Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.071
S Jamil, F Kirkham, P Xenofontos, R Techache, L Tomkow
Background Frailty is a poor prognostic indicator following cardiopulmonary resuscitation (CPR). Discussions about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are often contentious. While existing research focuses on patients’ and relatives’ perspectives, there is a lack of in-depth studies exploring clinicians’ experiences of DNACPR discussions. This study aims to explore how clinicians’ personal and professional beliefs and experiences influence their approach to DNACPR conversations with frail, older adults. Methods Ninety clinicians from primary and secondary care across the UK, all experienced in resuscitation discussions with frail older patients, participated in either semi-structured interviews (n = 45) or focus groups (n = 5). Participants included doctors of various grades, nurses, and advanced practitioners. Data were analysed using thematic analysis. Results Four key clinician-related themes emerged: professional experience, specialty culture, emotional response, and personal values. Some junior clinicians reported a lack of confidence in leading DNACPR discussions. Participants described how specialty culture shaped approaches, with geriatricians and palliative care teams most likely to initiate discussions. Some clinicians reported agreeing to CPR decisions that contradicted their medical judgement to avoid conflict with patients or families. Many expressed a personal preference for non-resuscitation in similar circumstances, influenced by professional exposure. A lack of formal training and a reliance on an informal ‘apprenticeship model’ were also commonly reported. Conclusion Clinician-specific factors appear to be important in DNACPR conversations with frail older adults. Addressing the personal and emotional aspects of these discussions is essential to improving clinician confidence and the overall quality of resuscitation decision-making.
{"title":"3792 Improving discussions about resuscitation with frail older adults: clinicians’ perspectives","authors":"S Jamil, F Kirkham, P Xenofontos, R Techache, L Tomkow","doi":"10.1093/ageing/afaf368.071","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.071","url":null,"abstract":"Background Frailty is a poor prognostic indicator following cardiopulmonary resuscitation (CPR). Discussions about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are often contentious. While existing research focuses on patients’ and relatives’ perspectives, there is a lack of in-depth studies exploring clinicians’ experiences of DNACPR discussions. This study aims to explore how clinicians’ personal and professional beliefs and experiences influence their approach to DNACPR conversations with frail, older adults. Methods Ninety clinicians from primary and secondary care across the UK, all experienced in resuscitation discussions with frail older patients, participated in either semi-structured interviews (n = 45) or focus groups (n = 5). Participants included doctors of various grades, nurses, and advanced practitioners. Data were analysed using thematic analysis. Results Four key clinician-related themes emerged: professional experience, specialty culture, emotional response, and personal values. Some junior clinicians reported a lack of confidence in leading DNACPR discussions. Participants described how specialty culture shaped approaches, with geriatricians and palliative care teams most likely to initiate discussions. Some clinicians reported agreeing to CPR decisions that contradicted their medical judgement to avoid conflict with patients or families. Many expressed a personal preference for non-resuscitation in similar circumstances, influenced by professional exposure. A lack of formal training and a reliance on an informal ‘apprenticeship model’ were also commonly reported. Conclusion Clinician-specific factors appear to be important in DNACPR conversations with frail older adults. Addressing the personal and emotional aspects of these discussions is essential to improving clinician confidence and the overall quality of resuscitation decision-making.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"69 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.121
C Carter, S Guerra, L Clothier, S Barlow, R Axenciuc, R Milton-Cole, X L Griffin, K J Sheehan
Introduction To synthesise the evidence available on components of reported rehabilitation interventions following pelvic fragility fracture in older adults and describe outcomes measured. Methods: A scoping review reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. A systematic search of Cochrane CENTRAL, Embase, MEDLINE and PEDr for studies of rehabilitation among patients 60 years and older with non-pathological pelvic fragility fracture, published up to May 2024. Single case studies were excluded. Screening and study selection were completed in duplicate by four independent reviewers. One reviewer completed extraction with accuracy checked by a second reviewer. A narrative synthesis approach was employed with text and tables. Results 17 studies reporting on rehabilitation after pelvic fragility fracture were identified. For 13 studies, descriptors were limited to mobilisation strategies with 9 citing unrestricted mobilisation as the first prescription. Three studies reporting multicomponent, multidisciplinary (physiotherapy-led), rehabilitation interventions across inpatient and community settings, incorporating exercise, psychological components, and education/advice were identified. 31 outcome domains were identified with key domains including pain, mobility, activities of daily living, quality of life, and mortality. There was an absence of consensus on which patient reported outcome instruments to use to measure relevant domains. Conclusions There is overall limited evidence to guide rehabilitation for older adults following fragility fracture of the pelvis. A standardised approach to rehabilitation should be designed which improves outcomes which matter most to those people affected.
