Pub Date : 2025-01-30DOI: 10.1093/ageing/afae277.021
S Sage, A Baxter, S O’Riordan, J Seeley, J McGarvey
Background East Kent has 38,101 people over 80 years, 39, 021 living with moderate or severe frailty and 304 care homes. This population have high levels of unplanned admissions which can put them at risk of long hospital stays, reduced mobility and increased delirium. East Kent Ambulance services (SECAMB), Acute hospitals (EKHUFT) and Community Services (KCHFT) have piloted a single-point of access consisting of an ED consultant, community frailty clinician, Urgent care senior nurse, advanced paramedic practitioners. They sit together at the ambulance bases, 10 am-6 pm Monday to Fridays. This team reviews all patients awaiting ambulances to assess whether there are alternative services to ED which would meet the individuals’ needs. Method The MDT assesses all patients listed as awaiting an emergency ambulance. Clinical records can be accessed from all services including GP records. If patients would benefit from treatment by alternative services, rather than conveyance, the paramedics are asked to call the MDT. This allows clinical assessment, history and investigation results to be taken into account in planning care. Patients and Carers are involved in deciding how they would like to receive medical care via a video or phone link with clinicians. Results Conveyance to hospital pre pilot 62% post pilot less than 50%. Ashford catchment: admissions save weekly 27.3, bed days saved weekly 179.2. Thanet Catchment: admissions saved weekly 19.1, bed days save weekly 106.9. Conclusion Many people can be treated effectively without conveyance to hospital through pre-hospital triage, consultation and planning by senior clinicians in a multi-disciplinary team.
{"title":"2851 Reducing the number of unplanned admissions to hospital through a multidisciplinary single point of access pre-hospital","authors":"S Sage, A Baxter, S O’Riordan, J Seeley, J McGarvey","doi":"10.1093/ageing/afae277.021","DOIUrl":"https://doi.org/10.1093/ageing/afae277.021","url":null,"abstract":"Background East Kent has 38,101 people over 80 years, 39, 021 living with moderate or severe frailty and 304 care homes. This population have high levels of unplanned admissions which can put them at risk of long hospital stays, reduced mobility and increased delirium. East Kent Ambulance services (SECAMB), Acute hospitals (EKHUFT) and Community Services (KCHFT) have piloted a single-point of access consisting of an ED consultant, community frailty clinician, Urgent care senior nurse, advanced paramedic practitioners. They sit together at the ambulance bases, 10 am-6 pm Monday to Fridays. This team reviews all patients awaiting ambulances to assess whether there are alternative services to ED which would meet the individuals’ needs. Method The MDT assesses all patients listed as awaiting an emergency ambulance. Clinical records can be accessed from all services including GP records. If patients would benefit from treatment by alternative services, rather than conveyance, the paramedics are asked to call the MDT. This allows clinical assessment, history and investigation results to be taken into account in planning care. Patients and Carers are involved in deciding how they would like to receive medical care via a video or phone link with clinicians. Results Conveyance to hospital pre pilot 62% post pilot less than 50%. Ashford catchment: admissions save weekly 27.3, bed days saved weekly 179.2. Thanet Catchment: admissions saved weekly 19.1, bed days save weekly 106.9. Conclusion Many people can be treated effectively without conveyance to hospital through pre-hospital triage, consultation and planning by senior clinicians in a multi-disciplinary team.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"77 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071741","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 : 2025-01-30DOI: 10.1093/ageing/afae277.073
J Hernández, V Ochoa, J Theran, L Badillo, H Torres, L Dulcey, J Gómez, M Trillos, D Vera, V Gómez, A Peña, C Amaya, M Rodriguez, G Ramos, N Gandur, V Gómez, A Olarte, V Trillos, M Picón
Introduction It is expected that by the fourth decade of the 21st century, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide. These data require awareness among treating physicians of these patients. Methods A pilot study was conducted from January 2020–December 2022 in a South American health institution in which cardiovascular risk was estimated using GLOBORISK and ATP-III criteria. Data derived from the metabolic profile included in the ATP-III criteria were collected. Quantitative variables are presented as mean ± standard deviation or median (interquartile range) according to their distribution and qualitative variables as percentages. Student’s t-test was performed to evaluate differences between two variables. All statistical analyses were performed with (SPSS for Windows, v.22.1; Chicago, IL). Results The present study showed that metabolic syndrome variables in these patients were elevated. Male sex was 77% and female 23%, smoking 61%. The GLOBORISK equation found mostly patients with low to moderate cardiovascular risk. It was found that there was a higher cardiovascular risk in those patients with FEV1 less than 30%, showing a statistical correlation of this alteration for the GLOBORISK scale. Conclusions This is the first pilot study that estimates cardiovascular risk using GLOBORISK in the COPD population. We consider integrating national and international networks to compare the results found here.
