Frailty Score Research Articles

Genetically-predicted effects of lifestyle factors on frailty: Evidence from Mendelian randomization study

ObjectiveTo evaluate the causal relationships between genetically predicted lifestyle factors and frailty using Mendelian randomization(MR). MethodsWe extracted summary data from genome-wide association studies conducted among individuals of European ancestry, examining lifestyle factors such as smoking, alcohol consumption, physical activity, and sedentary behaviors. The outcomes were assessed using Fried Frailty Score (FFS) and Frailty Index (FI). We conducted 2-sample single-variable Mendelian randomization (SVMR) and multivariable Mendelian randomization (MVMR) to simultaneously assess the independent causal effects were primarily estimated using inverse variance weighted methods. Multiple sensitivity and validation analyzes were used. ResultsThe IVW analyzes indicated that smoking increased frailty risk (FFS: β = 0.107, 95 % CI = 0.057 to 0.156, P < 0.001; FI: β = 0.899, 95 % CI = 0.016 to 0.191, P = 0.020.), this effect was amplified in the MVMR analysis after adjusting for alcohol consumption. Strenuous sports or other exercise(SSOE) reduced frailty risk (FFS: β = -0.473, 95 % CI = -0.646 to -0.299, P < 0.001; FI: β = -0.423, 95 % CI = -0.692 to -0.154, P = 0.002). Vigorous and moderate-to-vigorous physical activities were significantly related to lower FFS, although no effects were observed on FI. Increased television watching was linked to higher frailty incidence (FFS: β = 0.227, 95 % CI = 0.197 to 0.257, P < 0.001; FI: β = 0.297, 95 % CI = 0.249 to 0.346, P < 0.001), the impact remained persistent in MVMR adjusting for driving and computer use. ConclusionThis study suggests that modifications in smoking, alcohol consumption, and physical activity may help prevent or manage frailty.

Effect of a Multicomponent Intervention on Pre-Frailty Status Changes in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Study.

Aims/Background Pre-frailty is common in patients undergoing maintenance hemodialysis (MHD). Without proper management, it can quickly worsen and progress into frailty, leading to various adverse clinical outcomes. Therefore, timely interventions for pre-frail MHD patients are crucial. However, the response of pre-frail MHD patients to such interventions is currently unclear. This study evaluated the effect of a multicomponent intervention on changes in pre-frailty status, risk factors for frailty, quality of life, and clinical outcomes in pre-frail patients undergoing MHD. Methods Sixty MHD patients were randomly assigned to intervention (received a 12-week multicomponent intervention) and control (received standard care) groups, with 30 participants per group, between February and May 2018. Data were collected at baseline and at 3 and 9 months thereafter. Analyzed outcomes included changes in pre-frailty status, frailty risk factors (such as albumin level, pain, and anxiety), quality of life, and clinical outcomes during the follow-up period. Results Data from a total of 58 MHD patients were collected at three time points. At week 12, frailty scores were 0.9 points lower in the intervention group compared to the control group (p = 0.007). The intervention group showed a 26.2% higher proportion of patients who improved from pre-frailty to non-frailty compared to the control group (p = 0.029), and a 25.9% lower proportion of patients who progressed from pre-frailty to frailty (p = 0.021). Additionally, improvements in albumin levels, pain, anxiety, and quality of life were more significant in the intervention group (all p < 0.05). Although there were fewer incidents of falls and rehospitalizations in the intervention group during follow-up, these differences did not reach statistical significance (all p > 0.05). Conclusion This study validates the effectiveness and practicality of a multicomponent intervention in improving pre-frailty status, frailty risk factors, and quality of life in patients undergoing MHD. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR-IOR-17012176).

Implementation of a multidisciplinary approach to care for people with HIV aged 80 years and over.

Frailty adversely affects health and quality of life of people with HIV (PWH). A multidisciplinary-team (MDT) was established to perform a Comprehensive Geriatric Assessment (CGA) and to address modifiable risk factors in elderly PWH. PWH aged over 80years were reviewed by a dedicated HIV/geriatric clinic at Chelsea and Westminster Hospital. Descriptive statistics were used to report the variables of interest. Sixty-three PWH were reviewed, with a median age of 82 (IQR 80-86). Fifty-seven (88%) were men. The median number of co-morbidities was five (IQR 4-7) and polypharmacy was seen in 55 (85%), with a median of six (IQR 5-8) co-medications reported. The median Rockwood Clinical Frailty Score was two (IQR 2-5). Antiretrovirals were modernised in 18 (29%) individuals; co-medication changes and de-prescribing was recommended in 39 (62%). A MDT approach helped reducing polypharmacy and frailty, suggesting that specialised tools and MDT input are key to identify medical and social concerns in elderly PWH.