{"title":"3551 Rehabilitation after pelvic fragility fracture in older adults: a scoping review","authors":"C Carter, S Guerra, L Clothier, S Barlow, R Axenciuc, R Milton-Cole, X L Griffin, K J Sheehan","doi":"10.1093/ageing/afaf368.121","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.121","url":null,"abstract":"Introduction To synthesise the evidence available on components of reported rehabilitation interventions following pelvic fragility fracture in older adults and describe outcomes measured. Methods: A scoping review reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. A systematic search of Cochrane CENTRAL, Embase, MEDLINE and PEDr for studies of rehabilitation among patients 60 years and older with non-pathological pelvic fragility fracture, published up to May 2024. Single case studies were excluded. Screening and study selection were completed in duplicate by four independent reviewers. One reviewer completed extraction with accuracy checked by a second reviewer. A narrative synthesis approach was employed with text and tables. Results 17 studies reporting on rehabilitation after pelvic fragility fracture were identified. For 13 studies, descriptors were limited to mobilisation strategies with 9 citing unrestricted mobilisation as the first prescription. Three studies reporting multicomponent, multidisciplinary (physiotherapy-led), rehabilitation interventions across inpatient and community settings, incorporating exercise, psychological components, and education/advice were identified. 31 outcome domains were identified with key domains including pain, mobility, activities of daily living, quality of life, and mortality. There was an absence of consensus on which patient reported outcome instruments to use to measure relevant domains. Conclusions There is overall limited evidence to guide rehabilitation for older adults following fragility fracture of the pelvis. A standardised approach to rehabilitation should be designed which improves outcomes which matter most to those people affected.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.004
A Soma, L Jones, E Clift
Introduction Falls are a common presentation comprising 17% of all ED attendances in older people and can result in harm including fragility fractures (FFs). FFs lead to pain, functional decline, deconditioning, and high mortality. Validated tools such as FRAX can increase prescribing of antiresorptive medications (ARM), reducing harm. Comprehensive geriatric assessment (CGA) is the gold standard for assessing and managing geriatric syndromes including falls and can include fragility fracture risk assessment. Method: An audit was conducted of all inpatients over one day on Colwell Ward at Isle of Wight NHS Trust. Patients were screened meeting NICE criteria for Bone Health Assessment (BHA). Notes were reviewed for evidence of FRAX scores or BHAs. Bloods were reviewed for vitamin D and calcium. Drg charts, medicine reconciliations, and GP records were screened to see if vitamin D, calcium, and anti-resorptive medications were prescribed previously. Following the audit FRAX scoring has been included in the CGA being piloted by the acute frailty team. Results Of 30 inpatients, 100% met NICE criteria for BHA. Mean and median age was 85 (72–96). 63.3% were female (19/30). 16.7% had a history of osteoporosis or osteopenia (5/30). 6.7% (2/30) had a note mentioning BHA in their medical notes, however zero patients had had a FRAX score calculated. 46.7% (14/30) had vitamin D checked and 93.3% (28/30) had had calcium checked. 6.7% (2/30) were already on ARM and the same percentage were started on ARM that admission. 56.7% (17/30) had vitamin D and calcium prescribed on their drug charts. Conclusion All patients met NICE criteria for BHA however few had FRAX scores completed. This may lead to avoidable fragility fractures. Reasons for few BHAs are likely multifactorial. Embedding FRAX within the CGA increases opportunities to identify at-risk patients. Re-audit is recommended after the CGA has been fully implemented locally.
{"title":"3589 Embedding FRAX scoring into the comprehensive geriatric assessment following an inpatient audit","authors":"A Soma, L Jones, E Clift","doi":"10.1093/ageing/afaf368.004","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.004","url":null,"abstract":"Introduction Falls are a common presentation comprising 17% of all ED attendances in older people and can result in harm including fragility fractures (FFs). FFs lead to pain, functional decline, deconditioning, and high mortality. Validated tools such as FRAX can increase prescribing of antiresorptive medications (ARM), reducing harm. Comprehensive geriatric assessment (CGA) is the gold standard for assessing and managing geriatric syndromes including falls and can include fragility fracture risk assessment. Method: An audit was conducted of all inpatients over one day on Colwell Ward at Isle of Wight NHS Trust. Patients were screened meeting NICE criteria for Bone Health Assessment (BHA). Notes were reviewed for evidence of FRAX scores or BHAs. Bloods were reviewed for vitamin D and calcium. Drg charts, medicine reconciliations, and GP records were screened to see if vitamin D, calcium, and anti-resorptive medications were prescribed previously. Following the audit FRAX scoring has been included in the CGA being piloted by the acute frailty team. Results Of 30 inpatients, 100% met NICE criteria for BHA. Mean and median age was 85 (72–96). 63.3% were female (19/30). 16.7% had a history of osteoporosis or osteopenia (5/30). 6.7% (2/30) had a note mentioning BHA in their medical notes, however zero patients had had a FRAX score calculated. 46.7% (14/30) had vitamin D checked and 93.3% (28/30) had had calcium checked. 6.7% (2/30) were already on ARM and the same percentage were started on ARM that admission. 56.7% (17/30) had vitamin D and calcium prescribed on their drug charts. Conclusion All patients met NICE criteria for BHA however few had FRAX scores completed. This may lead to avoidable fragility fractures. Reasons for few BHAs are likely multifactorial. Embedding FRAX within the CGA increases opportunities to identify at-risk patients. Re-audit is recommended after the CGA has been fully implemented locally.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"111 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.014