{"title":"2638 First study of cardiovascular risk estimation using Globorisk in a Latin American geriatric cohort with COPD","authors":"J Hernández, V Ochoa, J Theran, L Badillo, H Torres, L Dulcey, J Gómez, M Trillos, D Vera, V Gómez, A Peña, C Amaya, M Rodriguez, G Ramos, N Gandur, V Gómez, A Olarte, V Trillos, M Picón","doi":"10.1093/ageing/afae277.073","DOIUrl":"https://doi.org/10.1093/ageing/afae277.073","url":null,"abstract":"Introduction It is expected that by the fourth decade of the 21st century, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide. These data require awareness among treating physicians of these patients. Methods A pilot study was conducted from January 2020–December 2022 in a South American health institution in which cardiovascular risk was estimated using GLOBORISK and ATP-III criteria. Data derived from the metabolic profile included in the ATP-III criteria were collected. Quantitative variables are presented as mean ± standard deviation or median (interquartile range) according to their distribution and qualitative variables as percentages. Student’s t-test was performed to evaluate differences between two variables. All statistical analyses were performed with (SPSS for Windows, v.22.1; Chicago, IL). Results The present study showed that metabolic syndrome variables in these patients were elevated. Male sex was 77% and female 23%, smoking 61%. The GLOBORISK equation found mostly patients with low to moderate cardiovascular risk. It was found that there was a higher cardiovascular risk in those patients with FEV1 less than 30%, showing a statistical correlation of this alteration for the GLOBORISK scale. Conclusions This is the first pilot study that estimates cardiovascular risk using GLOBORISK in the COPD population. We consider integrating national and international networks to compare the results found here.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071743","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 : 2025-01-30DOI: 10.1093/ageing/afae277.035
F Jumabhoy, S Ninan, D Narayana
Introduction We proactively reviewed nursing home residents using a multidisciplinary team (MDT) approach within a Primary Care Network (PCN). We aimed to enhance care coordination, reduce inappropriate medication use and ensure all residents had current advanced care plans in place. Method An MDT comprising a geriatrician, prescribing pharmacist, general practitioner, and nurse reviewed residents proactively. This involved reviewing the residents’ current health and care needs, falls risk, medication regimens and advance care plans. We then performed medication reviews, reviewed advanced care plans, and identified the need for further interventions. When we repeated the process, we used a proforma that could be pre-populated prior to the meeting by the pharmacist and geriatrician to improve efficiency of the discussion. Results The initiative was piloted in two residential nursing homes with a total of 65 residents reviewed, of which 86% (n = 56) received interventions. There was a 47% (n = 29) increase in completed advanced care plans. 62% (n = 40) of residents had medicines optimised, with polypharmacy being reduced in 46% (n = 30) by an average of 2 medications per resident. 8% (n = 5) were referred to additional services and 8% (n = 5) required further investigations. Conclusion(s) This proactive MDT model effectively addressed the needs of residents whilst demonstrating immediate positive outcomes. Key facilitators to good practice were teamwork, clarifying the objectives of the MDT, prior reviews of patient records, and ensuring staff who knew the residents well were present. We will use this approach with other nursing homes within the PCN and share our results with colleagues. This has the potential to reduce costs of medications and hospital admissions, as well as improve quality.
