Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.031
J Hughes, H Parker, S Birchenough, E Cattell, U Barthakur, S Woodhill, M Foster
Introduction Increasing numbers of patients live with both frailty and cancer, highlights highlighting the need for onco-geriatric services. Comprehensive Geriatric Assessment (CGA) of older oncology patients increases QoL and treatment tolerance. Recent guidance from British Geriatrics Society stresses the importance of frailty assessment to identify and optimise frailty related issues, alongside collaborative decision-making with patients. Methods OACOS was created at a District General Hospital in Somerset to identify and medically optimise frail patients in whom the treating oncologist had concerns about their ability to tolerate radical cancer treatment. Patients were referred to the service for a therapy assessment and geriatrician-led CGA to further investigate and manage concerns relating to co-morbidity, social isolation, cognitive impairment and falls. Results Between September 2022 and March 2024, 68 patients were discussed in Oncogeriatrics MDT. 49 patients were seen in the accompanying Oncogeriatrics clinic. Reasons for not being reviewed included not meeting referral criteria, redirection to alternative specialist clinic, sole OT input required and patients declining. Patients seen in clinic had an average CFS of 4 and an average G8 score of 12.5. All patients seen in clinic saw a geriatrician consultant or registrar, with 84% of patients seeing a physiotherapist for a personalised assessment. 92% of patients had a treatment escalation plan completed. All patients had a medication review with 93% of those seen having at least one medication discontinued. Other key interventions included optimisation of blood pressure, cognition and anaemia. Conclusions Patient feedback has been positive, appreciating the opportunity to review their health, optimise medical issues and reduce medication burden. Oncologists have appreciated rapid access to holistic geriatrician review alongside therapy input to improve health outcomes. Further exploration into patient’s reasons for declining review by OACOS may help identify barriers to access for some patients and the future clinic model.
{"title":"3785 Eighteen months of OACOS: evaluating the OACOS (older adults cancer optimisation service) at a district general hospital in Somerset","authors":"J Hughes, H Parker, S Birchenough, E Cattell, U Barthakur, S Woodhill, M Foster","doi":"10.1093/ageing/afaf368.031","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.031","url":null,"abstract":"Introduction Increasing numbers of patients live with both frailty and cancer, highlights highlighting the need for onco-geriatric services. Comprehensive Geriatric Assessment (CGA) of older oncology patients increases QoL and treatment tolerance. Recent guidance from British Geriatrics Society stresses the importance of frailty assessment to identify and optimise frailty related issues, alongside collaborative decision-making with patients. Methods OACOS was created at a District General Hospital in Somerset to identify and medically optimise frail patients in whom the treating oncologist had concerns about their ability to tolerate radical cancer treatment. Patients were referred to the service for a therapy assessment and geriatrician-led CGA to further investigate and manage concerns relating to co-morbidity, social isolation, cognitive impairment and falls. Results Between September 2022 and March 2024, 68 patients were discussed in Oncogeriatrics MDT. 49 patients were seen in the accompanying Oncogeriatrics clinic. Reasons for not being reviewed included not meeting referral criteria, redirection to alternative specialist clinic, sole OT input required and patients declining. Patients seen in clinic had an average CFS of 4 and an average G8 score of 12.5. All patients seen in clinic saw a geriatrician consultant or registrar, with 84% of patients seeing a physiotherapist for a personalised assessment. 92% of patients had a treatment escalation plan completed. All patients had a medication review with 93% of those seen having at least one medication discontinued. Other key interventions included optimisation of blood pressure, cognition and anaemia. Conclusions Patient feedback has been positive, appreciating the opportunity to review their health, optimise medical issues and reduce medication burden. Oncologists have appreciated rapid access to holistic geriatrician review alongside therapy input to improve health outcomes. Further exploration into patient’s reasons for declining review by OACOS may help identify barriers to access for some patients and the future clinic model.","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":"146122199","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/afaf368.056
C Kunemund-Hughes, E Tridimas, G Walker
Background National and local standards in acute frailty recommend a seven-day service, with front-door assessment and a dedicated frailty area. Many acute frailty teams struggle to maintain a dedicated space as they are vulnerable to becoming inpatient areas when bed pressures increase. The Acute Older Persons Unit (AOPU) at Guys and St Thomas has faced similar challenges and is based on the Acute Admissions Ward and the Emergency Department. This project assessed whether a dedicated Acute Frailty SDEC (F-SDEC) space increased the number of patients seen and the number of same-day discharges. Methods The AOPU was based in medical SDEC for a trial period of 16 weekends from 23nd February 2025 (F-SDEC). Th F-SDEC space has recliner chairs and consultation rooms but no beds or sluice meaning the referral criteria had to change excluding those who required two to transfer or needed a commode. Data was compared between the 3 weeks prior and for 5 weeks following the implementation of F-SDEC. Results The average number of new patients seen per weekend increased from 8 to 14 during F-SDEC. The number of same day discharges increased from 9/24 (37.5% of patients seen) to 33/62 (53.2% of patients seen). The mean clinical frailty score (CFS) decreased from 6.1 to 3.9. The most common presentation was falls (45.3%) pre-F-SDEC and falls (20.3%) and infection (20.3%) during F-SDEC. Conclusions F-SDEC increased the number of patients seen and the number of same-day discharges. The average CFS decreased due to the space not being suitable for the most frail patients. When advocating for space frailty services need to balance ambulatory requirements with the ability to serve the most frail patients. A dedicated F-SDEC area that accommodates the most frail patients has the potential to increase same day discharges and improve capacity across the system.
