Geriatric Research Articles

CHARTING NEW PATHS: LGBTQIA+ GERIATRICS FELLOWSHIPS

Abstract Background As the global population aged 65 and older continues to grow, so does the number of individuals identifying as LGBTQIA+. Despite this increase LGBTQIA+ health content are often overlooked in medical education, leading to significant disparities in care. Recognizing this gap, the American Geriatrics Society emphasized addressing LGBTQIA+ health disparities as early as 2015. Methods Our pilot program, a collaboration between the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai in New York and the Tel Aviv Medical Center (TAMC), is designed to address disparities in LGBTQIA+ healthcare. As part of this initiative, a geriatric resident from TAMC completed a four-month observership at Mount Sinai, receiving specialized training tailored to LGBTQIA+ healthcare for older adults. The hands-on curriculum allowed the resident to shadow various services, including geriatric and palliative care, rehabilitation, and specialized clinics such as the Institute for Advanced Medicine and the Center for Transgender Medicine. In addition, the resident engaged in one-on-one educational sessions focused on LGBTQIA+ care. Results The outcomes of this pilot program include the creation of a tailored and replicable curriculum for geriatric residency that can be applied to other programs, scholarly peer-reviewed publications, sustainable collaborations, partnerships with advocacy organizations, and the establishment of Tel Aviv’s first LGBTQIA+ geriatric clinic. Conclusions Pilot programs like ours hold significant promise for advancing LGBTQIA+ health education and improve the quality of care for older LGBTQIA+ adults, as evidenced by the establishment of Tel Aviv’s first LGBTQIA+ geriatric clinic.

CLINICIAN TYPE AND SETTING OF CARE DELIVERED TO MEDICARE BENEFICIARIES WITH DEMENTIA IN THE U.S

Abstract Improving care coordination for persons living with dementia (PLWD) requires understanding of the types of clinicians delivering care and the settings in which they practice. We identified all beneficiaries with dementia in traditional Medicare in 2019. We used the Medicare Carrier file—i.e., where bills for care provided by individual clinicians are recorded—to identify clinicians providing care to PLWD, which we then linked to the National Plan & Provider Enumeration System (NPPES). Using the Carrier and NPPES files, we characterized the workforce providing care to PLWD, including specialty and licensure (e.g., primary care physician, neurologist, nurse practitioner), setting of care delivery, and whether the clinician included a dementia diagnosis in the billing information. Overall, 1,934,318 PLWD received care from 783,225 unique clinicians. The most common settings of care were office (74.8% of PLWD), emergency room (63.9%), inpatient hospital (52.1%), and skilled nursing facility (37.1%). 87.0% of PLWD received care from a primary care physician, 62.9% from a nurse practitioner, and 33.1% from a physician assistant. Among all the clinicians that care for PLWD, 20.3% are primary care physicians, 15.3% nurse practitioners, and 9.0% physician assistants. 2.4% are psychiatrists, 1.7% neurologist, and just 0.5% are geriatric subspecialist physicians. For clinicians providing care to PLWD, the majority provide care in the outpatient setting, followed by hospital-based care. Programs to improve care coordination for PLWD, such as GUIDE Model programs, must account for delivery across multiple health care settings, recognizing that geriatric subspecialists comprise an extremely small proportion of the PLWD-serving workforce.

CLINICAL APPROACHES TO SUPPORT MALE DEMENTIA FAMILY CAREGIVERS

Abstract Integrated Memory Care (IMC) is a primary care practice for people living with dementia and their family caregivers. The practice integrates geriatric medicine, dementia specialty care/cognitive neurology, and palliative care along with caregiver services including support groups, classes, and psychotherapy for individuals and families. Finally, the practice hosts various opportunities to participate in caregiving research. Since 2015, the practice has treated over 2500 people living with dementia (PLWD) and supported their family caregivers. The mean age of patients is 78.6 years, the majority (66%) are female, and 42% identify as a racial or ethnic minoritized group. Caregiver relationship to patients (PLWD) is divided evenly between spouse (48%) and adult child (48%) and their mean age is 65.3 years. Men serving as primary family caregiver differ from their female counterparts in choice of clinical services, engagement in caregiver-specific programs, and participation in research. Successful marketing approaches include emphasis on caregiver as hero archetype, a clear message of the return-on-investment of services and activities. This presentation will describe the experience of supporting and engaging men as dementia family caregivers using aggregated data from multiple pilot studies as well as direct input from current active caregivers and IMC program staff.