{"title":"2852 A proactive multidisciplinary approach to reviewing health and care needs of nursing home residents in a primary care network","authors":"F Jumabhoy, S Ninan, D Narayana","doi":"10.1093/ageing/afae277.035","DOIUrl":"https://doi.org/10.1093/ageing/afae277.035","url":null,"abstract":"Introduction We proactively reviewed nursing home residents using a multidisciplinary team (MDT) approach within a Primary Care Network (PCN). We aimed to enhance care coordination, reduce inappropriate medication use and ensure all residents had current advanced care plans in place. Method An MDT comprising a geriatrician, prescribing pharmacist, general practitioner, and nurse reviewed residents proactively. This involved reviewing the residents’ current health and care needs, falls risk, medication regimens and advance care plans. We then performed medication reviews, reviewed advanced care plans, and identified the need for further interventions. When we repeated the process, we used a proforma that could be pre-populated prior to the meeting by the pharmacist and geriatrician to improve efficiency of the discussion. Results The initiative was piloted in two residential nursing homes with a total of 65 residents reviewed, of which 86% (n = 56) received interventions. There was a 47% (n = 29) increase in completed advanced care plans. 62% (n = 40) of residents had medicines optimised, with polypharmacy being reduced in 46% (n = 30) by an average of 2 medications per resident. 8% (n = 5) were referred to additional services and 8% (n = 5) required further investigations. Conclusion(s) This proactive MDT model effectively addressed the needs of residents whilst demonstrating immediate positive outcomes. Key facilitators to good practice were teamwork, clarifying the objectives of the MDT, prior reviews of patient records, and ensuring staff who knew the residents well were present. We will use this approach with other nursing homes within the PCN and share our results with colleagues. This has the potential to reduce costs of medications and hospital admissions, as well as improve quality.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"22 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071748","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 : 2025-01-30DOI: 10.1093/ageing/afae277.067
KY Loh, APY Ho, KS Lim, SD Varman
Introduction In older adults, anticholinergic burden (ACB) is associated with serious adverse effects including delirium, falls, functional decline, cognitive decline and death. We carried out a quality improvement project in an inpatient acute geriatric ward, aiming to reduce the percentage of older adults with high ACB scores on discharge by 15% from a baseline of 48% over a period of 3 months. Method A pre-interventional analysis of all patients discharged from a single acute geriatric ward in Changi General Hospital was performed. A pre-intervention survey was conducted to assess awareness among physicians of ACB and tools used. Fish-bone diagram, pareto chart and driver diagram were used to identify root causes, highlight the barriers and to prioritise interventions. Interventions in the form of educational posters on ACB, non-pharmacological management of delirium and behavioural symptoms of dementia were made available at the ward. ACB scores were generated for all patients on discharge, using an online ACB calculator [1], which combined the use of 2 validated scales: anticholinergic cognitive burden scale [2] and the German anticholinergic burden scale [3]. Results 396 patients were included in the analysis. Median percentage of patients with high ACB scores (≥3) on discharge was reduced from 48.4% pre-intervention to 16.1% post-intervention. Out of 14 physicians surveyed pre-intervention, 21.4% was unaware of the term ‘ACB’ and availability of ACB scoring systems. Conclusion An education approach is effective in raising awareness and reducing use of anticholinergic medications in an acute geriatric ward. This highlights the importance of incorporating ACB awareness and the tools into geriatric department teaching programmes. References 1. ACB Calculator. (n.d.). https://www.acbcalc.com/. 2. Boustani M., et al.Ageing Health. 2008. 4(3). 311–320. 3. Kiesel EK. et al.BMC Geriatr. 2018;18:239.
{"title":"2441 Reducing anticholinergic burden in older adults from an acute geriatric Ward—a quality improvement activity using education","authors":"KY Loh, APY Ho, KS Lim, SD Varman","doi":"10.1093/ageing/afae277.067","DOIUrl":"https://doi.org/10.1093/ageing/afae277.067","url":null,"abstract":"Introduction In older adults, anticholinergic burden (ACB) is associated with serious adverse effects including delirium, falls, functional decline, cognitive decline and death. We carried out a quality improvement project in an inpatient acute geriatric ward, aiming to reduce the percentage of older adults with high ACB scores on discharge by 15% from a baseline of 48% over a period of 3 months. Method A pre-interventional analysis of all patients discharged from a single acute geriatric ward in Changi General Hospital was performed. A pre-intervention survey was conducted to assess awareness among physicians of ACB and tools used. Fish-bone diagram, pareto chart and driver diagram were used to identify root causes, highlight the barriers and to prioritise interventions. Interventions in the form of educational posters on ACB, non-pharmacological management of delirium and behavioural symptoms of dementia were made available at the ward. ACB scores were generated for all patients on discharge, using an online ACB calculator [1], which combined the use of 2 validated scales: anticholinergic cognitive burden scale [2] and the German anticholinergic burden scale [3]. Results 396 patients were included in the analysis. Median percentage of patients with high ACB scores (≥3) on discharge was reduced from 48.4% pre-intervention to 16.1% post-intervention. Out of 14 physicians surveyed pre-intervention, 21.4% was unaware of the term ‘ACB’ and availability of ACB scoring systems. Conclusion An education approach is effective in raising awareness and reducing use of anticholinergic medications in an acute geriatric ward. This highlights the importance of incorporating ACB awareness and the tools into geriatric department teaching programmes. References 1. ACB Calculator. (n.d.). https://www.acbcalc.com/. 2. Boustani M., et al.Ageing Health. 2008. 4(3). 311–320. 3. Kiesel EK. et al.BMC Geriatr. 2018;18:239.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"86 1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071810","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 : 2025-01-30DOI: 10.1093/ageing/afae277.119
H Mohamed, J Tomlinson, E Ali, A Badawoud, J Silcock, A Jameson, A Sutherland, H Smith, B Fylan, PH Gardner