{"title":"3849 The case for space: does a dedicated frailty same day emergency care (F-SDEC) unit improve the impact of an acute frailty team?","authors":"C Kunemund-Hughes, E Tridimas, G Walker","doi":"10.1093/ageing/afaf368.056","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.056","url":null,"abstract":"Background National and local standards in acute frailty recommend a seven-day service, with front-door assessment and a dedicated frailty area. Many acute frailty teams struggle to maintain a dedicated space as they are vulnerable to becoming inpatient areas when bed pressures increase. The Acute Older Persons Unit (AOPU) at Guys and St Thomas has faced similar challenges and is based on the Acute Admissions Ward and the Emergency Department. This project assessed whether a dedicated Acute Frailty SDEC (F-SDEC) space increased the number of patients seen and the number of same-day discharges. Methods The AOPU was based in medical SDEC for a trial period of 16 weekends from 23nd February 2025 (F-SDEC). Th F-SDEC space has recliner chairs and consultation rooms but no beds or sluice meaning the referral criteria had to change excluding those who required two to transfer or needed a commode. Data was compared between the 3 weeks prior and for 5 weeks following the implementation of F-SDEC. Results The average number of new patients seen per weekend increased from 8 to 14 during F-SDEC. The number of same day discharges increased from 9/24 (37.5% of patients seen) to 33/62 (53.2% of patients seen). The mean clinical frailty score (CFS) decreased from 6.1 to 3.9. The most common presentation was falls (45.3%) pre-F-SDEC and falls (20.3%) and infection (20.3%) during F-SDEC. Conclusions F-SDEC increased the number of patients seen and the number of same-day discharges. The average CFS decreased due to the space not being suitable for the most frail patients. When advocating for space frailty services need to balance ambulatory requirements with the ability to serve the most frail patients. A dedicated F-SDEC area that accommodates the most frail patients has the potential to increase same day discharges and improve capacity across the system.","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":"146121872","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/afaf368.102
G Fisher, S True
Introduction Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality. Method The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine. Results Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly. Conclusion The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.
{"title":"2506 Barriers perceived by medical students when considering a career in geriatric medicine","authors":"G Fisher, S True","doi":"10.1093/ageing/afaf368.102","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.102","url":null,"abstract":"Introduction Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality. Method The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine. Results Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly. Conclusion The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"301 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121921","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/afaf368.030
E Mackenzie, L McIntosh, R McCall, M H Chin, L Mitchell, L Anderton
Introduction Syncope is a common clinical problem[1] posing a diagnostic and therapeutic challenge, due to varied presentations and underlying pathologies[2]. Although an MDT approach is a recognised key component in patient care[3], there is no current guidance in the context of syncope. The Syncope Service in QEUH Glasgow is run by Geriatricians with a specialist interest in Syncope. A formalised monthly MDT, introduced in November 2017, involves Geriatricians, Cardiologists, a Neurologist and Cardiac Physiologists. Method A retrospective case note analysis undertaken for patients reviewed at the Syncope MDT (November 2017–March 2023), assessed the impact on diagnosis, further investigation and treatment initiation. Results 149 patients, with an average age of 65, were discussed at the MDT. The reasons for referral were cardiology specialist advice (62.4%), neurology specialist advice (19.5%) and multi-specialty case review (16.8%). Following discussion, cases of unexplained syncope decreased from 28.9% to 21%. The diagnosis of a cardiac rhythm abnormality increased from 11.4% to 19.5%, and a provisional diagnosis of a seizure disorder increased from 12.8% to a confirmed 14.8%, without the need for additional specialty clinic review. The MDT facilitated prompt access to investigations such as ILR (9.4%) and commencement of appropriate treatment such as anti-epileptic medication (6.6%) or PPM insertion (8.6%). Conclusion By leveraging the collective expertise of diverse healthcare professionals, the syncope MDT enhances diagnostic precision, facilitates comprehensive investigations and streamlines the patient journey. References 1. Chen LY, Shen WK, Mahoney DW. et al. Prevalence of syncope in a population aged more than 45 years. Am J Medi 2006;119:–e1. 2. McLintock B, Reid J, Capek E. et al. Unscheduled care bed days can be reduced with a syncope pathway and rapid access syncope clinic. Br J Cardiol 2019;26:–. 3. McAlister FA, Stewart S, Ferrua S. et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomised trials. J Am Coll Cardiol 2004;44:–.