Frailty assessment and outcomes in primary care for patients with diabetes during Ramadan: implications for risk evaluation and care plans.

Frailty is a critical concern for older adults, impacting their susceptibility to adverse events and overall quality of life. This study aimed to determine the frailty status of patients 60 years or older in Abu Dhabi Ambulatory Healthcare Services (AHS) and assess its relation to the stress exerted by Ramadan fasting and the occurrence of any adverse outcomes. In this prospective observational study, participants were included if the attending physicians used the IDF-DAR risk stratification assessment tool. A tele-interview was conducted to complete the FRAIL score within 6 weeks before Ramadan 1,444 (CE 2022). The outcome was assessed through another tele-interview and an electronic medical record review after Ramadan. According to the FRAIL assessment tool, among the 204 patients aged 60 years or older included in the study, 109 (53.4%) were classified as either frail or pre-frail. In total, 20 (9.8%) patients were frail, that is, 1 out of 10, and 89 (43.6%) were pre-frail. The remaining 95 (46.6%) patients were robust. Using logistic regression to assess the occurrence of adverse outcomes after Ramadan fasting, a higher frailty score was identified as the third independent risk factor [B = 0.4, OR = 1.5 (1-2.02-1.86), and p = 0.039] for experiencing an adverse event. The identified factors associated with frailty were age, increased albumin-to-creatinine ratio (ACR), chronic kidney diseases (CKDs), and ischemic heart diseases (beta = 0.27, p = 0.003; beta = 0.24, p = 0.004; beta = 0.2, p = 0.039; and beta = 0.18, p = 0.041, respectively). One-third of the frail patients had an event, while the incidence in pre-frail patients was 11.2%, and among the robust patients, the incidence was 6.3%. Physicians' global assessment of frailty did not align well with the structured FRAIL scoring. Only five (25%) out of the 20 patients identified as frail by the FRAIL assessment tool were also judged as frail or having cognitive function impairment by the physicians' global assessment tool. Frailty is prevalent among elderly patients with diabetes. Disparity exists between subjective and objective frailty assessments, emphasizing the need for standardized evaluation methods. Using the FRAIL tool is recommended for patients aged 60 or older with diabetes in Abu Dhabi.

Flagging Frailty in the Emergency Department: A System to Identify and Visualise Frailty

Abstract Background Older adults with frailty who present to the Emergency Department (ED) are at increased risk of hospitalisation, prolonged length of stay, deconditioning and loss of independence.1 Early identification of frailty using a validated tool, such as the Clinical Frailty Scale (CFS), is widely recommended to inform clinical decisions, identify the best pathway of care for older adults with frailty, and for potential use as a predictor or an outcome.2 We aimed to develop and implement a system of frailty identification which is highly visible, digitised and integrated with routine ED processes. Methods In the ED of a large teaching hospital, an expanded interdisciplinary Acute Frailty Team (AFT) commenced work in the ED in February 2024. The AFT aimed to screen all over 70s presenting within working hours for frailty using CFS. ED consultants collaborated with software developers through iterative design stages to create a ‘Frailty Flag’ for the ED Whiteboard with the requirements that it is highly visible, easy to use and highlights patients with higher frailty scores. Results In April 2024, a ‘Frailty Flag’ was launched on the ED Whiteboard, prominently displaying the CFS and using traffic light colouring to highlight those with higher CFS scores. As part of standard work, the AFT populate the CFS on the ED Whiteboard, which is viewed by all staff in ED on large wall-mounted screens. Feedback from ED and inpatient staff indicate that a highly visible frailty score is a valuable addition to the ED Whiteboard which allows them to prioritise care and supports decision making regarding suitability for geriatric care pathways. Conclusion A Frailty Flag on the ED Whiteboard allows for easy, accessible communication of frailty scores to the ED multi-disciplinary team. Next steps involve integrating the Frailty Flag with in-patient systems and developing standard work for out of hours use of the system.