Can We Improve Geriatrics Recruitment? An Analysis of U.S. Geriatrics Fellowship Programs on X.

The COVID-19 pandemic accelerated the shift from in-person to virtual recruitment, prompting residency and fellowship programs to adopt innovative strategies, such as leveraging social media platforms to attract applicants and enhance visibility. Our aim was to identify and describe the presence of U.S. geriatric medicine fellowship programs on X. We identified all U.S. geriatric medicine fellowship programs using FREIDA, and then located their X accounts through a stepwise process. Data were collected on account creation, number of followers, posts, and activity level, with an analysis of the last 100 posts from the most active accounts. Descriptive statistics were used to analyze the data. Among the 147 geriatric medicine fellowship programs identified, 38 (25.9%) had an X account. The majority of accounts were created after the start of the pandemic, reflecting likely the adaptation to virtual recruitment processes. Only a few accounts generated the majority of posts and followers. The accounts primarily posted or reposted educational content, research highlights, and promotional material. The use of X by geriatric medicine programs is still significantly underutilized, with only one-fourth of them having an account. Half of the accounts were created after the COVID-19 pandemic began. Programs should focus on building a robust social media presence to increase their visibility, especially as virtual interviews have become a permanent part of recruitment.

Occupational-related risk of testing SARS-CoV-2 positive for publicly employed medical doctors in Sweden: A nationwide cohort study.

Doctors have an increased risk of SARS-CoV-2 infection caused by exposure to contagious patients. We aimed to identify which clinical specialities among medical doctors had the highest occupation-related risk of testing positive for SARS-CoV-2, utilizing data for all publicly employed medical doctors in Sweden. Data regarding positive SARS-CoV-2 test results and employment for publicly employed doctors in Sweden were divided into three observation periods: 1) 1 February to 31 December 2020, 2) 1 January to 30 June 2021 and 3) 1 July 2021 to 31 March 2022. Individuals were stratified according to occupation clinic and compared with clinical occupations with little to no patient contact. The risk of testing positive for SARS-CoV-2 was estimated using Cox proportional hazards regression, with sex, age and vaccination status as covariates. The study cohort included all publicly employed doctors in Sweden: 35,028 individuals. In the first period, Infectious Disease doctors had the highest incidence of SARS-CoV-2 positive tests, with an incidence of 20.2 %, compared with 8.7 % in the reference group, and an adjusted hazard ratio of 2.5 (95% confidence interval 2.02-3.04), which decreased during period 2-3. Doctors in Geriatric Medicine had an elevated risk throughout the whole study period. Our study shows an association between working in a speciality that involves caring for contagious COVID-19 patients, which raises concerns about infection control measures and routines being insufficient to prevent occupational infection in future pandemics.

Development of the Revised Entry-Level Essential Competencies in the Care of Older Adults: Linking Domains of Competence, Commission on Accreditation in Physical Therapy Education Standards, and the Geriatric 5Ms.

Geriatric physical therapy (PT) has evolved since 2011, when the Essential Competencies (ECs) in the Care of Older Adults at the Completion of the Entry-level Physical Therapy Professional Program of Study were published. The purpose of the ECs was to ensure that all entry-level physical therapists were prepared to meet the unique needs of the growing older adult population. Changes in population demographics, medical and research advances, coupled with advancements in the profession of PT, necessitate a revision of the ECs. The Academic Education Committee of APTA Geriatrics was convened to revise the original ECs. Participation was solicited and obtained from experts in clinical and academic geriatric PT; committee work lasted from 2021 to 2024. The committee recognized the intersection of the Domains of Competence Framework developed by the American Physical Therapy Association (APTA), American Council of Academic Physical Therapy, and the Academy of Education partnership, the geriatric medicine 5Ms model, and the Commission on Accreditation in Physical Therapy Education (CAPTE) standards in guiding entry-level PT education. The committee determined that the Domains of Competence, Geriatric 5Ms, and CAPTE standards could synergistically enhance the establishment of contemporary ECs. Input from a nonresearch-based informational survey of APTA Geriatrics members, supported by feedback from discussion at a platform presentation at the APTA's Combined Section Meeting San Diego 2023, informed the revised ECs presented in the current manuscript. This manuscript presents the revised ECs and describes how each EC links to the Domains of Competence, the Geriatric 5Ms, and CAPTE standards. The updated ECs aim to promote best practices in entry-level PT education by providing all stakeholders clear and concise competency statements for the physical therapy examination and treatment of older adults.