{"title":"3776 Syncope: the invaluable role of a multidisciplinary team (MDT) in managing complexity","authors":"E Mackenzie, L McIntosh, R McCall, M H Chin, L Mitchell, L Anderton","doi":"10.1093/ageing/afaf368.030","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.030","url":null,"abstract":"Introduction Syncope is a common clinical problem[1] posing a diagnostic and therapeutic challenge, due to varied presentations and underlying pathologies[2]. Although an MDT approach is a recognised key component in patient care[3], there is no current guidance in the context of syncope. The Syncope Service in QEUH Glasgow is run by Geriatricians with a specialist interest in Syncope. A formalised monthly MDT, introduced in November 2017, involves Geriatricians, Cardiologists, a Neurologist and Cardiac Physiologists. Method A retrospective case note analysis undertaken for patients reviewed at the Syncope MDT (November 2017–March 2023), assessed the impact on diagnosis, further investigation and treatment initiation. Results 149 patients, with an average age of 65, were discussed at the MDT. The reasons for referral were cardiology specialist advice (62.4%), neurology specialist advice (19.5%) and multi-specialty case review (16.8%). Following discussion, cases of unexplained syncope decreased from 28.9% to 21%. The diagnosis of a cardiac rhythm abnormality increased from 11.4% to 19.5%, and a provisional diagnosis of a seizure disorder increased from 12.8% to a confirmed 14.8%, without the need for additional specialty clinic review. The MDT facilitated prompt access to investigations such as ILR (9.4%) and commencement of appropriate treatment such as anti-epileptic medication (6.6%) or PPM insertion (8.6%). Conclusion By leveraging the collective expertise of diverse healthcare professionals, the syncope MDT enhances diagnostic precision, facilitates comprehensive investigations and streamlines the patient journey. References 1. Chen LY, Shen WK, Mahoney DW. et al. Prevalence of syncope in a population aged more than 45 years. Am J Medi 2006;119:–e1. 2. McLintock B, Reid J, Capek E. et al. Unscheduled care bed days can be reduced with a syncope pathway and rapid access syncope clinic. Br J Cardiol 2019;26:–. 3. McAlister FA, Stewart S, Ferrua S. et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomised trials. J Am Coll Cardiol 2004;44:–.","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":"146121927","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/afaf368.072
M Allcock, I Wilkinson
Introduction This study of patients attending East Surrey Hospital’s (ESH) Frailty Same Day Emergency Care (FSDEC) unit was designed to assess the interrelationship between onward destination from FSDEC, including existing location-based virtual wards (VW) offering ongoing care and remote monitoring at home, outpatient clinics and comorbidity. In ESH in October 2024, a 6-space FSDEC was created. Patients are pulled from the ED in the morning, with a small number being referred from GPs and community Urgent and Emergency Care teams. Method Data were reviewed from February 2025 to April 2025, in this time, for all 285 patients attending ESH FSDEC, patient records were reviewed to determine onward destination from FSDEC and to calculate Charlson Comorbidity Index (CCI). Outcomes included discharge to usual residence, discharge home under the care of a VW, or admission to further acute care. Additionally, any planned follow-up at point of discharge from FSDEC was recorded. Results Of the 285 patient encounters, 212/285 (74%) were discharged on the same day, 149/285 (52%) were discharged home, 63/285 (22%) were discharged under the care of a VW and 73/285 (26%) were admitted as inpatients. 80/285 patients (30%) attending FSDEC were discharged with planned follow-up outpatient appointments with a geriatrician or another specialty. CCI scores ranged from 3–11, with a mean score of 6. Conclusion This study provides evidence to support the East Surrey Hospital FSDEC model of care, with 74% of patients attending being discharged home the same day. The study shows a large proportion of patients, 22%, receive care & monitoring at home under a VW following discharge, a vital method of admission avoidance; suggesting these two services are important to be commissioned together. Analysis of Charlson Comorbidity Index scores also demonstrates the complex health background of those attending FSDEC and their need for specialist care.