P Godage, L Forsyth, T Bell, H Hobbs, E Litto, B McCluskey-Mayes, C Meilak
Introduction Our perioperative service for older people undergoing surgery (POPS) commenced inpatient reviews in September 2024. Method Patients being considered for laparotomy aged 80 and over were prioritised as part of the national emergency laparotomy audit (NELA) recommendations. Other patients reviewed were multi-morbid and frail patients with other pathologies, aged between 65–80. All patients reviewed had a comprehensive geriatric assessment (CGA) and shared decision making (SDM) as required. Results In 3 months, 115 patients were seen. Median age 83, median clinical frailty score 4 (mild frailty: range 2–8). 22% had surgery, LOS range 2–96 days (2 longest were admitted pre-POPS), median LOS 7. 7% were readmitted within 30 days. 32% already had a DNA CPR/ReSPECT in place, POPS discussed treatment escalation with an additional 25% patients. End of life discussions and pathways instigated by POPS in 8 patients. SDM discussions regarding surgical treatment plans were undertaken in 11 patients. 18% did not need intervention, 55% chose not to have treatment and 27% chose to proceed with surgery after SDM. 53% of patients had medical complications, to which POPS gave input. For the laparotomy group aged 80 and over, 3 months pre and post POPS LOS analysis was undertaken. There was a reduction in LOS from 17 to 14.8 days. There were 4 patients readmitted within 30 days pre-POPS and none in the post-POPS group. Patient and colleague feedback were obtained. Patient feedback was adapted from experience-based design. Feedback on the POPS intervention was overwhelmingly positive. Conclusion The POPS intervention was well received by patients and colleagues. There was a trend in reduction in LOS (by 2.2 days) and readmission rates in the older laparotomy group. Quality of care was improved for all seen by virtue of medical input, SDM and escalation discussions.
{"title":"3670 The role of comprehensive geriatric assessment and shared decision making in general surgical inpatients","authors":"P Godage, L Forsyth, T Bell, H Hobbs, E Litto, B McCluskey-Mayes, C Meilak","doi":"10.1093/ageing/afaf368.014","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.014","url":null,"abstract":"Introduction Our perioperative service for older people undergoing surgery (POPS) commenced inpatient reviews in September 2024. Method Patients being considered for laparotomy aged 80 and over were prioritised as part of the national emergency laparotomy audit (NELA) recommendations. Other patients reviewed were multi-morbid and frail patients with other pathologies, aged between 65–80. All patients reviewed had a comprehensive geriatric assessment (CGA) and shared decision making (SDM) as required. Results In 3 months, 115 patients were seen. Median age 83, median clinical frailty score 4 (mild frailty: range 2–8). 22% had surgery, LOS range 2–96 days (2 longest were admitted pre-POPS), median LOS 7. 7% were readmitted within 30 days. 32% already had a DNA CPR/ReSPECT in place, POPS discussed treatment escalation with an additional 25% patients. End of life discussions and pathways instigated by POPS in 8 patients. SDM discussions regarding surgical treatment plans were undertaken in 11 patients. 18% did not need intervention, 55% chose not to have treatment and 27% chose to proceed with surgery after SDM. 53% of patients had medical complications, to which POPS gave input. For the laparotomy group aged 80 and over, 3 months pre and post POPS LOS analysis was undertaken. There was a reduction in LOS from 17 to 14.8 days. There were 4 patients readmitted within 30 days pre-POPS and none in the post-POPS group. Patient and colleague feedback were obtained. Patient feedback was adapted from experience-based design. Feedback on the POPS intervention was overwhelmingly positive. Conclusion The POPS intervention was well received by patients and colleagues. There was a trend in reduction in LOS (by 2.2 days) and readmission rates in the older laparotomy group. Quality of care was improved for all seen by virtue of medical input, SDM and escalation discussions.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"6 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.088
N Malik, S Salman, K Ng, N Tan
* Both authors contributed equally to this work. Introduction Polypharmacy is a major risk for older patients aged 65 and above. Commonly prescribed medications may have anticholinergic properties causing dry mouth, constipation, and urinary retention which can exacerbate delirium in older adults1. ACB scores help quantify the cumulative effect of these medications. ACB scores of three or more are associated with confusion, falls and death2. Aim To evaluate whether automated alerts of ACB scores help reduce scores and encourage medication reviews in older patients. Method Over two weeks, automated alerts were set up within the hospital’s online noting system, which is simulated to flag high ACB scores based on inpatient drug charts. The alert identified the total ACB score and highlighted offending medications. Data was collected from 40 patients across four elderly care wards over two weeks, on alternate days. ACB scores were calculated using an online ACB calculator. ACB scores collected before and after two simulated alerts were analysed and compared. Results Out of 40 patients, 12 had an ACB score of 3 or more before the simulated alerts. Following two automated alerts, this reduced to 9 patients, which equates to a 25% reduction. However, in 31 patients, the ACB score remained unchanged. The ACB scores increased in 8 of the 40 patients. Furthermore, lansoprazole was the most common offending drug, followed by tricyclic antidepressants. Conclusion Our study demonstrated that automated reminders could facilitate regular medical reviews and reduce anticholinergic burden in elderly patients. However, this would work better in combination with regular teaching sessions to increase awareness. Importantly, proton pump inhibitors (PPIs) were prescribed to over a quarter of patients. This raises questions about the necessity of these medications in this age group and a potential QIP looking at deprescribing PPIs as per the deprescribing algorithm.