Recognition Of Frailty In Patients 75 Years And Older, Presenting To The Emergency Department Of A Level Three Hospital

Abstract Background Ireland is experiencing the challenges and opportunities with an ageing population. When these needs remain unmet, older patients with frailty may present to the emergency department. It is important to put processes in place to improve the management of older persons presenting to the Emergency Department. The variable indicative of placement risk is a tool to identify older people at risk of adverse health outcomes at the time of hospital admission. Determination of frailty status is useful to inform clinical decisions, as frailty scores can predict multiple adverse health-related outcomes following hospitalisation. The aim is for every patient to leave in a better condition, and to add value with every interaction. Methods A retrospective service evaluation, over a specified time period, ascertained provision prior to the implementation of frailty specific initiatives. 39 charts were selected for the clinical audit. The audit tool was devised utilising the NCAA 2023 guidelines. Reliability was assured through quality patient safety and support of clinical audit facilitation. Data collected and analysed utilising an excel audit tool. Results 100 percent of validated indicative placement risk is completed by nursing staff at triage. 92 percent of patients aged 75 years and older were triaged at 3. Cognition assessment was not standardized across assessment, with 26 percent of presentations with confusion observed, with collateral received on twenty eight percent. Overall, 34.8 percent of presentations had frailty recognition utilising agreed frailty terms. Conclusion The aim is to introduce clinical frailty assessment for all patients presenting aged seventy-five years and older. Delirium assessment is not standardized across assessment. The rapid clinical test for delirium (4AT) in line with national delirium assessment will be introduced. Frailty service is in position to support these changes. Ongoing education of Delirium and Frailty recognition for all Emergency department personal.

Frail Patients Referred to a Community Specialist Team- What Were Their Frailty Scores?

Abstract Background Frailty is synonymous with older patients, where multiple body systems slowly lose their reserves and lead patients to become more vulnerable. When developing the inclusion criteria for our integrated care programme for older persons (ICPOP), the limited resources and large geographical area played a role. In order to maximize the outcomes for patients we targeted those with a Rockwood Clinical Frailty Score (CFS) between 4 and 6. We perceived that these patients would benefit from multidisciplinary intervention. Methods All patients referred to ICPOP were reviewed from November 2022 to April 2024. Our electronic patient database records information on ICPOP patients. Using this database we searched for the word “frailty” in the reason for referral field. We also correlated this with any patients who had a CFS recorded. The level of frailty in older patients with the scores ranging from 1 (very fit) to 9 (terminally ill) was recorded. Results 182 patients were found during the database search. 55 patients were referred for frailty alone, 64 patients were referred for frailty with balance/mobility issues, 47 patients were referred for frailty with falls, 16 patients were referred for frailty with memory issues. CFS were available for 132/182(73%) patients. 119/132(90 %) patients with a CFS score were classified as scoring between 4 and 6 on the Rockwood scale. 3/132(2%) scored 2, 6/132(5%) scored 3 and 4/132(3%) scored 7 on the CFS. Conclusion The national ICPOP framework prioritise improving care of frail older patients. A measure of a persons’ frailty level is subjective and dependent on clinical judgement along with a good understanding of the term “frailty”. Overall, our findings highlight that the referrers to our service have a good knowledge of frailty as a term. Our ICPOP hub is also effectively targeting the appropriate cohort of patients as per our inclusion criteria.

A Novel Discharge Pathway for Older Adults presenting to the Emergency Department

Abstract Background A need was identified for an urgent therapy follow-up at home for older adults presenting to the Emergency Department (ED). The acute floor team worked together within an established therapy outreach team (for inpatients) to develop an ED outreach pathway within existing resources. The outreach team members worked within ED to ensure standardisation of assessment, practice and build strong working relationships. A trusted assessor approach was applied. The outreach team had access to the wider acute floor team including ANP for in-reach support if needed. Methods A review of the patient group who discharged home from ED using this new pathway was completed including demographics, presenting complaint, clinical frailty score (CFS) and intervention provided. Results To date, 30 patients have discharged from the ED with the therapy outreach team. Most (70%) were female and mean age 83. Presenting complaint included fall no fracture (50%, n=15), fall with fracture (26%, n=8), musculoskeletal injury (17%, n= 5) and functional decline (6%, n=2). The mean CFS was 5.1, with most (86%) living with mild to moderate frailty (CFS 4-6). All patients were offered a next clinical day home based functional and environmental assessment, continuing the assessment commenced by the acute floor team in ED. Interventions included transfers and mobility training, activities of daily living (personal/domestic/instrumental) training, carer education, environmental advice, falls education, support with care packages, liaising with other healthcare professionals and equipment provision including mobility aids, bed-levers, toilet-aids and rails. Conclusion A therapy lead team, supported by the wider acute floor team, can provide a safe alternative discharge pathway from the ED for older adults that can avoid admission with rapid therapy input at home. Future work will examine re-admission rates, re-presentation rates to ED and patient and stakeholder satisfaction.