{"title":"3805 Frailty same day emergency care: onward destination and effective utilisation of virtual wards","authors":"M Allcock, I Wilkinson","doi":"10.1093/ageing/afaf368.072","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.072","url":null,"abstract":"Introduction This study of patients attending East Surrey Hospital’s (ESH) Frailty Same Day Emergency Care (FSDEC) unit was designed to assess the interrelationship between onward destination from FSDEC, including existing location-based virtual wards (VW) offering ongoing care and remote monitoring at home, outpatient clinics and comorbidity. In ESH in October 2024, a 6-space FSDEC was created. Patients are pulled from the ED in the morning, with a small number being referred from GPs and community Urgent and Emergency Care teams. Method Data were reviewed from February 2025 to April 2025, in this time, for all 285 patients attending ESH FSDEC, patient records were reviewed to determine onward destination from FSDEC and to calculate Charlson Comorbidity Index (CCI). Outcomes included discharge to usual residence, discharge home under the care of a VW, or admission to further acute care. Additionally, any planned follow-up at point of discharge from FSDEC was recorded. Results Of the 285 patient encounters, 212/285 (74%) were discharged on the same day, 149/285 (52%) were discharged home, 63/285 (22%) were discharged under the care of a VW and 73/285 (26%) were admitted as inpatients. 80/285 patients (30%) attending FSDEC were discharged with planned follow-up outpatient appointments with a geriatrician or another specialty. CCI scores ranged from 3–11, with a mean score of 6. Conclusion This study provides evidence to support the East Surrey Hospital FSDEC model of care, with 74% of patients attending being discharged home the same day. The study shows a large proportion of patients, 22%, receive care & monitoring at home under a VW following discharge, a vital method of admission avoidance; suggesting these two services are important to be commissioned together. Analysis of Charlson Comorbidity Index scores also demonstrates the complex health background of those attending FSDEC and their need for specialist care.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"28 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121971","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/afaf368.086
C Wong, H Freeman, S Rizwan, S Reddy
Introduction Delirium is common in older inpatients and associated with cognitive decline, underlying dementia, and mortality. NICE recommends that current or resolved delirium diagnosis is communicated to general practitioners (GPs) upon discharge. However, a 2021–22 study at Lister Hospital found that only 25% of delirium cases were documented in discharge letters. This gap poses significant risks to patient safety, as unresolved delirium may be overlooked, and underlying dementia missed. This project aimed to improve documentation of delirium diagnoses, resolution status, and follow-up advice in discharge letters. Method Electronic patient records were retrospectively analysed for patients aged ≥65 years with a recorded 4AT score ≥ 4 under Unplanned Care at Lister Hospital. Cycle 1 targeted resident doctors with formal teaching and ward-based education on delirium assessment and documentation practices. Wards with high delirium rates were prioritised. Cycle 2 expanded to the multidisciplinary team (MDT), with teaching delivered at a Trust Clinical Governance meeting, Nursing Manager Huddle, and alongside Dementia Champions during Dementia Awareness Week. Posters and patient information leaflets were distributed. Results Following Cycle 1, 4AT reassessment on discharge rose from 5% to 13%. Delirium documentation in discharge letters improved significantly from 54% to 76%. Discharge advice to GPs recommending referral to memory clinics more than quadrupled from 5% to 22%. After Cycle 2, 4AT reassessment reached 16% and follow-up advice 25%. Delirium documentation dipped to 61% but remained above baseline. Conclusion Sustained improvement is achievable through targeted educational interventions reinforced across the MDT. Resident-focused teaching yields rapid improvements—and it will continue moving forward—but sustainable change requires wider MDT engagement. Long-term progress may necessitate systemic changes, such as integrating delirium prompts into electronic discharge templates. Future work could assess downstream outcomes, including GP follow-up, community referrals, dementia diagnostic yield, and re-admissions.
