality initiatives to improve 52-week follow-up based on FLS-DB guidance","authors":"L Scanlon, J Coffey, C Thomas, A Edwards, G Rose, I Singh","doi":"10.1093/ageing/afaf368.053","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.053","url":null,"abstract":"Introduction Fracture liaison services (FLS) aim to prevent secondary fractures by promptly identifying patients above 50 years with fragility fractures. The standard recommendation by FLS Database (FLS-DB) is to identify 80% expected fragility fractures, commencing treatment for 50% and monitor 80% at 52 weeks. Methods A quality improvement methodology based on the model of improvement; Plan-Do-Study-Act (PDSA) cycles was introduced in 2022. The fragility fracture case identification increased from 22.7% (2021) to 41.1% (2022) and 58.4% in 2023, a 149% increase. Process mapping for the Aneurin Bevan FLS (AB-FLS) showed that follow-up clinics were only ad-hoc and not formalised. A separate clinic code for annual review of patients, led by Speciality Geriatric Trainee was tested in 2023. One-year follow-up clinic streamlined service and improved performance to 25.9% (360 cases) in 2023, just above the national benchmark (24.2%). Our objective is to introduce multi-stakeholder involvement to further improve and sustain 52-weeks follow-up improvement to meet the service demand and national target. Results Multiple PDSA cycles led to AB-FLS Quality Assurance group including clinicians, Pharmacist, Primary Care General Practitioner as Influencers and three Patient Representatives. Team met formally every 3 months to review interventions and introduce changes. Challenges were overcome by providing a dedicated 52-weeks follow-up clinic. In addition, engagement with Primary Care for longer-term osteoporosis care unless requiring specialist bone health reviews is ongoing. In 2024, AB-FLS identified 2620 cases (70%; National benchmark = 39.9%) and commenced bone treatment for 1611 cases (61.5%; National Benchmark = 56.4%). The 52-weeks follow-up improved from 25.9% (360 cases) in 2023 to 62.7% (1010 cases) in 2024, which is more than double the national benchmark (24.2%). Conclusion This work is aligned with Welsh Prudent Healthcare principles of evidence-based medicine, partnership working with patients and meeting the unmet needs of the most vulnerable. Collaborative efforts with diverse stakeholders including primary care and patient representative have improved 52-week follow-up in 62% fracture patients. The success of this multi-stakeholder quality initiatives offers compelling evidence that this model is scalable across Wales, providing a sustainable and impactful solution to managing osteoporosis and preventing secondary fractures.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"89 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122147","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/afaf368.142
N Wee, L C Heng, C Y Chia, W Q Mok, J A Low, C Y Cheong, P L K Yap
Introduction Mobility decline during hospitalisation is common among older adults and is associated with adverse outcomes including prolonged length of stay, institutionalisation, and mortality. While physical activity and sleep are key modifiable factors influencing recovery and mobility improvement, their relationships remain underexplored in acute geriatric settings. Methods We conducted a prospective observational pilot study involving 15 hospitalised older adults (mean age 84.9 years) admitted to an acute geriatric ward. Participants wore wrist- and thigh-worn ActiGraph wGT3X-BT accelerometers continuously during admission to measure sleep parameters and physical activity. Mobility was assessed at baseline and discharge using the de Morton Mobility Index (DEMMI). Accelerometry-derived metrics included daily time spent in light, moderate, and vigorous physical activity, moderate-to-vigorous physical activity (MVPA) as a percentage of waking hours, and sleep fragmentation indices (number of awakenings, sleep efficiency). Descriptive analyses and Mann–Whitney U tests were conducted to examine relationships between activity, sleep, and mobility changes. Results DEMMI scores improved significantly (mean change +6.8 points, 95% CI: −13.4 to −0.2, p = 0.045). Participants spent a median of 63 minutes/day in light activity and 2.4 minutes/day in moderate activity. Median MVPA comprised 0.25% of waking hours. Sleep was fragmented (mean 18 awakenings/night; sleep efficiency 69%). Among participants with improved mobility (n = 6), the mean number of nocturnal awakenings was 14.2 (SD = 2.1) compared to 17.4 (SD = 2.4) in those with stable or worsened mobility (n = 5), though not statistically significant (p = 0.114). Sleep efficiency was 76.4% (SD = 19.9) in the improved group versus 80.1% (SD = 3.7) in the stable/worsened group (p = 0.680). Conclusions Despite low physical activity levels and fragmented sleep, mobility improved significantly during admission. Although participants with mobility improvement showed fewer nocturnal awakenings, differences were not statistically significant. Larger studies are needed to clarify these associations and to inform interventions targeting sleep and activity to optimise mobility outcomes in hospitalised older adults.
{"title":"3863 Associations between accelerometry-measured physical activity, sleep, and mobility improvement in hospitalised older adults","authors":"N Wee, L C Heng, C Y Chia, W Q Mok, J A Low, C Y Cheong, P L K Yap","doi":"10.1093/ageing/afaf368.142","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.142","url":null,"abstract":"Introduction Mobility decline during hospitalisation is common among older adults and is associated with adverse outcomes including prolonged length of stay, institutionalisation, and mortality. While physical activity and sleep are key modifiable factors influencing recovery and mobility improvement, their relationships remain underexplored in acute geriatric settings. Methods We conducted a prospective observational pilot study involving 15 hospitalised older adults (mean age 84.9 years) admitted to an acute geriatric ward. Participants wore wrist- and thigh-worn ActiGraph wGT3X-BT accelerometers continuously during admission to measure sleep parameters and physical activity. Mobility was assessed at baseline and discharge using the de Morton Mobility Index (DEMMI). Accelerometry-derived metrics included daily time spent in light, moderate, and vigorous physical activity, moderate-to-vigorous physical activity (MVPA) as a percentage of waking hours, and sleep fragmentation indices (number of awakenings, sleep efficiency). Descriptive analyses and Mann–Whitney U tests were conducted to examine relationships between activity, sleep, and mobility changes. Results DEMMI scores improved significantly (mean change +6.8 points, 95% CI: −13.4 to −0.2, p = 0.045). Participants spent a median of 63 minutes/day in light activity and 2.4 minutes/day in moderate activity. Median MVPA comprised 0.25% of waking hours. Sleep was fragmented (mean 18 awakenings/night; sleep efficiency 69%). Among participants with improved mobility (n = 6), the mean number of nocturnal awakenings was 14.2 (SD = 2.1) compared to 17.4 (SD = 2.4) in those with stable or worsened mobility (n = 5), though not statistically significant (p = 0.114). Sleep efficiency was 76.4% (SD = 19.9) in the improved group versus 80.1% (SD = 3.7) in the stable/worsened group (p = 0.680). Conclusions Despite low physical activity levels and fragmented sleep, mobility improved significantly during admission. Although participants with mobility improvement showed fewer nocturnal awakenings, differences were not statistically significant. Larger studies are needed to clarify these associations and to inform interventions targeting sleep and activity to optimise mobility outcomes in hospitalised older adults.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"89 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122379","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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