A Step towards Alignment between Impactful Research and Impact Factors: Annals of Geriatric Medicine and Research Indexed in MEDLINE

A Step towards Alignment between Impactful Research and Impact Factors: Annals of Geriatric Medicine and Research Indexed in MEDLINE

Association Between Gastrointestinal-Related Quality of Life and Frailty Using Baseline Data of the Prospective Cohort Study (JUSTICE-TOKYO Study).

Objective: To determine the prevalence of frailty and examine its association with gastrointestinal-related quality of life (QOL) among older outpatients in a geriatric hospital. Methods: This cross-sectional study involved 1042 outpatients (age: ≥65 years) diagnosed using the revised Japanese version of the cardiovascular health study criteria. Data collection was performed by a multidisciplinary team. Results: Of the 1039 eligible subjects (male: n = 460 [44.3%]; mean age: 78.2 ± 6.1 years), 172 (16.6%) had frailty (male: n = 77 [44.8%]; mean age: 80.9 ± 6.2 years). The multivariate analysis revealed that age (odds ratio [OR]: 1.070, p < 0.001), QOL (OR: 0.982, p = 0.009), a history of falls (OR: 1.702, p = 0.029), sarcopenia (OR: 4.708, p < 0.001), steroid use (OR: 3.741, p = 0.001), analgesic drug use (OR: 2.056, p = 0.014), Mini Mental State Examination (OR: 0.915, p = 0.011), Geriatric Depression Scale 15 (OR: 1.101, p = 0.008), fullness-related QOL score (OR: 1.119, p = 0.010), chronic obstructive pulmonary disease assessment test (OR: 1.048, p = 0.007), and 10-item Eating Assessment Tool (OR: 1.071, p = 0.009) were related to frailty. Conclusions: The prevalence rate of frailty in older outpatients at a university hospital specializing in geriatric medicine was higher than that previously reported in community-dwelling individuals. Our study clarified that the fullness-related QOL score was related to frailty.

Abstracts of the 20th Congress of the European Geriatric Medicine Society.

Abstracts of the 20th Congress of the European Geriatric Medicine Society.

Screening of non-communicable diseases at Dukuh Gerjo Posyandu

Lifestyle changes, technological advances, and demographic transitions have triggered an increase in cases of non-communicable diseases (NCDs). Hypertension and diabetes mellitus are two of the most common NCDs and are often associated with other health problems, such as stroke, heart disease, kidney disorders, and death. Therefore, screening and education to improve public understanding and the effectiveness of therapy are crucial. In Padukuhan Gerjo, Grogol Village, Gunung Kidul Regency, an area with a population of about 408 people, including approximately 146 older adults, there is a need to improve access to NCD screening. To support the establishment of a senior health post, community service activities were conducted to screen the health status of local residents, focusing on NCDs. Health checks included measuring blood pressure, random blood sugar (RBS), height and weight, and conducting interviews regarding eating habits. Twenty-eight older adults participated. Health workers from the Grogol Health Center and local health cadres participated to ensure sustainability. The results showed that 55.14% of participants had hypertension; two (7.14%) had hyperglycemia; and approximately 10.71% were obese (BMI ≥25), placing them at high risk of health problems. This initiative will inform future counseling and socialization efforts regarding NCDs among older adults in Padukuhan Gerjo.

Reducing in-hospital complications in older patients undergoing plastic surgery through a collaborative model of care.