{"title":"3730 Enhancing delirium documentation at the hospital-community interface","authors":"C Wong, H Freeman, S Rizwan, S Reddy","doi":"10.1093/ageing/afaf368.086","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.086","url":null,"abstract":"Introduction Delirium is common in older inpatients and associated with cognitive decline, underlying dementia, and mortality. NICE recommends that current or resolved delirium diagnosis is communicated to general practitioners (GPs) upon discharge. However, a 2021–22 study at Lister Hospital found that only 25% of delirium cases were documented in discharge letters. This gap poses significant risks to patient safety, as unresolved delirium may be overlooked, and underlying dementia missed. This project aimed to improve documentation of delirium diagnoses, resolution status, and follow-up advice in discharge letters. Method Electronic patient records were retrospectively analysed for patients aged ≥65 years with a recorded 4AT score ≥ 4 under Unplanned Care at Lister Hospital. Cycle 1 targeted resident doctors with formal teaching and ward-based education on delirium assessment and documentation practices. Wards with high delirium rates were prioritised. Cycle 2 expanded to the multidisciplinary team (MDT), with teaching delivered at a Trust Clinical Governance meeting, Nursing Manager Huddle, and alongside Dementia Champions during Dementia Awareness Week. Posters and patient information leaflets were distributed. Results Following Cycle 1, 4AT reassessment on discharge rose from 5% to 13%. Delirium documentation in discharge letters improved significantly from 54% to 76%. Discharge advice to GPs recommending referral to memory clinics more than quadrupled from 5% to 22%. After Cycle 2, 4AT reassessment reached 16% and follow-up advice 25%. Delirium documentation dipped to 61% but remained above baseline. Conclusion Sustained improvement is achievable through targeted educational interventions reinforced across the MDT. Resident-focused teaching yields rapid improvements—and it will continue moving forward—but sustainable change requires wider MDT engagement. Long-term progress may necessitate systemic changes, such as integrating delirium prompts into electronic discharge templates. Future work could assess downstream outcomes, including GP follow-up, community referrals, dementia diagnostic yield, and re-admissions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"28 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122025","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/afaf368.149
S Subbarayan, I Smith-Dodd, G Nicolson, J K Burton, J Scott, S S Vasan, S D Shenkin, R L Soiza
Introduction Older care home (CH) residents are particularly vulnerable to infections and often experience adverse outcomes. Despite this group being prioritised for vaccination, no COVID-19 vaccine trials recruited CH residents. Given that the social and biological characteristics of CH residents may influence vaccine effectiveness, it is crucial to test vaccines in this population. Methods The Widening Access to Trials in Care Homes (WATCH) project was established to develop best practice guidance on designing and conducting vaccine trials in the CH population. As part of this project, a scoping review was conducted using the Joanna Briggs Institute methodology to identify vaccine trials that recruited CH residents and reported recruitment challenges and strategies. A comprehensive search was carried out in five databases: EMBASE, MEDLINE, PsycINFO, CINAHL, and Cochrane Library, from 1990 to 2025. Three authors independently screened articles and extracted data. Results are reported as descriptive summaries. Results We retrieved 701 articles and included 20 studies from 11 countries. 7479 participants from 238 CHs were recruited to influenza (N = 17) or pneumococcal (N = 3) vaccine trials. Median sample size was 270 and the weighted mean age was 82.3 years. Screen failure and dropout rate averaged 70% (seven studies) and 8% (five studies), respectively. The two most common reasons for screen failure were residents’ declining participation (46%) and not meeting eligibility criteria (27%). Death (21%) was the most common reason for dropout. Barriers identified include eligibility criteria and recruitment, consent and assent issues, ethical and regulatory concerns, CH-related factors, and study time frame and logistical factors. Facilitators identified include recruitment and data collection methods, consent and assent factors, and collaboration with CHs. Conclusion Our review is the first to report quantitative and qualitative evidence on barriers and facilitators to recruiting CH residents in vaccine trials. The findings will assist researchers in planning future vaccine trials in this population.