Introduction Adverse drug events from medication-related harm (MRH) can lead to hospital readmissions, compromised quality of life, and even death. After hospital discharge, older people can experience heightened vulnerability and are often unprepared for self-care and medication self-management. Effective medication self-management involves more than adherence; it requires patients to monitor their condition(s), build routines, recognise errors, seek help, understand when to alter medications, and discuss these issues with healthcare professionals. Determining medication self-management capability in older people can guide supportive interventions and improve medication-related outcomes. This systematic review identifies measures which assess medication self-management capability for older people transitioning from hospital-to-home. Method A comprehensive search was conducted in electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Cochrane Library of Systematic Reviews, and PROSPERO) for articles from database inception to 2023. Eligible studies included participants aged 65 or older experiencing a hospital-to-home transition, and measures containing at least one medication self-management component. Data extraction was performed using a standardised form. Characteristics of measures were tabulated and summarised descriptively. This review is registered with PROSPERO (CRD42023464325). Results 14 studies were included, identifying 12 unique measures. These measures predominantly had an adherence-focus, with other medication self-management components included to a lesser degree. Timing of measure administration and the individual administering the measure varied greatly across studies. Medication self-management capability was assessed through physical and cognitive skills. The number and type of skills assessed differed between measures. None of the measures considered all medication self-management components, with self-monitoring and adaptability specifically lacking. Conclusion Current measures for medication self-management capability assessment primarily focus on cognitive and physical skills, with significant emphasis on medication adherence. This can lead to other important skills being overlooked. Findings further highlight the importance of comprehensive definitions when considering medication self-management across the hospital-to-home transition, and recommendations are provided for developing future measures.
{"title":"2806 Assessing medication self-Management in Older People at hospital-to-home transition: a systematic review of measures and tools","authors":"H Mohamed, J Tomlinson, E Ali, A Badawoud, J Silcock, A Jameson, A Sutherland, H Smith, B Fylan, PH Gardner","doi":"10.1093/ageing/afae277.119","DOIUrl":"https://doi.org/10.1093/ageing/afae277.119","url":null,"abstract":"Introduction Adverse drug events from medication-related harm (MRH) can lead to hospital readmissions, compromised quality of life, and even death. After hospital discharge, older people can experience heightened vulnerability and are often unprepared for self-care and medication self-management. Effective medication self-management involves more than adherence; it requires patients to monitor their condition(s), build routines, recognise errors, seek help, understand when to alter medications, and discuss these issues with healthcare professionals. Determining medication self-management capability in older people can guide supportive interventions and improve medication-related outcomes. This systematic review identifies measures which assess medication self-management capability for older people transitioning from hospital-to-home. Method A comprehensive search was conducted in electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Cochrane Library of Systematic Reviews, and PROSPERO) for articles from database inception to 2023. Eligible studies included participants aged 65 or older experiencing a hospital-to-home transition, and measures containing at least one medication self-management component. Data extraction was performed using a standardised form. Characteristics of measures were tabulated and summarised descriptively. This review is registered with PROSPERO (CRD42023464325). Results 14 studies were included, identifying 12 unique measures. These measures predominantly had an adherence-focus, with other medication self-management components included to a lesser degree. Timing of measure administration and the individual administering the measure varied greatly across studies. Medication self-management capability was assessed through physical and cognitive skills. The number and type of skills assessed differed between measures. None of the measures considered all medication self-management components, with self-monitoring and adaptability specifically lacking. Conclusion Current measures for medication self-management capability assessment primarily focus on cognitive and physical skills, with significant emphasis on medication adherence. This can lead to other important skills being overlooked. Findings further highlight the importance of comprehensive definitions when considering medication self-management across the hospital-to-home transition, and recommendations are provided for developing future measures.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"27 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071815","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 : 2025-01-30DOI: 10.1093/ageing/afae277.016
I Mohangee, S Keir
Introduction In hospital incontinence increases length of stay (1), in orthopaedic patients is associated with increased likelihood of discharge to an institutionalised setting (2) and can have a major negative impact, with many rating bowel and bladder incontinence as a health state the same or worse than death (3). Yet of the Geriatric Giants, it is given relatively little attention. At a busy teaching hospital, we sought to raise awareness and improve management of incontinence across our 167 beds, by using a standardised, multi-disciplinary approach involving identification of patients and use of the components of BASICS (Bladder diary, A physical assessment, Symptom profile, Infection and Constipation check and a bladder Scan, fig. 1). Method Baseline data of a sample of 14 patients with new urinary incontinence with their aspects of continence assessment were added to a cumulative audit. Alongside checklists, a poster was designed and placed on each ward, a local teaching session about incontinence was delivered, and data shared at our local governance meetings. Following this, a further cycle of audit was performed. Reversible causes were identified and addressed appropriately. Results Between cycle 1 and 2 (February and June 2024), significant improvements were seen in most aspects of BASICS assessment with notable increases in use of the bladder diary (7 to 50%) and medical examination (7 to 57%). See fig. 2 for breakdown. As a consequence, there were multiple interventions aiming to improve patient symptoms. Conclusion Paying consistent and sustained attention to this neglected area of practice has demonstrated a change of culture is possible. We are now incorporating continence assessment into our medical trainee audit programme to support a sustained multi-disciplinary approach and maintain improvements.
