Abstract Introduction Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis and guiding osteoporosis treatment, particularly when used alongside fracture risk assessment tools such as FRAX. Limited access to DXA scans in some centres, highlighting the need to prioritise their use effectively. The project is aimed to improve DXA access and prompt reporting to meet Fracture Liaison Service Database (FLS-DB) national standards. Methods This multi-dimensional improvement project began in 2022 using the Model for Improvement. Process mapping identified inefficiencies, with ownership secured through Radiology Directorate and cross-divisional engagement involving Clinical Leads from Rheumatology and Care of the Elderly. A small multidisciplinary working group was formed to drive the change. Progress was monitored via FLS-DB Key Performance Indicator 5 (KPI 5): percentage of patients receiving a DXA within 90 days of fracture and DXA waiting list. Results Baseline results in 2021: 875 fragility fracture patients identified; 29.2% (255) scanned within 90 days, average DXA waiting list 1028/month. Initiatives between 2022 and 2024 included training of radiographer, expanding scanning from 3 to 5 days/week; dedicated DXA reporting training and non-reporting agreement for FLS patients. Impact of FLS expansion on DXA scan waiting: 2022: 1648 fracture patients identified; 16.8% (276) scanned; waiting list rose to 1541/month. 2023: 2179 fracture patients identified; 17.4% (379) scanned; waiting list increased to 1980/month. Impact of quality initiatives: 2024: 2621 patients identified; 25.7% (673) scanned (163% increase from 2021); DXA waiting list dropped to an average 849/month. 2025: DXA waiting list reduced further to average 786/month. Conclusion The quality improvement project initiated in 2022, took three years to streamline our referral pathways. Two radiology staff training and operating five-day DXA scanning helped reduce both the DXA scan waiting list and clinician reporting time. The current service has adopted good practices to improve DXA scanning provision to match the demand of increased fracture case identification. However, further improvement is needed.

Abstract Background Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric care but is challenging to implement in low- and middle-income countries (LMICs) due to scale, workforce limitations and the absence of culturally appropriate tools. Community Health Workers (CHWs) play a critical role in rural India, yet they lack a suitable screening instrument to identify older adults who require further and detailed CGA. Objectives To develop and validate the Elderly Health Status Assessment and Screening (EHSAS) tool—a concise, culturally adapted, and multidimensional screening tool for early identification of common geriatric syndromes among rural community-dwelling older adults in India. Methods We employed a three-phase mixed-methods approach: tool development (literature review, expert consensus, face and content validation, field testing with older adults and CHWs), scale development (exploratory factor analysis, convergent and discriminant validity testing), and scale evaluation (cut-off score determination, diagnostic accuracy testing, and reliability assessment). The tool’s performance was benchmarked against standard geriatric assessment instruments, with frailty status as the criterion variable. Results The final EHSAS tool comprises 11 items spanning the key geriatric domains, excluding the frailty item. A cut-off of ≥3 ‘Yes’ responses was selected based on ROC curve analysis and Youden’s Index to maximise sensitivity and specificity. It demonstrated good psychometric properties, including high internal consistency (Cronbach’s alpha >0.7), substantial test–retest reliability (Cohen’s kappa >0.79), and balanced diagnostic accuracy (sensitivity 76.3%, specificity 76.5%, negative predictive value 93.2%). Field testing confirmed that EHSAS was usable by and acceptable to CHWs and older adults. Conclusion The EHSAS tool fills a critical gap in geriatric care in LMIC settings by offering a validated, brief, and culturally appropriate screening instrument for CHWs. Its adoption can strengthen early detection of geriatric syndromes and support timely referrals for CGA, ultimately improving health outcomes for older adults in resource-constrained rural areas.