{"title":"3839 A scoping review of randomised controlled trials of vaccines that recruited care home residents: lessons for future trials","authors":"S Subbarayan, I Smith-Dodd, G Nicolson, J K Burton, J Scott, S S Vasan, S D Shenkin, R L Soiza","doi":"10.1093/ageing/afaf368.149","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.149","url":null,"abstract":"Introduction Older care home (CH) residents are particularly vulnerable to infections and often experience adverse outcomes. Despite this group being prioritised for vaccination, no COVID-19 vaccine trials recruited CH residents. Given that the social and biological characteristics of CH residents may influence vaccine effectiveness, it is crucial to test vaccines in this population. Methods The Widening Access to Trials in Care Homes (WATCH) project was established to develop best practice guidance on designing and conducting vaccine trials in the CH population. As part of this project, a scoping review was conducted using the Joanna Briggs Institute methodology to identify vaccine trials that recruited CH residents and reported recruitment challenges and strategies. A comprehensive search was carried out in five databases: EMBASE, MEDLINE, PsycINFO, CINAHL, and Cochrane Library, from 1990 to 2025. Three authors independently screened articles and extracted data. Results are reported as descriptive summaries. Results We retrieved 701 articles and included 20 studies from 11 countries. 7479 participants from 238 CHs were recruited to influenza (N = 17) or pneumococcal (N = 3) vaccine trials. Median sample size was 270 and the weighted mean age was 82.3 years. Screen failure and dropout rate averaged 70% (seven studies) and 8% (five studies), respectively. The two most common reasons for screen failure were residents’ declining participation (46%) and not meeting eligibility criteria (27%). Death (21%) was the most common reason for dropout. Barriers identified include eligibility criteria and recruitment, consent and assent issues, ethical and regulatory concerns, CH-related factors, and study time frame and logistical factors. Facilitators identified include recruitment and data collection methods, consent and assent factors, and collaboration with CHs. Conclusion Our review is the first to report quantitative and qualitative evidence on barriers and facilitators to recruiting CH residents in vaccine trials. The findings will assist researchers in planning future vaccine trials in this population.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"384 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122143","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/afaf368.047
C Miller, E Laithwaite, E Crackell
Introduction Older adults living with frailty are at high risk of harm in traditional emergency care settings whilst frailty prevalence is rising. The Frailty Same Day Emergency Care (FSDEC) service at University Hospitals of Leicester (UHL) was launched in January 2025 to provide rapid, specialist-led, multidisciplinary care outside the Emergency Department (ED) footprint. The aim to assess, treat, and discharge patients on the same day, avoiding unnecessary and unwanted admissions and aligning with the NHS Long Term Plan. Method FSDEC operated as a three-month pilot within the medical SDEC, open daily 0900–1700. Patients were referred from ED, GPs, ambulance services, and community teams. A multidisciplinary team (MDT)—including geriatricians, ACPs, nurses, therapists, pharmacists, and care coordinators—delivered integrated, person-centred care. Results Between January and March 2025, 471 patients were seen, with 75.5% discharged. Alongside the Frailty Emergency Squad (FES; frailty inreach team in ED), 835 discharges were achieved over 10 weeks, more than doubling previous rates. FSDEC improved ED flow and reduced inpatient bed days by approximately 573 per month. Staff reported improved satisfaction and decision-making. Despite challenges (e.g. space, IT, and social care delays), the service demonstrated feasibility and scalability using existing resources. Conclusion(s) FSDEC offers a replicable model for urgent frailty care that is proactive, integrated, and person-centred. It delivers better outcomes, faster care, and aligns with national priorities. Now adopted as a substantive service, considerations are in place to extend hours, improve IT, and deepen community integration. FSDEC is poised to become a cornerstone of urgent care for older people across Leicester, Leicestershire and Rutland.