There is increasing evidence to support collaborative care and proactive comprehensive geriatric assessment and management in a number of surgical specialties. Data are lacking in older people under the care of plastic surgeons. This before/after study evaluates the impact of the introduction of a shared care model between geriatric medicine and plastic surgery in an Australian metropolitan teaching hospital. A shared care model was implemented for all patients aged 75 years and older admitted electively and emergently under the plastic surgery team with patients admitted jointly under a plastic surgeon and geriatrician. Comprehensive geriatric assessment and management was undertaken on admission with tailored intervention along with regular inpatient review. The primary outcome of interest was rate of in-hospital complications. Secondary outcome measures included individual complications, length of stay, readmission, and discharge disposition. A total of 123 consecutive patients were eligible for inclusion (63 pre-intervention, 60 intervention). The rate of complications was significantly lower in the intervention group (47.6% vs. 28.3%, P = 0.03). There was a non-significant reduction in rate of delirium and new discharge to residential aged care facility. Subgroup analysis of frailer patients (Clinical Frailty Scale ≥4) demonstrated a significant reduction in rates of delirium (44.4% vs. 15.6%, P = 0.02) and new institutionalization (18.5% vs. 0.0%, P = 0.02). A shared care model between geriatricians and plastic surgeons has the potential to improve patient outcomes with the greatest benefit likely to be seen in older patients with frailty.

Determinants of First Practice Location among Canadian Geriatric Medicine Trainees and Recent Graduates: Findings of a Cross-sectional Survey in 2023.

There is a projected and growing gap of geriatricians in Canada. Geriatricians play a crucial role in addressing the health needs of older adults. We aimed to understand the factors that influence the choice of first-practice location for new geriatricians in the context of an aging Canadian population. We distributed an online survey to geriatric medicine subspecialty residents and recently licensed geriatricians in Canada. The survey was developed through expert opinions, career planning sessions, and a literature review. There were nine survey sections: general characteristics, location determinants, practice determinants, colleague determinants, support and space, non-clinical opportunities, income models, lifestyle factors, and recruitment determinants. The data were analyzed descriptively. A total of 61 respondents (51 English, 10 French) completed the survey. The respondents were new practicing geriatricians (37) and geriatric medicine residents (24). Most planned to practice in Ontario (26.2%) or Quebec (27.9%), and 75.4% were women. Flexibility in work-life balance (95.1%), collegiality (93.4%) and reasonable call schedules (93.4%) were the most important factors influencing first practice location. Income did not rank among the highest priorities for choosing the first practice location relative to other factors but was mentioned in open-ended responses to recruitment questions. This is the first survey identifying the determinants of first practice location in geriatric medicine in Canada. Work-life balance and collegial support are a priority for new geriatricians and may be the strongest incentives a program can provide. For recruitment, income incentives may be beneficial to building new specialized geriatric services. Future research will examine determinants of first practice location among Care of the Elderly clinicians.

An anesthesiology-led perioperative outreach service: experience from a Canadian centre and a focused narrative literature review.

Approximately 320 million surgeries occur annually worldwide, increasingly performed on an ageing, comorbid population in whom postoperative complications contribute significantly to mortality. While anesthesiologists have led advances in perioperative care, the optimal structure of the provision of postoperative care has lacked discourse. In this article, we describe the implementation, structure, role, and benefits of an Anesthesiology Perioperative Outreach Service (APOS) at a Canadian tertiary hospital, providing proactive daily review and management of high-risk surgical patients. The APOS involves routine reviews and care on surgical wards, emphasizing collaboration among anesthesiology, internal medicine, surgery, and geriatric medicine teams, with a specific screening pathway to identify patients experiencing myocardial injury after noncardiac surgery. We discuss case vignettes to illustrate common examples of how the APOS enabled early detection and treatment escalation for deteriorating patients and provide a focused narrative literature review. The anesthesiology-led perioperative outreach model described herein could provide an implementable framework for institutions seeking to enhance their quality of postoperative care-particularly among complex, comorbid patients at risk of postoperative morbidity.

Community Group-Based Physical Activity Programs for Immigrant Older Adults: A Systematic Realist Review.

Physical activity program interventions often lack sensitivity to the needs of older immigrant adults. The objective of this systematic realist review is to explain how, why, for whom, and under which circumstances community group-based physical activity programs work for immigrant older adults. The initial program theory was developed using prior research, team expertise, social cognitive theory, and knowledge user consultations. The program theory was tested and refined via a systematic review of the literature. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, Sports Medicine and Education Index, and SPORTDiscus. A total of 22 sources of evidence met inclusion criteria and included intervention studies, systematic reviews, and a discussion paper. Intervention studies were appraised using the Mixed Methods Appraisal Tool. The final program theory constituted eight context-mechanism-outcome configurations that highlight the importance of facilitator characteristics, access to safe spaces, group dynamics, and social support. A limitation was the small number and variable quality of included evidence. Physical activity programs that target immigrant older adults must strengthen physical and psychological safety and maximize opportunities for role modeling and socialization. This research was supported by the Alberta Health Services Seniors Health Strategic Clinical Network and is registered in PROSPERO (ID#258179).