Incidence of Vestibular Dysfunction in Frail Older Adults Attending an Integrated Care Programme for Older Persons (ICPOP)

Abstract Background The World Falls Guidelines (2022) recommend a vestibular assessment as part of a multifactorial falls risk assessment in older adults. There is a possibility however, of vestibular dysfunction being overlooked because of no subjective complaints in older fallers i.e. vestibular agnosia. This study aimed to determine the prevalence of vestibular dysfunction in older adults presenting to physiotherapy in Integrated Care Programme for Older Persons (ICPOP) regardless of complaints of dizziness. Methods This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel. This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or subjective indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel. Results A vestibular assessment was carried out on 69% (n=52) of physiotherapy patients with a mean age of 80.9 years and mean Clinical Frailty Score of 5. 75% of patients that underwent a vestibular assessment had vestibular dysfunction with the most prevalent diagnoses being Benign Paroxysmal Positional Vertigo (40%), Unilateral Vestibular Hypofunction (13%) &amp; reduced gain of Vestibulo-Ocular Reflex (13%). 77% of those who tested positively for vestibular dysfunction had a fall within the last 12 months. 48% of those patients that had vestibular dysfunction did not complain of dizziness. Conclusion Almost half of patients with vestibular dysfunction had no dizziness highlighting the incidence of vestibular agnosia. This study highlights the high prevalence of vestibular dysfunction amongst older adults and supports vestibular assessments in older fallers regardless of the presence of dizziness.

An Examination of EOL Trajectories and Audit of EOL Documentation In Patients Admitted Under the Department for Older Persons Services

Abstract Background End of Life Care is a core element of care provided in acute hospitals, with 44% of Irish deaths taking place in the hospital setting. Our audit looks at the quality of documentation around end of life for older patients and looks to characterize these hospitalized patients’ terminal life stages. Methods Inclusion criteria were patients over the age of 65 who died under the care of the Department for Older Persons Services in 2023 utilizing a retrospective chart review. The Oxford Audit Assessment Tool for Care of the Dying was used to evaluate end of life documentation for patients recognized as dying in the acute hospital setting using a 1–5-point scale. The hospital courses of patients who died were characterized along one of six in-hospital courses: (1) acutely unwell, (2) end stage organ failure, (3) dwindling trajectory, (4) unexpected cardiac arrest, (5) admission with known specialist palliative care needs, and (6) combination of medical complexity and high dependency. Data points included Clinical Frailty Score and NecPal Score, as well as length of hospital stay, length of dying and specialist palliative care input. Results Greater than 90% of patients under the Department for Older Persons service had satisfactory, good or excellent documentation around end-of-life care. One-third of patients who died under the service were acutely unwell, one-fifth of the patients who died in hospital followed a dwindling trajectory, and 15% of patients were admitted with known indication and need for specialist palliative care. Approximately 10% of patients who died suffered an unexpected cardiac arrest. Conclusion Overall, documentation at end of life was quite good and specialist palliative care services were frequently involved. Older patients frequently experience a complex interplay of high dependency, medical complexity and palliative care needs at end of life, highlighting the need for skilled serious illness communication.