{"title":"2827 Getting the BASICS right improves recognition and management of incontinence in a hospital setting","authors":"I Mohangee, S Keir","doi":"10.1093/ageing/afae277.016","DOIUrl":"https://doi.org/10.1093/ageing/afae277.016","url":null,"abstract":"Introduction In hospital incontinence increases length of stay (1), in orthopaedic patients is associated with increased likelihood of discharge to an institutionalised setting (2) and can have a major negative impact, with many rating bowel and bladder incontinence as a health state the same or worse than death (3). Yet of the Geriatric Giants, it is given relatively little attention. At a busy teaching hospital, we sought to raise awareness and improve management of incontinence across our 167 beds, by using a standardised, multi-disciplinary approach involving identification of patients and use of the components of BASICS (Bladder diary, A physical assessment, Symptom profile, Infection and Constipation check and a bladder Scan, fig. 1). Method Baseline data of a sample of 14 patients with new urinary incontinence with their aspects of continence assessment were added to a cumulative audit. Alongside checklists, a poster was designed and placed on each ward, a local teaching session about incontinence was delivered, and data shared at our local governance meetings. Following this, a further cycle of audit was performed. Reversible causes were identified and addressed appropriately. Results Between cycle 1 and 2 (February and June 2024), significant improvements were seen in most aspects of BASICS assessment with notable increases in use of the bladder diary (7 to 50%) and medical examination (7 to 57%). See fig. 2 for breakdown. As a consequence, there were multiple interventions aiming to improve patient symptoms. Conclusion Paying consistent and sustained attention to this neglected area of practice has demonstrated a change of culture is possible. We are now incorporating continence assessment into our medical trainee audit programme to support a sustained multi-disciplinary approach and maintain improvements.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"15 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071845","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 : 2025-01-30DOI: 10.1093/ageing/afae277.055
S Gupta, H Jos, J Brampton, A Sharma
Introduction National guidance suggests that all patients with neck of femur fractures (NOFF) should be mobilised day one post-operatively (NICE, 2023, QS16). This reduces rates of delirium, pneumonia and length of stay (Sallehuddin & Ong, Age and Ageing, 2021, 50, 356–357). Hypotension is a leading cause of immobilisation post-operatively. National guidance advises appropriate fluid resuscitation and review of polypharmacy when indicated (British Orthopaedic Association, 2007). This quality improvement project aimed to reduce post-operative hypotension and improve day one post-operative mobilisation in NOFF patients. Method Three months of NOFF patients were retrospectively reviewed pre-intervention. Those who did not receive surgical intervention were excluded. The proportion of NOFF patients that were unable to mobilise due to post-operative hypotension on day one was identified. We reviewed if intravenous fluids were given pre-operatively and if anti-hypertensives were held. An intervention was then implemented including educational posters and teaching sessions for doctors and nurses to encourage prescription of fluids on admission, holding of antihypertensives pre-operatively and detection and escalation of oliguria or hypotension post-operatively. Data were then re-collected in a three-month period post-intervention to ascertain if there was any change in practice. Results 70 patients underwent NOFF repair pre-intervention compared to 54 patients who underwent the procedure post-intervention. There was a decrease in the proportion of patients unable to mobilise day one post-operatively due to hypotension from 15.7% pre-intervention to 9.3% post-intervention. There was an increase in the proportion of patients who received pre-operative intravenous fluids from 64.3% pre-intervention to 77.8% post-intervention. Of those patients who took anti-hypertensive medication, a higher proportion had this suspended pre-operatively, increasing from 82.9% pre-intervention to 88.2% post-intervention. Conclusion Simple educational interventions can reduce post-operative hypotension in NOFF patients. Developing local guidelines may facilitate persistent clinical change, as improvements following poster distribution and teaching sessions may be transient.