{"title":"3647 ‘All hands on FSDEC’: implementation of an MDT delivered same day emergency care unit for older patients living with frailty","authors":"C Miller, E Laithwaite, E Crackell","doi":"10.1093/ageing/afaf368.047","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.047","url":null,"abstract":"Introduction Older adults living with frailty are at high risk of harm in traditional emergency care settings whilst frailty prevalence is rising. The Frailty Same Day Emergency Care (FSDEC) service at University Hospitals of Leicester (UHL) was launched in January 2025 to provide rapid, specialist-led, multidisciplinary care outside the Emergency Department (ED) footprint. The aim to assess, treat, and discharge patients on the same day, avoiding unnecessary and unwanted admissions and aligning with the NHS Long Term Plan. Method FSDEC operated as a three-month pilot within the medical SDEC, open daily 0900–1700. Patients were referred from ED, GPs, ambulance services, and community teams. A multidisciplinary team (MDT)—including geriatricians, ACPs, nurses, therapists, pharmacists, and care coordinators—delivered integrated, person-centred care. Results Between January and March 2025, 471 patients were seen, with 75.5% discharged. Alongside the Frailty Emergency Squad (FES; frailty inreach team in ED), 835 discharges were achieved over 10 weeks, more than doubling previous rates. FSDEC improved ED flow and reduced inpatient bed days by approximately 573 per month. Staff reported improved satisfaction and decision-making. Despite challenges (e.g. space, IT, and social care delays), the service demonstrated feasibility and scalability using existing resources. Conclusion(s) FSDEC offers a replicable model for urgent frailty care that is proactive, integrated, and person-centred. It delivers better outcomes, faster care, and aligns with national priorities. Now adopted as a substantive service, considerations are in place to extend hours, improve IT, and deepen community integration. FSDEC is poised to become a cornerstone of urgent care for older people across Leicester, Leicestershire and Rutland.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"29 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122378","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/afaf368.115
M R Sarfraz, I Mushtaq, A Ali, S Anwar, F Ikram, M F Hemida, S Ajaz
Introduction Falls are a leading cause of death in older adults, with hypertension (HTN) potentially increasing this risk. However, trends in fall-related mortality with co-existing HTN remain understudied. We hypothesise an increasing trend in fall-related mortality among older adults with HTN, with disparities by sex, region, and place of death. Methods A retrospective analysis of adults ≥65 years was conducted using CDC WONDER (1999–2023). Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, region, and place of death. Trends were assessed using annual and average percentage change (APC & AAPC). Results From 1999 to 2023, 215,214 fall-related deaths with co-existing hypertension were recorded, showing a significant increasing mortality trend (p < 0.000001). Males had higher mortality than females (20.39 vs. 17.13 per 100,000), with significant AAPCs of 11.24% and 10.57%, respectively. In males, AAMRs rose from 2.93 in 1999 to 42.59 in 2023, with sharp increases from 1999–2001 (APC: 45.19%) and 2018–2021 (APC: 13.56%). Females showed a similar trend, rising from 2.87 to 35.57, with notable spikes in the same periods (APC: 42.44% and 13.43%). Most deaths occurred in medical facilities (52.84%), followed by nursing homes (19.09%), hospices (12.99%), and homes (10.86%). Regionally, the Midwest had the highest AAMR (22.88), followed by the West (18.58), South (18.15), and Northeast (14.11), with corresponding AAPCs of 10.81%, 8.68%, 11.45%, and 10.86%. Conclusion Mortality rates among older adults has risen significantly over the past two decades, with consistently higher rates in males and marked regional disparities. The predominance of deaths in medical and long-term care facilities underscores the need for enhanced fall-prevention strategies in these settings. Targeted interventions, particularly in high-burden regions like the Midwest and sex-specific approaches are essential to mitigate this growing public health concern.
{"title":"3815 Disparities in fall mortality among hypertensive older adults: an epidemiological analysis of geographic and gender differences","authors":"M R Sarfraz, I Mushtaq, A Ali, S Anwar, F Ikram, M F Hemida, S Ajaz","doi":"10.1093/ageing/afaf368.115","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.115","url":null,"abstract":"Introduction Falls are a leading cause of death in older adults, with hypertension (HTN) potentially increasing this risk. However, trends in fall-related mortality with co-existing HTN remain understudied. We hypothesise an increasing trend in fall-related mortality among older adults with HTN, with disparities by sex, region, and place of death. Methods A retrospective analysis of adults ≥65 years was conducted using CDC WONDER (1999–2023). Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, region, and place of death. Trends were assessed using annual and average percentage change (APC & AAPC). Results From 1999 to 2023, 215,214 fall-related deaths with co-existing hypertension were recorded, showing a significant increasing mortality trend (p &lt; 0.000001). Males had higher mortality than females (20.39 vs. 17.13 per 100,000), with significant AAPCs of 11.24% and 10.57%, respectively. In males, AAMRs rose from 2.93 in 1999 to 42.59 in 2023, with sharp increases from 1999–2001 (APC: 45.19%) and 2018–2021 (APC: 13.56%). Females showed a similar trend, rising from 2.87 to 35.57, with notable spikes in the same periods (APC: 42.44% and 13.43%). Most deaths occurred in medical facilities (52.84%), followed by nursing homes (19.09%), hospices (12.99%), and homes (10.86%). Regionally, the Midwest had the highest AAMR (22.88), followed by the West (18.58), South (18.15), and Northeast (14.11), with corresponding AAPCs of 10.81%, 8.68%, 11.45%, and 10.86%. Conclusion Mortality rates among older adults has risen significantly over the past two decades, with consistently higher rates in males and marked regional disparities. The predominance of deaths in medical and long-term care facilities underscores the need for enhanced fall-prevention strategies in these settings. Targeted interventions, particularly in high-burden regions like the Midwest and sex-specific approaches are essential to mitigate this growing public health concern.