Abstract Introduction ‘Instant Ageing’ technologies and simulated ward rounds are established parts of geriatric medicine teaching in many centres. However, these once innovative methods received negative feedback when delivered during our undergraduate BMBS programme. We set out to explore whether adding gamification to established teaching methods could enhance student knowledge, attitudes towards frailty and perceptions of their attachment. Method We designed a ‘Frailty Escape Room’ where students rotated around stations completing tasks related to falls, polypharmacy, delirium, frailty assessment, pressure sores, activities of daily living and Comprehensive Geriatric Assessment. Students undertook tasks under time conditions whilst wearing different ‘instant ageing’ simulation equipment. Successful task completion generated a code that, when combined, enabled ‘escape’ from the room. Students were assessed using pre-post session questionnaires. Four Likert-scale (score 1–4) questions evaluated empathy/understanding of life with frailty, confidence in assessing, managing and communicating with older people living with frailty. Sixteen single best answer multiple choice questions assessed core knowledge. Summary statistics were calculated and test item performance before and after teaching were compared using pairwise student t-tests and chi-square for parametric scale and categorical variables respectively. Anonymous free-text feedback was collected at the end of the session to assess student satisfaction. Results 121 students completed the Escape Room and pre/post-testing. Mean (SD) Likert scores increased from 2.2(0.7)-3.3(0.6), 2.5(0.5)-3.2(0.5), 2.1(0.5)-2.9(0.5) and 2.8(0.6)-3.4(0.5) for empathy/understanding, confidence investigating, managing and communicating with older people with frailty respectively (p < 0.05 for all). Mean (SD) total knowledge score increased from 8.5(2.1)-11.8(1.9) (p < 0.05), with significant improvements across all except three questions. Free-text feedback indicated high student satisfaction, and attendance has improved markedly following the teaching intervention. Conclusions Introduction of gamification to existing simulated ward round and instant ageing teaching improved student attendance and satisfaction. The teaching improved knowledge of, and attitudes towards, care of older people.

Abstract Background A Quality Improvement Project (QIP) at University Hospitals Dorset involving multiple specialties (Older People’s Services, General Surgery, Pain Team, Anaesthetics, Emergency Department, Radiology, Pharmacy) focused on improving care for adult patients with Chest Wall Trauma. Incidence and severity increase significantly with age (recent audits found a 12% mortality), with complications that can be life-threatening. Key to good management is early injury recognition, effective pain control, frailty assessment, and timely escalation planning. Introduction A series of deaths following falls in older patients revealed delayed or missed diagnoses of traumatic haemothorax. In 56% of cases, significant chest trauma went unrecognised. A Chest Wall Trauma (CWT) pathway was introduced. A notable issue was reluctance among resident doctors to prescribe NSAIDs in older patients, with only 24.5% receiving appropriate NSAID therapy. Our aims Earlier recognition, frailty identification, optimal analgesia, and reduced morbidity/mortality. Methods The CWT pathway was developed through 3 PDSA cycles, using QI methodology. Retrospective data was collected via coded and bulk admission data. Initial cycles revealed under-recognition of injury, suboptimal analgesia, weak shared care between surgery and OPS, and limited escalation planning. These insights informed pathway iterations, now in its 4th version. Results Prompt injury recognition improved, with 94–96% of patients receiving early trauma CT scans. Paracetamol and opiates were prescribed in 100% of cases. NSAIDs remained underutilised in older adults (24.5% prescribed). Collaborative care improved markedly, with >94% of patients admitted under the most appropriate specialty (up from 58%). Escalation planning has been found to be reactive, with only 45% of patients having a documented escalation status during admission. Conclusions Timely injury recognition and appropriate ward admission have improved significantly. The 4th pathway iteration includes clearer NSAID guidance for older patients, structured escalation prompts, and digital integration within the Electronic Patient Record (EPR) improving availability of the pathway. Research Ethics approval not obtained as Clinical Audit Facilitator did not feel it was necessary.