Statistical Analysis of Forensic Autopsies in Busan and Gyeongnam: Changes and Characteristics in the Past 10 Years

The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.

The association between gait speed and depressive disorders – A cross-sectional analysis of very old adults in the 21st century

Objectives To investigate the association between gait speed and depressive disorders among very old adults (≥85 years). Method This study utilized the GERDA-database, which encompasses a representative sample of those aged 85, 90, and 95+ years residing in northern Sweden and western Finland. From four data collections between 2000 and 2017, this study included 1794 participants. Self-paced gait speed was measured over 2.4-m and depressive disorders was evaluated by a specialist in geriatric medicine according to the DSM-IV-TR criteria. T-tests and multivariable logistic regressions were used to explore differences and associations between gait speed and depressive disorders. Results Gait speed was independently associated with depressive disorders among very old adults (p < .001). The results showed significantly different mean gait speeds (m/s) between individuals with/without a depressive disorder (0.34 ± 0.24/0.52 ± 0.26, p < .001), between individuals with a depressive disorder with/without antidepressant treatment (0.35 ± 0.24/0.44 ± 0.24, p < .001) and between non-responders/responders to antidepressants (0.36 ± 0.21/0.42 ± 0.22, p = .020). Conclusion This is the first study focusing on very old adults that has shown an independent association between gait speed and depressive disorders. Responders to antidepressant medication had a higher mean gait speed than non-responders, which may imply shifts in function upon successful treatment.

Prevalence of Value-Based Care for Older People with Dementia Likely to Be Nearing End of Life: A Hospital Retrospective Cohort.

Background: Patients with dementia (PwD) nearing end of life (nEOL) do not always receive optimal end-of-life care, including timely specialist palliative care input. In hospitalized PwD likely to be nEOL, we aimed to determine the prevalence of goals of care discussions; the incidence and timing of referral to palliative care; factors associated with palliative care referral and timely (within 2 days) palliative care referral; and the prevalence of polypharmacy (>5 medications) and in-hospital deprescribing (cessation). Methods: A retrospective chart review of a cohort of PwD admitted under geriatric medicine 1 July 2021-30 June 2022 was conducted, screening to identify nEOL status. Results: A total of 298 patients (mean age of 83.5 [SD 7.4] and 51.3% females) were included in the final analysis. Eleven percent of eligible patients (33/298) died during admission. Overall, 80.9% had discussed an advance care plan (ACP). The mean time from admission to the discussion of an ACP was 1 day (SD = 5.02). One in twenty (5.4%) had their goals of care revised during admission, with 15 transitioning to palliation. Only 7.1% were referred to palliative care during admission. The mean time to referral was 9.8 days (SD 7.3; range 0-26). One in fourteen (7.4%) were discharged from hospital on an end-of-life pathway. In multivariable analysis, both the clinical frailty score (CFS) (aOR per unit increase 3.66; 95%CI 1.65-8.09, p = 0.001) and meeting ≥ 2 deterioration criteria (per CriSTAL tool) (OR 3.68; 95% CI 1.07-12.70, p = 0.039) were independently associated with referral to palliative care. Polypharmacy was common at admission (76.2%), with a mean number of medications of 8.4 (SD = 4). The median number of medications ceased during admission was two (IQR 0-4). Conclusions: Contrary to our hypothesis, we found a high quality of care of PwD likely nEOL, reflected by frequent ACPs in hospital, but it fell short of palliative care specialist input. Polypharmacy on admission and discharge may be further improved by aligning medication use with goals of care among PwD approaching the end of life, and considering the hospital nurse-driven identification of practice gaps is encouraged.