{"title":"3765 Reducing anticholinergic burden (ACB) within the elderly care wards through implementation of automated alerts","authors":"N Malik, S Salman, K Ng, N Tan","doi":"10.1093/ageing/afaf368.088","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.088","url":null,"abstract":"* Both authors contributed equally to this work. Introduction Polypharmacy is a major risk for older patients aged 65 and above. Commonly prescribed medications may have anticholinergic properties causing dry mouth, constipation, and urinary retention which can exacerbate delirium in older adults1. ACB scores help quantify the cumulative effect of these medications. ACB scores of three or more are associated with confusion, falls and death2. Aim To evaluate whether automated alerts of ACB scores help reduce scores and encourage medication reviews in older patients. Method Over two weeks, automated alerts were set up within the hospital’s online noting system, which is simulated to flag high ACB scores based on inpatient drug charts. The alert identified the total ACB score and highlighted offending medications. Data was collected from 40 patients across four elderly care wards over two weeks, on alternate days. ACB scores were calculated using an online ACB calculator. ACB scores collected before and after two simulated alerts were analysed and compared. Results Out of 40 patients, 12 had an ACB score of 3 or more before the simulated alerts. Following two automated alerts, this reduced to 9 patients, which equates to a 25% reduction. However, in 31 patients, the ACB score remained unchanged. The ACB scores increased in 8 of the 40 patients. Furthermore, lansoprazole was the most common offending drug, followed by tricyclic antidepressants. Conclusion Our study demonstrated that automated reminders could facilitate regular medical reviews and reduce anticholinergic burden in elderly patients. However, this would work better in combination with regular teaching sessions to increase awareness. Importantly, proton pump inhibitors (PPIs) were prescribed to over a quarter of patients. This raises questions about the necessity of these medications in this age group and a potential QIP looking at deprescribing PPIs as per the deprescribing algorithm.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"68 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.016
H Kingston, R Podmore
Introduction Frailty is a strong prognostic predictor. By incorporation routine frailty scoring as part of routine primary care this can help as guide to clinical teams. Method In 2021 we recognised that our we needed to improve identification of frailty. We undertook whole team training of nurse, GPs and Health Care Assistants, and incorporated scoring the Rockwood Clinical Scale as a routine part of regular chronic disease reviews and template for those over 80. An alert was added on the clinical system to highlight last Rockwood score or where this remained outstanding. Results In May 2020 we have proactively recorded frailty status as mild moderate or severe frailty or a Rockwood score in only 22% patients and 27% patients in May 2021 and 33% in May 2022. With implementation of a systematic approach the completeness of our data has improved from to 66% by May 2023 and has since steadily increased to 81% in May 2024 and 90% in May 2025. Comparison with neighbouring practices in Mendip where this change was not implemented shows a smaller incremental rise in completeness of recording from 33% in 2020 to 47% in May 2025. Conclusion Although in 2021 our proactive coding for frailty lagged behind the performance of other Mendip practices, we have been able to make improvements from coding 24.3% of those over 80 to now having coded 90.1% of this group through a systematic approach. Working as a whole practice team it has been possible to identify those living with frailty using Rockwood scoring. The coding of those at advanced age who are not frail can also help ensure this group continue to have full medical interventions and are not subject to age discrimination.