Abstract Background Anticipatory medications (AMssupport symptom management in patients nearing end of life. NICE guidance recommends early, individualised prescribing with shared decision-making. At WUTH, AMsare prescribed via a Cerner PowerPlan. A 2023 quality improvement project (QIP) identified delays in prescribing and inconsistent documentation. Interventions included junior doctor and pharmacist teaching, and feedback to the palliative team. Methods A retrospective review of adult inpatient deaths during October 2024 at Arrowe Park Hospital was undertaken. Exclusions included sudden and paediatric deaths. Extracted data from electronic records included AM timing, prescribing team and Care in the Last Days of Life (CILDOL) template usage. Results were compared to October 2023 data. Results: 90 patients met inclusion criteria. AMswere prescribed in 98% of patients, up from 96% in 2023. Average time between prescribing and death improved from 6.9 hours to 4.8 days. 76% received AMswithin one week of death. Prescription of all four recommended drug classes rose from 84% to 93%. Palliative care referrals occurred in 85% of cases. CILDOL use by the palliative team improved from 60% to 76%, but parent team use remained low (13%). Documentation of side effect discussions improved from 44% to 70%, though over half were brief. Conclusions Improvements were seen in timely and comprehensive AM prescribing following targeted education. However, underuse of the CILDOL template by non-specialist teams persists, highlighting the need for ongoing sustained education and system-level prompts. Regular re-audits are planned to embed best practice and support high-quality end-of-life care.

Abstract Background Physical inactivity in community-dwelling older adults is modifiable, and physical interventions are effective in reducing age-related decline and disease. Despite this, engagement and retention of older adults in community physical activity (PA) programmes are limited. This review explores factors affecting implementation of effective PA programmes for older people in the community. Methods Review of qualitative literature identified from MEDLINE, Social Policy and Practice, PsycINFO, CINAHL, Cochrane Library and Frontiers in Rehabilitation Science from 1999–2024. Data were extracted inductively by two independent reviewers and synthesised thematically using the Capability, Opportunity and Motivations (COM-B) and Theoretical Domains Frameworks (TDF). Results 8647 articles were identified from searches and 57 (42 qualitative, 15 mixed-methods) studies included in the review. The review found complex interacting factors that affected the delivery of PA interventions (skillset of the instructors, regular training and habit formation) alongside factors that influenced older adult’s motivations to first engage in PA interventions and to maintain physically active over time (social influence of others, family members influence, resources and environmental conditions). A key finding was the identification of facilitators that are required to create both a cohesive, social environment for the intervention to take place, alongside the need for tailored interventions that meet the needs of participants. Conclusions This review has extended previous works by including factors that are influential to PA from the perspectives of intervention deliverers and highlighted the importance of assessing the needs of those who deliver the intervention. These factors should be taken into consideration when implementing programmes to support older adults to engage long-term with PA interventions.

Abstract Background The NHS 10-year plan outlines the ambition to shift care from a hospital-centric model to integrated community-based systems, but little is known about how to implement this change. The integrated frailty crisis multidisciplinary team working across acute and community settings were motivated to improve services but lacked the confidence/knowledge to lead quality improvement (QI). A whole pathway QI practitioner development programme was established with projects aligned to the overarching system strategy to embed the change. Methods A structured training and coaching programme was introduced, aligned to the Trust’s A3 QI methodology and underpinned by testing using Plan–Do–Study–Act (PDSA) cycles. The programme aimed to build sustainable improvement capability across Advanced Clinical Practitioners and Specialty Doctors. A fishbone analysis identified barriers to applying QI in daily practice. Staff received training in QI methods (including driver diagrams, measurement, and PDSA cycles) and were supported to deliver improvement projects. The programme was refined through multiple PDSA cycles and tests of change in coaching methods used. [JA1]. Results Nine MDT members completed projects and achieved QI Practitioner certification. Confidence and knowledge in QI improved significantly (70% reporting limited/no confidence/knowledge at baseline [JA2] vs 85% reporting some/good knowledge/confidence afterwards). Wider impact of the programme through QI initiatives included: Frailty identification in ED increased from 0% to 79%. Use of triage tools with CFS and NEWS2 rose from 0% to 100%. Standardised UCR board rounds improved collaboration and decision-making. A lunch club initiative enhanced patient activity, social connection, and staff morale. Conclusions It is possible to embed a culture of QI and align this to an overarching strategy to improve integrated frailty pathways across previously fragmented services. It is recommended to develop QI practitioner skills among frontline staff to maximise the benefits to transformation of pathways and services. Using QI methodology to design the QI programme and Testing and refining this through PDSA cycles ensured engagement, ownership, and measurable improvement. This model is scalable across any healthcare system.