{"title":"2819 Improving Ortho-geriatric outcomes: reducing immobility and post-operative hypotension in patients with neck of femur fractures","authors":"S Gupta, H Jos, J Brampton, A Sharma","doi":"10.1093/ageing/afae277.055","DOIUrl":"https://doi.org/10.1093/ageing/afae277.055","url":null,"abstract":"Introduction National guidance suggests that all patients with neck of femur fractures (NOFF) should be mobilised day one post-operatively (NICE, 2023, QS16). This reduces rates of delirium, pneumonia and length of stay (Sallehuddin & Ong, Age and Ageing, 2021, 50, 356–357). Hypotension is a leading cause of immobilisation post-operatively. National guidance advises appropriate fluid resuscitation and review of polypharmacy when indicated (British Orthopaedic Association, 2007). This quality improvement project aimed to reduce post-operative hypotension and improve day one post-operative mobilisation in NOFF patients. Method Three months of NOFF patients were retrospectively reviewed pre-intervention. Those who did not receive surgical intervention were excluded. The proportion of NOFF patients that were unable to mobilise due to post-operative hypotension on day one was identified. We reviewed if intravenous fluids were given pre-operatively and if anti-hypertensives were held. An intervention was then implemented including educational posters and teaching sessions for doctors and nurses to encourage prescription of fluids on admission, holding of antihypertensives pre-operatively and detection and escalation of oliguria or hypotension post-operatively. Data were then re-collected in a three-month period post-intervention to ascertain if there was any change in practice. Results 70 patients underwent NOFF repair pre-intervention compared to 54 patients who underwent the procedure post-intervention. There was a decrease in the proportion of patients unable to mobilise day one post-operatively due to hypotension from 15.7% pre-intervention to 9.3% post-intervention. There was an increase in the proportion of patients who received pre-operative intravenous fluids from 64.3% pre-intervention to 77.8% post-intervention. Of those patients who took anti-hypertensive medication, a higher proportion had this suspended pre-operatively, increasing from 82.9% pre-intervention to 88.2% post-intervention. Conclusion Simple educational interventions can reduce post-operative hypotension in NOFF patients. Developing local guidelines may facilitate persistent clinical change, as improvements following poster distribution and teaching sessions may be transient.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"39 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071903","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 : 2025-01-30DOI: 10.1093/ageing/afae277.065
E Gravell, G Williams, B Smith, C Willimont, C Beynon-Howells, P Quinn, T Green, DJ Burberry, S Fernandez, EA Davies
Introduction The National Early Warning Score (NEWS) (2017) incorporated new confusion as a category for consciousness. NEWS2 is evidenced to have high specificity but low sensitivity in detecting delirium. Methods Morriston Hospital. 261 patients assessed. Consciousness, overall NEWS2 score and AMT4 recorded. 227 NEWS2 charts available. 208 patients recorded as alert. 44% (n = 87) scored less than 4 on AMT4, 55% (n = 48) didn’t have documented past medical history (PMH) of cognitive impairment. Data missing for 14 patients. Ysbyty Gwynedd. 178 patients assessed.161 recorded as alert. 58.4% patients scored less than 4 on AMT4, 77% had no PMH of cognitive impairment. Data missing for 15 patients. University Hospital Llandough. 40 patients; 38 patients were marked as Alert, 2 were excluded from observations.32.5% (n = 13) had a diagnosis of possible or definite delirium. An electronic survey coupled with training delivery of 103 Health Care Workers (HCW) and 112 Registered Nurses (RN) was undertaken at Morriston. 39 HCWs (37.8%) and 31 RNs (27.6%) weren’t confident in the use of NEWS2 in regards to acute confusion. Training was offered on a 1 to 1 basis for these 215 staff members. Results Post intervention, 221 patients were assessed at Morriston, 209 marked as alert. 2 patients had been identified as having a new confusion and 10 patients did not have their consciousness recorded. Of the 209 marked alert 42% (88 patients) scored less than 4 on AMT4; 53 had no PMH of cognitive impairment. Training yielded little benefit. Conclusion The accuracy of recording consciousness has wider implications on the use of the NEWS2. NEWS2 uses routine observations and delirium assessment is variably implemented meaning routine information is not always available. The NEWS2 should be used in conjuction with other tools developed for delirium e.g 4AT and SQiD.