Supporting Complex Severely Frail Patients at Home with Community Specialist Team Intervention

Abstract Background The Community Specialist Team for Older Persons (CST-OP) was created to support older people to live well at home. The team primarily aims to reduce ED presentations and admissions into acute facilities for over 65s. The team became the first fully staffed CST-OP in Q3 2022. Referrals are responded to within 24-48 hours and each referral has a comprehensive geriatric assessment completed. Interdisciplinary assessment is used to identify interventional needs which the team then addresses. This abstract specifically examines the success of supporting people with a Clinical Frailty Score (CFS) of 7 and above to remain at home. Methods The team consists of a senior 1 WTE Social Worker, Physiotherapist, Therapy Assistant, Consultant Geriatrician, Advanced Nurse Practitioner and Clinical Nurse Specialist. The team also has 0.5 WTE Senior Speech and Language Therapist and Dietician. Referrals are accepted from the FIT team, GPs and Older Persons OPD clinic. The team operates on a 100% domiciliary based assessment. A comprehensive geriatric assessment is completed with each referral. A care plan is generated, and interdisciplinary intervention carried out. Results From September 2022 to December 2023 69 patients with a CFS of 7 or above were reviewed by the CST-OP. 60 remained at home, 7 transitioned to LTC and 2 RIP. These figures represent an 86% success rate. Conclusion Evidence suggests older people living with severe frailty can be supported to live well at home by Community Specialist Teams via timely interdisciplinary assessment and intervention and appropriate utilisation of community supports.

Advance Care Planning Practices For Nursing Home Residents Referred To Specialist Palliative Care In An Acute Hospital Setting

Abstract Background Advance care planning (ACP) is a structured process of discussion between patients, their loved ones and health care professionals, which aims to establish and record an individual’s goals and preferences for future medical treatment and care. It is of significant relevance to nursing home residents, a comorbid and frail population at high risk of clinical deterioration. Methods This prospective, observational study included all nursing home residents referred to an inpatient specialist palliative care (SPC) service in a model four hospital over a six-month period (November 2023 to May 2024). Basic clinical and demographic information as well as data on functional status and advance care planning was anonymised and collated using Microsoft excel. Results 36 patients (mean age 79 years) were recruited. 36% (n=13) were referred within 48 hours of admission. The average Australia-modified Karnofsky Performance Scale score was 40 on admission. 94% (n=34) had a clinical frailty score of ≥7 on admission. 72% (n=26) had an advance care plan in the nursing home. However, 22% (n=8) had not recorded their wishes pertaining to hospital readmission and 3 patients were admitted despite documenting a preference to remain in the nursing home. 53% (n=19) had not documented their preferred place for end-of-life care. 69% (n=25) died in hospital. Conclusion Most nursing home residents referred to the inpatient SPC team had severe frailty and died in hospital, reflecting the prognostic implications of severe frailty. Crucial components of the advance care plan were omitted in a significant proportion of patients, which may have influenced their referral to hospital. Provision of increased support to staff caring for older, frail adults in the residential care setting should be considered to enhance ACP.

Association of preoperative frailty with suboptimal weight loss response among patients undergoing metabolic and bariatric surgery.

Preoperative patient frailty (i.e., aging-related functional decline across multiple physiological systems) has been linked to greater perioperative complications following metabolic bariatric surgery (MBS). This study evaluated whether preoperative patient frailty predicts 1-year suboptimal weight loss response after primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The Bariatric Frailty Score (BFS), an adapted version of the Canadian Study of Health and Aging-Frailty Index based on 10 variables from MBSAQIP, assessed degree of frailty based on number of deficits (i.e., 0-10). Suboptimal response to MBS was defined as < 20% and < 30% percentage total weight loss (%TWL) at 1year following SG and RYGB, respectively. Multiple linear and logistic regression models evaluated associations of preoperative BFS score with %TWL and %TWL response thresholds, respectively. Patients (n = 1574; 78.9% female, 28.3% non-white, mean age 45 ± 12year; 67% SG) had a mean BFS of 1.6 ± 1.3 (range = 0-7). Overall, higher BFS related to lower %TWL after SG and RYGB (ß = - 0.12 and ß = - 0.17, respectively, p = 0.001). Compared to patients with 0-1 deficits (BFS score ≤ 1; n = 785, 49.9%), those with multiple deficits (BFS score ≥ 2; n = 789, 50.1%) had higher odds of suboptimal weight loss response after SG (OR 1.88, 95% CI 1.40-2.52, p < 0.001) and RYGB (OR 2.18, 95% CI 1.43-3.32, p < 0.001). Having multiple preoperative frailty deficits is associated with higher odds of suboptimal weight loss response after MBS. These findings point to the need for increased frailty screening and appropriate adjunctive interventions (i.e., exercise, nutrition, and cognitive), as these interventions may improve frailty status and MBS outcomes.

