137 Harnessing technology to augment comprehensive geriatric assessment for older adults with frailty in CRISP admissions

Abstract

Abstract Background The Community Rehabilitation Inpatient Specialist Program (CRISP) is an Advance Nurse Practitioner (RANP) led program that provides direct access for community-dwelling older adults to short-term (2-weeks) in-patient, intensive multidisciplinary rehabilitation based on a Comprehensive Geriatric Assessment (CGA). Patients attending the CRISP program are typically frail and have complex, multi-morbid medical backgrounds, many having multiple falls prior to admission. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk. Ambulatory blood pressure monitoring (ABPM) is recognised as especially helpful for identifying hypotension in older adults, where antihypertensive treatment should be individualised. The novel use of 24-hour ABPM in this setting offers these patients early diagnostics and early treatment options. Methods For patients, whom the CGA deems ABPM would be beneficial, monitors are fitted by the RANP as they return home for weekend leave mid-program. Results are promptly available to the RANP/Consultant Geriatrician and treatment plans are initiated and monitored throughout the remainder of the inpatient stay. Results In April 2023, the first month of use, APBM equipment was used for 80% (n-8) of older adults admitted to CRISP. 24-hour APBM has benefitted patients with a new diagnosis of hypertension, those with poorly controlled hypertension, patients with suspected orthostatic hypotension and those with concurrent hypertension and orthostatic hypotension where alterations to antihypertensive medication are initiated. We anticipate performing ABPM on 64 older adults in 2023 (80% of predicted admissions to CRISP). Conclusion The introduction of 24-hour ABPM as a diagnostic tool in this setting offers immediate diagnostic and early treatment options, reducing referrals, waiting lists and costs at over-stretched cardiac departments and increases the value of the Comprehensive Geriatric Assessment for older adults attending CRISP.