Abstract Introduction Improving ageing education for health professionals requires meaningful involvement of those with lived experience. Giving older adults a voice in curriculum design and delivery helps shape education to be inclusive, authentic, and relevant, preparing students for person-centred care. Methods We hosted a community engagement outreach workshop, bringing together multidisciplinary health professions students (n = 7: medicine; pharmacy) and educators (n = 26), with older members of the public (n = 8) and other key stakeholders in older peoples’ care (n = 12: care home staff; charity representatives; researchers). The workshop began using a creative focus to stimulate reflection, followed by mixed small group discussions exploring participants’ lived experiences of ageing, caring for older people, and/or ageing education. Groups identified opportunities for innovation where there was mismatch between current teaching and lived experience of ageing, with particular focus on opportunities that would involve older people, multiple professions, and community settings. Discussion points were noted and have been grouped into broad themes. Results Participants emphasised the value of early and repeated engagement with community-dwelling older people to build empathy and skills beyond clinical settings. The arts were identified as a powerful means to deepen understanding and challenge ageism. Involving older adults as co-educators emerged as essential for humanising ageing education. Additionally, interprofessional education was recognised as crucial to preparing students to work effectively within multidisciplinary teams. Conclusions Our workshop identified practical strategies to transform undergraduate ageing education by connecting multidisciplinary students with older people in the community and those involved in the care of older people, giving them a meaningful voice in curriculum design and delivery. Incorporating these diverse insights will help us to innovate geriatric medicine teaching in a manner that meaningfully prepares students to care for our ageing population.

Abstract Introduction Parkinson’s disease (PD) affects 1/50 people over 65 years, with complex health and social care needs and difficulty accessing timely support. We co-designed and tested a self-management toolkit for people with PD and their carers (UCL Live Well with Parkinson’s), to improve health outcomes and healthcare needs. The toolkit contains information about symptoms, treatment, optimising wellbeing, and practical advice. The sub-sections, personalised with the help of a supporter, cover information on health and support, allow symptom reviewing/tracking, and to work towards health priorities. Method The clinical and cost-effectiveness were tested in a single-blind RCT in England. We randomised community-dwelling participants with PD 1:1 to the intervention or treatment-as-usual. The primary outcome was health-related quality of life (PDQ-39) at 12-months. Outcomes were analysed using linear mixed models, controlling for baseline. Results We recruited 346 participants between January 2022–July 2023 (mean age 69 (SD 9) years, 159 (46%) women, 321 (93%) white). Data collection was completed in August 2024 with 88% retention at 12-months. Small, but not statistically significant differences in PDQ-39 were seen for intervention participants (−1.03(−3.03 to 0.97); p = 0.31). There were significant differences in favour of the intervention arm in symptom changes on the MDS-UPDRS part I and II at 6- and 12-months (−2.19(−3.95 to −0.43) and − 2.61(−4.58 to −0.64)). We found significant differences in psychological distress (GHQ-12) (−0.87(−1.71 to −0.03)) and overall health status (EQ-5D-5L VAS) (3.87(0.32 to 7.41)) at 6-months. At 12-months, intervention group participants had significantly lower health and social care costs (mean incremental cost saving per participant -£1459(−£2903 to -£16)), inclusive of the average per-participant intervention costs of £284. There was no difference in 12-month QALYs (mean incremental QALYs 0.02(−0.01 to 0.04)) and hence dominates treatment-as-usual. Conclusion Our self-management tool has potential to improve PD symptoms and support cost-effective management of patients with PD.