{"title":"3683 Improving frailty coding through a systems approach in primary care","authors":"H Kingston, R Podmore","doi":"10.1093/ageing/afaf368.016","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.016","url":null,"abstract":"Introduction Frailty is a strong prognostic predictor. By incorporation routine frailty scoring as part of routine primary care this can help as guide to clinical teams. Method In 2021 we recognised that our we needed to improve identification of frailty. We undertook whole team training of nurse, GPs and Health Care Assistants, and incorporated scoring the Rockwood Clinical Scale as a routine part of regular chronic disease reviews and template for those over 80. An alert was added on the clinical system to highlight last Rockwood score or where this remained outstanding. Results In May 2020 we have proactively recorded frailty status as mild moderate or severe frailty or a Rockwood score in only 22% patients and 27% patients in May 2021 and 33% in May 2022. With implementation of a systematic approach the completeness of our data has improved from to 66% by May 2023 and has since steadily increased to 81% in May 2024 and 90% in May 2025. Comparison with neighbouring practices in Mendip where this change was not implemented shows a smaller incremental rise in completeness of recording from 33% in 2020 to 47% in May 2025. Conclusion Although in 2021 our proactive coding for frailty lagged behind the performance of other Mendip practices, we have been able to make improvements from coding 24.3% of those over 80 to now having coded 90.1% of this group through a systematic approach. Working as a whole practice team it has been possible to identify those living with frailty using Rockwood scoring. The coding of those at advanced age who are not frail can also help ensure this group continue to have full medical interventions and are not subject to age discrimination.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"110 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.163
K Ali, E Mensah, J M Stevenson, S Nyangoma, V Hamer, N Parekh, C Rajkumar, J G Davies, M Touray, H Gage, S Fowler-Davis
Introduction Medication-related harm (MRH) is a challenge for older adults in the period following hospital discharge. NHS Discharge Medicines Service (DMS), within the Community Pharmacy Contractual Framework, aims to reduce post-discharge MRH through improved communication between hospital, community pharmacists, and patients. The aim of the study was to investigate the effectiveness of an individualised medicine management plan (MMP) plus DMS in reducing medication-related harm compared to DMS only. Method Older adults ≥65 years were recruited from 8 hospitals in England and randomised to intervention (MMP of patient education about medicines and discussion around medication risk plus DMS) or control (DMS only). Baseline data included patients’ clinical and social demographics and medication risk calculated using a risk-prediction tool at the point of discharge. At 8-weeks post-discharge, trained study pharmacists or doctors verified MRH via triangulation of outcome data obtained from telephone interview with study participants and/or carers, review of GP records and identifying cause of readmission if it occurred. A process evaluation assessed the acceptability of study methods by hospital pharmacists. Results A total of 274 patients were included (140 control, 134 intervention), mean age of 80.1 years (range 65–100), 151 (55.1%) females. In both study arms, MRH was strongly associated with hospital readmission (OR = 5.29, 95% CI: 1.57–17.77) and use of A&E services (OR = 4.21, 95% CI: 1.33–13.31). Although not statistically significant, there was a consistent trend towards reduced odds of adverse outcomes in the intervention group, OR = 0.52 (95% CI: 0.16–1.68). The process evaluation showed that the study strengths were a standardised medicine management plan, objectively assessing medications risk, and identifying opportunities for pharmacist-led interventions. Conclusion MRH after leaving hospital has a substantial impact on healthcare utilisation. The study intervention has the potential to deliver clinically important benefits through reducing MRH.
{"title":"3767 Results of a randomised controlled study to reduce medication-related harm in older adults after hospital discharge","authors":"K Ali, E Mensah, J M Stevenson, S Nyangoma, V Hamer, N Parekh, C Rajkumar, J G Davies, M Touray, H Gage, S Fowler-Davis","doi":"10.1093/ageing/afaf368.163","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.163","url":null,"abstract":"Introduction Medication-related harm (MRH) is a challenge for older adults in the period following hospital discharge. NHS Discharge Medicines Service (DMS), within the Community Pharmacy Contractual Framework, aims to reduce post-discharge MRH through improved communication between hospital, community pharmacists, and patients. The aim of the study was to investigate the effectiveness of an individualised medicine management plan (MMP) plus DMS in reducing medication-related harm compared to DMS only. Method Older adults ≥65 years were recruited from 8 hospitals in England and randomised to intervention (MMP of patient education about medicines and discussion around medication risk plus DMS) or control (DMS only). Baseline data included patients’ clinical and social demographics and medication risk calculated using a risk-prediction tool at the point of discharge. At 8-weeks post-discharge, trained study pharmacists or doctors verified MRH via triangulation of outcome data obtained from telephone interview with study participants and/or carers, review of GP records and identifying cause of readmission if it occurred. A process evaluation assessed the acceptability of study methods by hospital pharmacists. Results A total of 274 patients were included (140 control, 134 intervention), mean age of 80.1 years (range 65–100), 151 (55.1%) females. In both study arms, MRH was strongly associated with hospital readmission (OR = 5.29, 95% CI: 1.57–17.77) and use of A&E services (OR = 4.21, 95% CI: 1.33–13.31). Although not statistically significant, there was a consistent trend towards reduced odds of adverse outcomes in the intervention group, OR = 0.52 (95% CI: 0.16–1.68). The process evaluation showed that the study strengths were a standardised medicine management plan, objectively assessing medications risk, and identifying opportunities for pharmacist-led interventions. Conclusion MRH after leaving hospital has a substantial impact on healthcare utilisation. The study intervention has the potential to deliver clinically important benefits through reducing MRH.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"235 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.028