{"title":"2838 Evaluation of the use of the National Early Warning Score (NEWS2) for delirium identification in welsh hospitals","authors":"E Gravell, G Williams, B Smith, C Willimont, C Beynon-Howells, P Quinn, T Green, DJ Burberry, S Fernandez, EA Davies","doi":"10.1093/ageing/afae277.065","DOIUrl":"https://doi.org/10.1093/ageing/afae277.065","url":null,"abstract":"Introduction The National Early Warning Score (NEWS) (2017) incorporated new confusion as a category for consciousness. NEWS2 is evidenced to have high specificity but low sensitivity in detecting delirium. Methods Morriston Hospital. 261 patients assessed. Consciousness, overall NEWS2 score and AMT4 recorded. 227 NEWS2 charts available. 208 patients recorded as alert. 44% (n = 87) scored less than 4 on AMT4, 55% (n = 48) didn’t have documented past medical history (PMH) of cognitive impairment. Data missing for 14 patients. Ysbyty Gwynedd. 178 patients assessed.161 recorded as alert. 58.4% patients scored less than 4 on AMT4, 77% had no PMH of cognitive impairment. Data missing for 15 patients. University Hospital Llandough. 40 patients; 38 patients were marked as Alert, 2 were excluded from observations.32.5% (n = 13) had a diagnosis of possible or definite delirium. An electronic survey coupled with training delivery of 103 Health Care Workers (HCW) and 112 Registered Nurses (RN) was undertaken at Morriston. 39 HCWs (37.8%) and 31 RNs (27.6%) weren’t confident in the use of NEWS2 in regards to acute confusion. Training was offered on a 1 to 1 basis for these 215 staff members. Results Post intervention, 221 patients were assessed at Morriston, 209 marked as alert. 2 patients had been identified as having a new confusion and 10 patients did not have their consciousness recorded. Of the 209 marked alert 42% (88 patients) scored less than 4 on AMT4; 53 had no PMH of cognitive impairment. Training yielded little benefit. Conclusion The accuracy of recording consciousness has wider implications on the use of the NEWS2. NEWS2 uses routine observations and delirium assessment is variably implemented meaning routine information is not always available. The NEWS2 should be used in conjuction with other tools developed for delirium e.g 4AT and SQiD.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"60 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071906","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 : 2025-01-30DOI: 10.1093/ageing/afae277.054
C Moore-Gillon, E Thompson, J Agwada-Akeru
Introduction Loneliness affects nearly a third of adults aged >70. It increases the risk of conditions including depression, coronary artery disease and stroke. Lonely individuals are at increased risk of falls, hospital attendances and prolonged admissions. Following hip fracture, patients are particularly at risk and pre-fracture loneliness is associated with poorer outcomes. An inpatient stay offers the opportunity to screen for and address pre-fracture loneliness. Aims 100% of patients to have a University of California Los Angeles (UCLA) 3-item loneliness score by day 5 post-operatively. A score of 6 or above necessitates referral for community befriending services. Study population Patients aged >70 admitted with femoral neck fractures to orthogeriatric wards. Methods The project followed a Plan-Do-Study-Act approach. Electronic records were reviewed weekly for documentation of loneliness scores and referral to community befriending. Interventions 1. Doctor education session on loneliness and the UCLA 3-item loneliness scoring. 2. Inclusion of the loneliness score in the pre-populated ward round proforma. Results Of 102 patients, 63% of patients were female, mean age 85. At baseline, 0% had a loneliness score documented. This improved to 57% following intervention 1, returning to 0% after 2 weeks. Following intervention 2, this improved to 56% but fell to 25% after 6 weeks. Of 23 patients with completed scores, 5 (22%) had a high loneliness score and 4 patients were referred for befriending services. Conclusion High rates of loneliness were demonstrated, in line with national predictions. Assessment improved following interventions but was not sustained. Investigation suggested this was due to rapid turnover of doctors, and successive cohorts were unaware of quality improvement programmes before moving on. We believe this to be an important finding, with wider implications for research into improving patient care. Further steps include discussion of loneliness in weekly departmental meetings with the wider Multi-Disciplinary Team.