Development of a Hospital Wide Inpatient Frailty Screening Pathway in a Model-2 Hospital

Abstract Background Our model-2 hospital is experiencing a higher proportion of frail older adults presenting to our medical assessment unit (MAU) and via direct ward admissions. Frailty increases the risk of co-morbidity, falls and mortality during hospital admission. Screening for frailty a point of admission allows early identification of these patients who are at higher risk of adverse outcomes. Early frailty screening also assists healthcare professionals with multidisciplinary team (MDT) management and treatment plans. Our hospital frailty committee established a frailty screening pathway for all inpatients aged 75 years and older to screen for frailty and minimise the risk of adverse outcomes secondary to frailty. Methods A hospital wide consultant chaired frailty committee was established with stakeholders from the MDT. Two separate screening pathways were developed, one for MAU admissions and one for direct ward admissions. A standardised frailty policy and standardised operating procedure (SOP) with algorithm illustration were compiled. Hospital wide education emphasised the development of a bespoke Clinical Frailty Score (CFS) sticker in conjunction with referral pathways to the newly established Clinical Nurse Specialist (CNS) For The Older Adult. In each pathway CFS-screening is completed for adults ≥75years at first-point of contact using the CFS, a score ≥6 triggers onward referral, CNS for inpatient and public health nurse for MAU discharged patients. Results Both pathways are established and used effectively and routinely on a daily basis. Associated educational sessions have emphasised the importance of frailty in our inpatient cohort. Conclusion The developed algorithms have been useful for identifying frailty and improving patient care with onward CNS referral. Future audits will assess effectiveness of screening and support advancement of frailty committee objectives via supporting business cases for resourcing.

Unexpected Journeys: Investigating Urgent and Emergency Care Trends of Patients Attending a Community Specialist Team for Older Adults

Abstract Background Transitions of care for older people via ICPOP and Urgent and Emergency Care (UEC) pathways are becoming more complex. Demand for unscheduled care for older adults with complex care needs will increase with an ageing society, requiring proactive case management and practical realisation of integrated care pathways. Methods Retrospective analysis of UEC presentations of older patients attending a community specialist team (CST) who underwent Comprehensive Geriatric Assessment (CGA) between January-July 2023. Demographics and functional status [Clinical Frailty Score (CFS), Barthel Index (BI), Lawton-Brody Score (IADL), Montreal Cognitive Assessment (MOCA)] were extracted, along with UEC presentations post-CGA until March 2024. Results 356 patients underwent CGA and 42% (n=148) had subsequent unscheduled care attendance(s). Of those with an UEC attendance 36% (n=54) lived alone. Median functional scores were: CFS 5, BI 17, IADL 3, MOCA 17. Median time to UEC presentation was 100 days since CGA. There were 283 UEC interactions in total. 39% (n=58) had &amp;gt;1 interaction. 73% (n=206) of interactions resulted in acute hospital admissions, 21% (n=58) were ED visits, and 6% (n=19) were Pathfinder interactions. Falls (31%) and infection (19%) were the leading causes for presentation. Of 206 admissions, 61% were admitted under medical specialties, 26% under Geriatric Medicine, and 13% under Surgery. Average hospital stay was 13 days. 65% (n=134), were discharged home, 11% (n=22) to transitional care beds, 7% (n=15) to rehabilitation, 7% (n=14) to nursing home, 3% (n=5) transferred to other hospitals, 7%(n=15) died. Conclusion Over half of patients attending a CST had an UEC presentation, reflecting the complexity of this cohort and their level of healthcare utilisation. Case management roles that complement and pull together existing elements of the older persons pathway are lacking across healthcare settings and are fundamental to successful implementation of a patient-centred age friendly health system.