A Turna, E Lines
Introduction Elderly patients undergoing surgery for neck of femur (NOF) fractures are at high risk of post-operative hypotension due to reduced physiological reserve. Hypotension in this context is associated with an increased risk of cardiovascular events and impaired recovery. Therefore, senior clinicians often pre-emptively hold angiotensin-converting enzyme inhibitors (ACE-Is) and calcium channel blockers (CCBs) for 48 hours post-operatively, but this practice is inconsistently followed by resident doctors. We audited the prevalence and impact of this practice and introduced an intervention to improve consistency. Methods A two-cycle audit was conducted on an orthogeriatric ward. Inclusion criteria were patients aged >65 requiring surgery for NOF fractures. Data collected included antihypertensive use on admission, whether antihypertensives were held post-operatively, systolic blood pressure on post-operative days (POD) 1–3, episodes of moderate (90–100 mmHg) and severe (<90 mmHg) systolic hypotension, and potential confounders (haemoglobin drop, fluid resuscitation, age). Ethical approval was waived. After the first cycle, an intervention was introduced: (1) an induction teaching session for resident doctors and (2) a revised post-op proforma prompting holding of ACE-Is and CCBs. Results Twenty-four patients were included pre-intervention, and 25 post-intervention. 75% of patients were taking at least one antihypertensive on admission. Already in the first cycle, patients in whom antihypertensives were held pre-emptively had significantly fewer days of severe hypotension in POD 1–3 (0.36 vs. 0.64 days, p = 0.03). Prior to the intervention, antihypertensives were appropriately held in 40% of cases. Post-intervention, this rose to 88% (p = 0.04). The average number of days with severe hypotension decreased from 0.62 to 0.28 (p = 0.03), and hypotension incidence fell from 35% to 28% (p = 0.01). Conclusion Pre-emptively withholding ACE-Is and CCBs post-operatively for 48 hours in elderly patients reduces the incidence and duration of hypotension. Teaching and documentation prompts can embed this practice into routine care and improve post-operative outcomes.
{"title":"3761 Pre-emptive holding of antihypertensives after neck of femur fracture surgery: a PDSA audit in an orthogeriatric ward","authors":"A Turna, E Lines","doi":"10.1093/ageing/afaf368.028","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.028","url":null,"abstract":"Introduction Elderly patients undergoing surgery for neck of femur (NOF) fractures are at high risk of post-operative hypotension due to reduced physiological reserve. Hypotension in this context is associated with an increased risk of cardiovascular events and impaired recovery. Therefore, senior clinicians often pre-emptively hold angiotensin-converting enzyme inhibitors (ACE-Is) and calcium channel blockers (CCBs) for 48 hours post-operatively, but this practice is inconsistently followed by resident doctors. We audited the prevalence and impact of this practice and introduced an intervention to improve consistency. Methods A two-cycle audit was conducted on an orthogeriatric ward. Inclusion criteria were patients aged &gt;65 requiring surgery for NOF fractures. Data collected included antihypertensive use on admission, whether antihypertensives were held post-operatively, systolic blood pressure on post-operative days (POD) 1–3, episodes of moderate (90–100 mmHg) and severe (&lt;90 mmHg) systolic hypotension, and potential confounders (haemoglobin drop, fluid resuscitation, age). Ethical approval was waived. After the first cycle, an intervention was introduced: (1) an induction teaching session for resident doctors and (2) a revised post-op proforma prompting holding of ACE-Is and CCBs. Results Twenty-four patients were included pre-intervention, and 25 post-intervention. 75% of patients were taking at least one antihypertensive on admission. Already in the first cycle, patients in whom antihypertensives were held pre-emptively had significantly fewer days of severe hypotension in POD 1–3 (0.36 vs. 0.64 days, p = 0.03). Prior to the intervention, antihypertensives were appropriately held in 40% of cases. Post-intervention, this rose to 88% (p = 0.04). The average number of days with severe hypotension decreased from 0.62 to 0.28 (p = 0.03), and hypotension incidence fell from 35% to 28% (p = 0.01). Conclusion Pre-emptively withholding ACE-Is and CCBs post-operatively for 48 hours in elderly patients reduces the incidence and duration of hypotension. Teaching and documentation prompts can embed this practice into routine care and improve post-operative outcomes.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"87 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.024
F Bako, M Myint
Introduction Controlling BP minimises the rate of ICH and reperfusion to promote adequate cerebral perfusion (2). Antiplatelets reduce the risk of recurrent stroke and other vascular events (3). Cholesterol reduction reduces the risk of stroke by reducing harming lipids (4). Diet and exercise are independent stroke reducers and positively impacts both weight and blood pressure (5). Smoking cessation can greatly reduce your risk of stroke (7) (8) (9). If carotid endarterectomy takes place sooner the absolute risk reduction (ARR) is increased and the outcome for the patient is much better (1). Standards and Ethics National Clinical Guideline for Stroke and it is under the section Acute Care Criteria for Carotid Doppler Ultrasound Scan (CDUS) include: Short lived symptoms (TIA), Minor non debilitating symptoms so that they can have further surgery (in this audit we have defined this as NIHSS score < 5) and has to be anterior stroke. Ethic approval was not needed as it is focused on improving the quality of care within routine clinical practice and do not involve interventions or data collection beyond standard acre. The audit was registered with the audit department and the audit registration number is Ca11032. Methods A re-evaluation of 49 patients with an (National Institutes of Health Stroke Scale) NIHSS score admitted to E58 in Sunderland Royal Hospital between 21st June 2024- 67th August 2024 were analysed. Aims and Objectives. Aim Complete cycle 2 of an audit investigating if ward E58 have improved their management of patients appropriate for CDUS. Objectives Document how many patients had their carotid doppler ultrasound scans. Log how many were seen within 24 hours. Establish how many patients undergo vascular surgery. Calculate how long patients were seen between CDUS report and surgery. Demonstrate how many patients were treated correct with pharmacological therapy including: Correct statin treatment; Correct antiplatelet treatment. Demonstrate how many patients had non-pharmacological treatment explored. Diet, Lifestyle and Smoking cessation. Results 100% success rate in all strokes reviewed receiving the correct antiplatelet therapy. 