{"title":"2807 Lonely-less: a quality improvement project addressing loneliness in the elderly following neck of femur fracture","authors":"C Moore-Gillon, E Thompson, J Agwada-Akeru","doi":"10.1093/ageing/afae277.054","DOIUrl":"https://doi.org/10.1093/ageing/afae277.054","url":null,"abstract":"Introduction Loneliness affects nearly a third of adults aged >70. It increases the risk of conditions including depression, coronary artery disease and stroke. Lonely individuals are at increased risk of falls, hospital attendances and prolonged admissions. Following hip fracture, patients are particularly at risk and pre-fracture loneliness is associated with poorer outcomes. An inpatient stay offers the opportunity to screen for and address pre-fracture loneliness. Aims 100% of patients to have a University of California Los Angeles (UCLA) 3-item loneliness score by day 5 post-operatively. A score of 6 or above necessitates referral for community befriending services. Study population Patients aged >70 admitted with femoral neck fractures to orthogeriatric wards. Methods The project followed a Plan-Do-Study-Act approach. Electronic records were reviewed weekly for documentation of loneliness scores and referral to community befriending. Interventions 1. Doctor education session on loneliness and the UCLA 3-item loneliness scoring. 2. Inclusion of the loneliness score in the pre-populated ward round proforma. Results Of 102 patients, 63% of patients were female, mean age 85. At baseline, 0% had a loneliness score documented. This improved to 57% following intervention 1, returning to 0% after 2 weeks. Following intervention 2, this improved to 56% but fell to 25% after 6 weeks. Of 23 patients with completed scores, 5 (22%) had a high loneliness score and 4 patients were referred for befriending services. Conclusion High rates of loneliness were demonstrated, in line with national predictions. Assessment improved following interventions but was not sustained. Investigation suggested this was due to rapid turnover of doctors, and successive cohorts were unaware of quality improvement programmes before moving on. We believe this to be an important finding, with wider implications for research into improving patient care. Further steps include discussion of loneliness in weekly departmental meetings with the wider Multi-Disciplinary Team.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"60 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071746","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 : 2025-01-30DOI: 10.1093/ageing/afae277.106
A Steeves, P Jarrett, K Faig, CC Tranchant, G Handrigan, L Witkowski, J Haché, K MacMillan, A Gullison, H Omar, C Pauley, A Sexton, CA McGibbon
Introduction Research suggests that physical and cognitive exercise can have a positive effective on those with dementia, but less is known about such interventions in those at risk for dementia. Understanding the feasibility of administering clinical assessments remotely using Zoom for HealthcareTM in the context of a dementia prevention trial for at risk older adults is not well understood. Methods SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681) is a home-based, remotely delivered clinical trial targeting older adults at risk for dementia. Participants underwent a screening/baseline assessment and were randomised to one of four physical and cognitive exercise intervention arms for 16 weeks (3 times per week). They were reassessed immediately post-intervention and 6-months later. The standardised assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life were done at all three points. A research coordinator completed the assessments on a one-on-one basis via Zoom for HealthcareTM. The quality-of-life questionnaire was mailed to the participant. Results Forty-eight of 60 participants (80%) (mean age 68.7 ± 5.7 years, 81.3% female) completed the study. Most participants (75.0%) were cognitively intact with at least 2 dementia risk factors. No participants withdrew from the trial because of difficulty with the remote delivery of the assessments. There were no statistically significant changes in any of the assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, or quality of life throughout the study. Conclusion This study demonstrates it is possible to administer standardised clinical assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life remotely in the context of a clinical trial. The study was not powered to detect meaningful differences in these assessments. Nevertheless, this confirms the feasibility of remotely administering clinical assessments to older adults at risk for dementia.
{"title":"2860 Can clinical assessments be administered in a remotely delivered clinical trial targeting older adults at risk for dementia?","authors":"A Steeves, P Jarrett, K Faig, CC Tranchant, G Handrigan, L Witkowski, J Haché, K MacMillan, A Gullison, H Omar, C Pauley, A Sexton, CA McGibbon","doi":"10.1093/ageing/afae277.106","DOIUrl":"https://doi.org/10.1093/ageing/afae277.106","url":null,"abstract":"Introduction Research suggests that physical and cognitive exercise can have a positive effective on those with dementia, but less is known about such interventions in those at risk for dementia. Understanding the feasibility of administering clinical assessments remotely using Zoom for HealthcareTM in the context of a dementia prevention trial for at risk older adults is not well understood. Methods SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681) is a home-based, remotely delivered clinical trial targeting older adults at risk for dementia. Participants underwent a screening/baseline assessment and were randomised to one of four physical and cognitive exercise intervention arms for 16 weeks (3 times per week). They were reassessed immediately post-intervention and 6-months later. The standardised assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life were done at all three points. A research coordinator completed the assessments on a one-on-one basis via Zoom for HealthcareTM. The quality-of-life questionnaire was mailed to the participant. Results Forty-eight of 60 participants (80%) (mean age 68.7 ± 5.7 years, 81.3% female) completed the study. Most participants (75.0%) were cognitively intact with at least 2 dementia risk factors. No participants withdrew from the trial because of difficulty with the remote delivery of the assessments. There were no statistically significant changes in any of the assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, or quality of life throughout the study. Conclusion This study demonstrates it is possible to administer standardised clinical assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life remotely in the context of a clinical trial. The study was not powered to detect meaningful differences in these assessments. Nevertheless, this confirms the feasibility of remotely administering clinical assessments to older adults at risk for dementia.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"84 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071809","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：