Evaluating the Documentation of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) among Older Adults Inpatients

Abstract Background Cardiopulmonary resuscitation (CPR) can save a person’s life, but rate of success is low especially in older frail cohort. Attempted CPR is not without harm and many patients long for a natural dignified death. DNACPR orders provide a means by which decisions to withhold CPR &amp; set ceilings of appropriate care in hospital can be recorded in advance of a potential cardiac event. Our department aims enhance the overall quality of end-of-life care for our patients. The objectives of this project were to evaluate the documentation around end-of-life care to support the introduction of a new DNACPR policy in September 2023. Methods A retrospective review of the deaths in the department for the period between July 2021 to July 2023 was undertaken. Thirty random charts from the deaths were examined, assessing the timing and quality of the DNACPR documentation and communication. A further random 30 charts of patients discharged alive were reviewed to assess any existing care plan for DNACPR. Results There were 202 deaths within the study period (mean age was 85, 114 (56%) male). Of the deaths examined, there were 50% male &amp; mean age of 83. The average length of stay (LOS) was14.5 days. This was a dependent group with 56.7% having a clinical frailty score of &amp;gt;/= 6 and 43.4% having known dementia. DNACPR decisions and evidence of communication was documented in 29 patients (96.7%). Ceilings of care were documented in the majority. We also assessed 30 medical notes of community discharged patients (36.7% male, mean age 83, mean LOS 13.86). Pneumonia (33%) was the most common diagnosis. Only 13.3% had DNACPR and ceiling of care documentation. Conclusion Recognition of dying seems good in the department with room for improvement in broader advanced care discussions. Further training on end-of-life conversations is planned with regular simulation sessions.

Determining Inclusion Criteria For Post-Acute Care Rehabilitation – Home Alone Is Not A Barrier To Success

Abstract Background Older adults discharged after acute hospitalisation are at risk for functional decline and adverse health outcomes. With population ageing, traditional approaches to rehabilitation with extended acute care stay are not sustainable. Successful outcomes in home-based rehabilitation relies on appropriate patient selection criteria. Some evidence suggests that older adults living alone are at highest risk for poor health-related outcomes including prolonged hospital admission and high readmission rates due to lack of cohabitants to support their needs. Methods Retrospective case analysis of consecutive participants in an older persons home based rehabilitation programme were included. Demographics including age, gender, frailty status, living arrangements, length of inpatient stay savings (days) and functional improvement (FIM) were measured. Logistical regression was used to estimate the relationship between living alone and functional gains. Results Eighty-three consecutive cases were reviewed, 10 cases excluded as readmitted (n=8), or clinically deteriorated and unable to complete the programme (n=2). Readmission rate (30 day) was 9.6%. Of 73 cases, 42.5%(n=31) lived alone, and 57.5%(n=42) co-habited during the programme. Mean (SD) clinical frailty score for those living alone was 5.26(1.03) and 4.98(1.07) for those not living alone. Improvements in FIM were similar in both groups, mean (SD) 11.4(7.2) versus 9.0(6.0). There was no statistically significant difference in change in FIM score between groups (-2.40(-5.56 to 0.77), p=0.136). Of 18 items in FIM, greatest benefit was seen in locomotion, bed/chair/toilet transfers, grooming, dressing and bathing skills. Mean bed-day savings was 6.45(2.07) acute inpatient bed-days per participant. Conclusion Our findings demonstrate that older adults who live alone benefit equally well from home based rehabilitation programme. Therefore, living alone should not limit enrolment on such programmes. Rehabilitation gains in the home environment were greatest in parameters that are challenging to target in acute care settings.

Development and Validation of the IDS-TILDA FI; A Novel Frailty Instrument for People with Intellectual Disability

Abstract Background Adults with Intellectual Disabilities (ID) are a vulnerable population, experiencing higher rates of multimorbidity, polypharmacy and healthcare inequities. Pre-existing functional disability and dependency complicates frailty measurement in ID. This study aimed to develop an ID-specific Frailty Index (FI), and compare frailty measurements between adults with and without ID. Methods This cross-sectional study was conducted using the Intellectual Disability Supplement to The Irish Longitudinal Database of Aging (IDS-TILDA). A 31-item IDS-TILDA FI was developed. Markers of functional dependence were excluded avoid disability bias. The index was applied to 745 adults with ID, with results compared to the general population. Statistical analysis included multivariate regression on frailty controlling for age, sex, level of ID and presence of Down syndrome (DS). Multivariate logistic regression on Mortality controlling for age, Level of ID and DS was also conducted. Predictive validity was tested using receiver operating characteristic (ROC) curves and evaluated the area under the curve (AUC). Results FI scores ranged from 0.00 to 0.59; median 0.16 and mean 0.19. These scores are lower than in other studies of frailty in ID, but higher than seen in the general population. Increasing frailty score was associated with older age (p&amp;lt;0.05), female sex (p&amp;lt;0.05) and severe/profound ID (p&amp;lt;0.05). Increasing frailty was associated with mortality, even when controlling for age (p&amp;lt;0.05). This association was lost when ID severity was included in analysis. FI score demonstrated moderate predictive validity for mortality (controlling for age, sex and Level of ID) with an AUC of 0.6101 (p&amp;lt;0.05, 95% CI: 0.564-0.656). Conclusion It is possible to measure frailty without measuring functional dependence. Frailty is more prevalent among adults with ID compared to the general population. The IDS-TILDA FI is associated with age and mortality, though the impact of severe ID could not be overcome highlighting the complexity of medical needs for adults with ID.