25/30 (83.3%) patients were started on cholesterol lowering therapy. This is a three percent increase from last time. 4/30 patients (13.3%) were talked to about diet and exercise/lifestyle measures. This is a 2% increase from last time. The doctors did well in this study and were better at commenting on blood pressure. 18/30 (60%) of patients which is a great improvement as there were only 3% of cases commented on previously. Only one patient received vascular surgery and they did not have it within seven days. There were multiple factors leading to delay in surgery—they had their CDUS as an outpatient and there was a delay in the aorta CTa being ordered. Then the surgery was booked for 3 weeks after the aorta CTA was reported. Conclusion What we excel at: Prescribing antiplatelet medications and stat
{"title":"3479 Re-evaluation of stroke patients with NIHSS score < 5 at Sunderland Royal Hospital","authors":"F Bako, M Myint","doi":"10.1093/ageing/afaf368.024","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.024","url":null,"abstract":"Introduction Controlling BP minimises the rate of ICH and reperfusion to promote adequate cerebral perfusion (2). Antiplatelets reduce the risk of recurrent stroke and other vascular events (3). Cholesterol reduction reduces the risk of stroke by reducing harming lipids (4). Diet and exercise are independent stroke reducers and positively impacts both weight and blood pressure (5). Smoking cessation can greatly reduce your risk of stroke (7) (8) (9). If carotid endarterectomy takes place sooner the absolute risk reduction (ARR) is increased and the outcome for the patient is much better (1). Standards and Ethics National Clinical Guideline for Stroke and it is under the section Acute Care Criteria for Carotid Doppler Ultrasound Scan (CDUS) include: Short lived symptoms (TIA), Minor non debilitating symptoms so that they can have further surgery (in this audit we have defined this as NIHSS score &lt; 5) and has to be anterior stroke. Ethic approval was not needed as it is focused on improving the quality of care within routine clinical practice and do not involve interventions or data collection beyond standard acre. The audit was registered with the audit department and the audit registration number is Ca11032. Methods A re-evaluation of 49 patients with an (National Institutes of Health Stroke Scale) NIHSS score admitted to E58 in Sunderland Royal Hospital between 21st June 2024- 67th August 2024 were analysed. Aims and Objectives. Aim Complete cycle 2 of an audit investigating if ward E58 have improved their management of patients appropriate for CDUS. Objectives Document how many patients had their carotid doppler ultrasound scans. Log how many were seen within 24 hours. Establish how many patients undergo vascular surgery. Calculate how long patients were seen between CDUS report and surgery. Demonstrate how many patients were treated correct with pharmacological therapy including: Correct statin treatment; Correct antiplatelet treatment. Demonstrate how many patients had non-pharmacological treatment explored. Diet, Lifestyle and Smoking cessation. Results 100% success rate in all strokes reviewed receiving the correct antiplatelet therapy. 25/30 (83.3%) patients were started on cholesterol lowering therapy. This is a three percent increase from last time. 4/30 patients (13.3%) were talked to about diet and exercise/lifestyle measures. This is a 2% increase from last time. The doctors did well in this study and were better at commenting on blood pressure. 18/30 (60%) of patients which is a great improvement as there were only 3% of cases commented on previously. Only one patient received vascular surgery and they did not have it within seven days. There were multiple factors leading to delay in surgery—they had their CDUS as an outpatient and there was a delay in the aorta CTa being ordered. Then the surgery was booked for 3 weeks after the aorta CTA was reported. Conclusion What we excel at: Prescribing antiplatelet medications and stat","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"17 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/ageing/afaf368.146
T Tay, F Chen, H Amin, B Maan, S Dryden, M Fertleman, L Shepherd, K Grailey, A Darzi
Introduction Frailty is defined as a clinically recognised state of increased vulnerability, reflecting a decline in an individual’s psychological and physical reserves. Digital interventions, such as smartwatches, are increasingly utilised to monitor and support the health of older adults. Evidence on the effectiveness of digital interventions in reducing or reversing frailty is limited. This systematic review aimed to investigate the types of digital interventions tested and the resulting outcomes. Method The following databases: Medline, CINAHL, Scopus, PsychInfo and Embase were searched from time of origin until July 2024. A search strategy was designed to identify randomised controlled trials assessing the impact of digital interventions on older adults. Outcome measures explored include frailty, wellbeing and quality of life. Narrative synthesis was performed for all studies and meta-analysis was performed for outcomes reported in four or more studies. Risk of bias was conducted using Cochrane Risk of Bias-2 tool. Results From 4476 titles and abstracts screened, 17 studies were included following full text review. Overall, 12 studies included exercises as a component or the sole form of intervention. The mean duration of intervention was 4.04 (SD 2.56) months. Mean adherence to the intervention was 59%. The most reported frailty-specific outcome was walking speed (n = 8), while the least reported outcome was self-reported exhaustion level (n = 2). Meta-analysis showed non-exercise-based interventions showed significant improvements in SPPB. There was no statistically significant change in TUG and handgrip strength. Narrative synthesis indicates there was insufficient evidence to evaluate the impact of digital interventions on frailty, cognition, wellbeing, activities of daily living and health-related quality of life. Conclusions The findings suggest low technological readiness and adherence among digital interventions for older adults. Narrative synthesis of overall frailty and outcome measures showed mixed results and insufficient evidence on the impact of digital interventions on frailty and outcomes reviewed.