A narrative review of the role of geriatric advanced practice nurses in the care of frail older adults in Singapore

In Singapore's rapidly ageing population where the demand for tailored healthcare services is increasing, but is confronted with a shortage of geriatric medicine trained physicians, innovative and sustainable ways to provide quality healthcare care for frail older adults need to be explored. Recognising, developing, growing and establishing the role of geriatric Advanced Practice Nurses (APNs) in Singapore, not just in clinical practice but in education and research as well, potentially offers one such solution to this problem. This narrative review, therefore, examines the available literature on how geriatric APNs can meet the healthcare needs of frail older adults in various local healthcare settings. Using a combination of keywords, a comprehensive search for relevant literature (original articles, theses, and abstracts published in English between 1999 till present) was conducted across databases including PubMed and Cochrane Library. Additional articles referenced in chosen articles were also reviewed when deemed relevant to the topic. Based on more established overseas models of care, it is evident that geriatric APNs can positively and significantly contribute to the healthcare of frail older adults locally. However, there is ambiguity surrounding the definition and description of the APN's role in Singapore, resulting in challenges that limit APNs from functioning to the full extent of their capabilities. A clear definition of the roles, responsibilities and expectations of geriatric APNs will facilitate their effective and significant contribution to caring for frail older adults in Singapore.

Consumer and multidisciplinary clinician experiences after implementation of the Drug Burden Index intervention bundle to facilitate deprescribing in older inpatients: A mixed method study.

The Drug Burden Index (DBI) measures exposure to anticholinergic and sedative drugs, which are associated with harm in older adults. To facilitate deprescribing in older Australian inpatients, we piloted an intervention bundle integrating the DBI in Electronic Medical Records, clinician deprescribing guides, consumer information leaflets and a stewardship pharmacist. To understand (i) hospital clinician experiences of using the bundle and (ii) consumer (patient and carer) and General Practitioner (GP) experiences of in-hospital deprescribing, following bundle implementation. Hospital clinicians from target services (General and Geriatric Medicine) at an Australian metropolitan tertiary-referral hospital, were invited to complete surveys, including the System Usability Scale (SUS), and interviews. Patients aged ≥75 years with high DBI (DBI ≥1) were admitted to target services, and their carers, received interview invitations. Consenting patients' GPs received surveys. Qualitative data was thematically analysed. Hospital clinician interviews were mapped to the Human Organisation Technology-fit Framework. Patient interviews were mapped to an adaptation of the National Health Service Patient Experience Framework. Seventeen hospital clinicians (n = 15 medical, n = 2 pharmacists) and four GPs completed surveys. Eight hospital clinicians (n = 7 medical, n = 1 pharmacist), seven patients and two carers completed interviews. Hospital clinicians reported good usability (SUS score 71.5 ± 12.5). Most themes were around system use and user satisfaction. They reported the intervention was useful for medication review, identified challenges from pre-existing heavy workload and suggested further integration into workflows. Patients and carers reported themes around information, communication and education. Patients reported feeling better or no different post-deprescribing. Patients, carers and GPs described poor communication regarding in-hospital medication changes and their rationale. The intervention was well accepted by hospital clinicians. The bundle requires further integration into workflows for sustainability and assessment of generalisability in other health services. Given patients, carers and GPs reported poor medication-related communication, future interventions may target this.

Association Between Standard Gait Measures and Anterior Quadriceps Muscle Thickness as Measured by Point of Care Ultrasound (POCUS).

Background: Gait parameters and sarcopenia both predict falls risk among older adults. Our objective was to evaluate whether fast, easy-to-obtain measures of anterior thigh muscle by point of care ultrasound (POCUS) are significantly associated with standard gait measures. Methods: All subjects were referred from ambulatory geriatric medicine clinics at an academic center. Quadriceps muscle thickness was measured by a portable ultrasound device. Gait variables were measured by the patient in comfortable walking shoes walking for six minutes. The primary response variables were gait variables, and the predictor variables were age, biological sex, body mass index, and muscle thickness. Univariate and multivariate regression analyses were performed. Results: A total of 150 participants were recruited from geriatric medicine clinics (65 women, 84 men). Muscle thickness was measured in 149 participants, and the mean (SD) was 1.91 (0.52) (median 1.82 cm, 0.96 to 3.68 cm). Univariate analysis of gait parameters with age showed a statistically significant correlation with gait speed (R2=0.16, P < 0.000), average stride length (R2=0.142, P < 0.000), and average stride velocity (R2=0.182, P < 0.000). Among all the gait variables, average swing time (P = 0.010) and average stance time (P = 0.010) were correlated significantly with muscle thickness. For multivariate analysis with age and gait variables, age was a significant independent variable for all gait variables that were significant in univariate analysis. Conclusion: POCUS showed a significant association with average swing time, average stance time, and step time variability. Although more work needs to be done, POCUS has the potential to be a rapid screening tool for gait assessment.