Community-based Geriatric Assessments: Is There an Urban/Rural Divide?

Abstract Background There is a paucity of literature describing urban/rural differences in baseline demographic factors and patterns of referral for those undergoing community based comprehensive geriatric assessment (CGA) in Ireland. We analysed differences in baseline demographics, referral sources and referral reasons among older persons who underwent CGA with a community specialist team, which accepts referrals from one predominantly rural community health network (CHN) and one predominantly urban CHN. Methods Data including baseline demographic characteristics, reasons for referral, referral sources, clinical frailty score (CFS), prevalence of polypharmacy (more than 10 prescribed medicines) and location of CGA was prospectively collected on all persons referred to an older persons' integrated care service from February 2023 to March 2024 and who underwent CGA. Data was stored on a secure database. Persons were categorised as either urban dwelling or rural dwelling, based on their local CHN. Descriptive statistics were used to describe differences between the urban and rural cohorts. Results 235 persons characterised as urban underwent CGA and 191 persons characterised as rural underwent CGA. There was a higher median CFS score amongst rural persons (CFS = 5, IQR=2) compared to urban persons (CFS=4, IQR=2). Urban persons were more likely to be referred by their G.P. (81% of total referrals) compared with rural persons (67%). Rural persons were more likely to be male (48% vs 37%) and experience polypharmacy (33% vs 27%) than urban persons. A similar proportion of persons underwent initial CGA in their home (20% rural vs 19% urban). Conclusion Here we describe the characteristics of urban and rural users attending an integrated care service. Future research should examine how these differences might affect healthcare utilisation and outcomes and provide opportunity to inform regional health and social care planning.

Assess, Diagnose and Intervene: Are Hospital Based Out-patient Frailty Intervention Teams Perfectly Positioned to Prevent the Frailty Crisis?

Abstract Background This Frailty Intervention Team (FIT) is relatively novel in the sense that it is a hospital based multidisciplinary team (MDT) that provides an outpatient service to community based frail adults. Its main source of referral is from General Practitioners (GP)1, with the average Clinical Frailty Score of those assessed being 4.98 (4.91 men, 5.05 women) 1. Indicating that the mean service user is ‘Living with Mild Frailty’2. Our objective was to establish if this model of service provision is identifying any new diagnoses and what interventions it provides. Our overarching aim is to establish ‘what we are adding to the patient journey’. Methods 3 independent researchers came together to develop a database for the service that would record new diagnoses made, medical &amp; non-medical interventions provided and frequency of on-wards referral. Standard definitions and codes were agreed upon, and the information inputted by patients facing staff on a daily basis. A descriptive data analysis of this database was carried out after the first quarter. Results 51 new patients were assessed in 4 months. Of these patients, 37.25% of cases received new diagnoses; Parkinson’s disease (15.68%), Orthostatic Hypotension (11.76%), Cognitive Impairment / Dementia (11.76%) and Idiopathic Normal Pressure Hydrocephalus (iNPH) (5.88%). Subsequently 62.74% had changes made to their medications. 96.08% of new service users received at least 1 non-medical intervention. Onward referral was made for 58.82% of service users, to a total of 22 organizations. The total amount of onward referrals made was 54. 51 new patients were assessed in 4 months. Conclusion A hospital-based frailty intervention team adds value to a patient’s journey as it is perfectly placed to make rapid diagnosis due to their MDT nature and access to diagnostics. Furthermore, it provides immediate intervention and appropriate onwards referral. Is this a model of service provision that should be made more readily available nationally?