虚弱被定义为一种临床公认的脆弱性增加的状态，反映了个人心理和身体储备的下降。智能手表等数字干预措施越来越多地用于监测和支持老年人的健康。关于数字干预措施在减少或扭转脆弱性方面的有效性的证据有限。本系统综述旨在调查所测试的数字干预措施的类型及其结果。方法检索自文献来源时间至2024年7月的Medline、CINAHL、Scopus、PsychInfo和Embase数据库。设计了一种搜索策略，以确定评估数字干预对老年人影响的随机对照试验。研究结果包括虚弱、健康和生活质量。对所有研究进行叙事综合，并对四项或更多研究报告的结果进行荟萃分析。偏倚风险采用Cochrane Risk of bias -2工具进行。结果从筛选的4476篇标题和摘要中，纳入了17项研究。总的来说，有12项研究将锻炼作为干预的组成部分或唯一形式。平均干预时间为4.04个月（SD 2.56）。干预的平均依从性为59%。报告最多的虚弱特异性结果是步行速度（n = 8），而报告最少的结果是自我报告的疲劳水平（n = 2）。荟萃分析显示，非运动干预对SPPB有显著改善。TUG和握力没有统计学上的显著变化。叙述性综合表明，没有足够的证据来评估数字干预措施对脆弱性、认知、福祉、日常生活活动和与健康相关的生活质量的影响。结论：研究结果表明，老年人数字干预的技术准备程度和依从性较低。对总体脆弱性和结果测量的叙述性综合结果显示，数字干预措施对脆弱性和结果的影响结果好坏参半，证据不足。
{"title":"3734 The impact of digital interventions to reverse frailty—systematic review and meta-analysis","authors":"T Tay, F Chen, H Amin, B Maan, S Dryden, M Fertleman, L Shepherd, K Grailey, A Darzi","doi":"10.1093/ageing/afaf368.146","DOIUrl":"https://doi.org/10.1093/ageing/afaf368.146","url":null,"abstract":"Introduction Frailty is defined as a clinically recognised state of increased vulnerability, reflecting a decline in an individual’s psychological and physical reserves. Digital interventions, such as smartwatches, are increasingly utilised to monitor and support the health of older adults. Evidence on the effectiveness of digital interventions in reducing or reversing frailty is limited. This systematic review aimed to investigate the types of digital interventions tested and the resulting outcomes. Method The following databases: Medline, CINAHL, Scopus, PsychInfo and Embase were searched from time of origin until July 2024. A search strategy was designed to identify randomised controlled trials assessing the impact of digital interventions on older adults. Outcome measures explored include frailty, wellbeing and quality of life. Narrative synthesis was performed for all studies and meta-analysis was performed for outcomes reported in four or more studies. Risk of bias was conducted using Cochrane Risk of Bias-2 tool. Results From 4476 titles and abstracts screened, 17 studies were included following full text review. Overall, 12 studies included exercises as a component or the sole form of intervention. The mean duration of intervention was 4.04 (SD 2.56) months. Mean adherence to the intervention was 59%. The most reported frailty-specific outcome was walking speed (n = 8), while the least reported outcome was self-reported exhaustion level (n = 2). Meta-analysis showed non-exercise-based interventions showed significant improvements in SPPB. There was no statistically significant change in TUG and handgrip strength. Narrative synthesis indicates there was insufficient evidence to evaluate the impact of digital interventions on frailty, cognition, wellbeing, activities of daily living and health-related quality of life. Conclusions The findings suggest low technological readiness and adherence among digital interventions for older adults. Narrative synthesis of overall frailty and outcome measures showed mixed results and insufficient evidence on the impact of digital interventions on frailty and outcomes reviewed.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"48 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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