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"83 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122410","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/afaf368.033
H Dasgupta, J James, B Al-Lami, T Ali, A Parbhoo
Introduction Knowledge of social history and functional baseline is of paramount importance in Geriatric Medicine. Often a lack of adequate history leads to poor treatment outcomes in patients with advanced frailty. At our hospital, we have tried to identify the possible areas of improvement in collateral history documentation and designed a short and objective pro forma that allows any doctor to take a detailed collateral history for geriatric patients. Method We retrospectively reviewed the notes of 30 inpatients in geriatric wards to assess documentation across various domains of collateral history. After identifying major gaps, we developed a concise collateral history pro forma. The first PDSA cycle involved implementing the proforma over 2 months, followed by a re-audit of 30 patients. A second PDSA cycle was completed after incorporating staff feedback and further refinement of the proforma. Results The initial audit revealed significant gaps in documentation—key areas such as baseline cognition, falls history, memory loss, and personality changes were recorded in fewer than 40% of patients. Following the introduction of the proforma, the first PDSA cycle showed marked improvements: falls and baseline cognition were documented in over 70% of cases, and coverage of mood, memory, and personality domains more than doubled. After further refinement based on feedback, the second PDSA cycle saw even greater gains—falls were documented in all patients, and memory loss, mood, and personality changes were each recorded in over 75% of cases. Broader social history areas such as food intake, employment, and ADLs also improved significantly. Notably, domains that were previously overlooked—like smoking, alcohol use, and finances—were now consistently captured. Conclusion Taking a detailed social history can be a difficult and time-consuming process for junior doctors, often leading to incomplete information. Our Collateral History Proforma aims to bridge that gap for any new doctor joining Geriatric Medicine. Its implementation is especially valuable in settings where paper-based records are still in use, ensuring that essential collateral history information is readily accessible and systematically documented.
{"title":"3809 Quality improvement project on collateral history taking for geriatric patients at a district general hospital in South Wales","authors":"H Dasgupta, J James, B Al-Lami, T Ali, A Parbhoo","doi":"10.1093/ageing/afaf368.033","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.033","url":null,"abstract":"Introduction Knowledge of social history and functional baseline is of paramount importance in Geriatric Medicine. Often a lack of adequate history leads to poor treatment outcomes in patients with advanced frailty. At our hospital, we have tried to identify the possible areas of improvement in collateral history documentation and designed a short and objective pro forma that allows any doctor to take a detailed collateral history for geriatric patients. Method We retrospectively reviewed the notes of 30 inpatients in geriatric wards to assess documentation across various domains of collateral history. After identifying major gaps, we developed a concise collateral history pro forma. The first PDSA cycle involved implementing the proforma over 2 months, followed by a re-audit of 30 patients. A second PDSA cycle was completed after incorporating staff feedback and further refinement of the proforma. Results The initial audit revealed significant gaps in documentation—key areas such as baseline cognition, falls history, memory loss, and personality changes were recorded in fewer than 40% of patients. Following the introduction of the proforma, the first PDSA cycle showed marked improvements: falls and baseline cognition were documented in over 70% of cases, and coverage of mood, memory, and personality domains more than doubled. After further refinement based on feedback, the second PDSA cycle saw even greater gains—falls were documented in all patients, and memory loss, mood, and personality changes were each recorded in over 75% of cases. Broader social history areas such as food intake, employment, and ADLs also improved significantly. Notably, domains that were previously overlooked—like smoking, alcohol use, and finances—were now consistently captured. Conclusion Taking a detailed social history can be a difficult and time-consuming process for junior doctors, often leading to incomplete information. Our Collateral History Proforma aims to bridge that gap for any new doctor joining Geriatric Medicine. Its implementation is especially valuable in settings where paper-based records are still in use, ensuring that essential collateral history information is readily accessible and systematically documented.","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":"146121923","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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