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Background: concern over the sustainability of the National Health Service (NHS) is often focussed on rising numbers of hospital admissions, particularly among older people. Hospital admissions are enumerated routinely by the Hospital Episode Statistics (HES) Service, but published data do not allow individual-level service use to be explored. This study linked information on Hertfordshire Cohort Study (HCS) participants with HES inpatient data, with the objective of describing patterns and predictors of admissions among individuals.Methods: 2,997 community-dwelling men and women aged 59–73 years completed a baseline HCS assessment between 1998 and 2004; HES and mortality data to 31 March 2010 were linked with the HCS database. This paper describes patterns of hospital use among the cohort at both the admission and individual person level.Results: the cohort experienced 8,741 admissions; rates were 391 per 1,000 person-years among men (95% CI: 380, 402) and 327 among women (95% CI: 316, 338), P < 0.0001 for gender difference. A total of 1,187 men (75%) and 981 women (69%) were admitted to hospital at least once; among these, median numbers of admissions were 3 in men (inter-quartile range, (IQR): 1, 6) and 2 in women (IQR: 1, 5). Forty-eight percent of those ever admitted had experienced an emergency admission and 70% had been admitted overnight.Discussion: It is possible to link routinely collected HES data with detailed information from a cohort study. Hospital admission is common among community-dwelling ‘young-old’ men and women. These linked datasets will facilitate research into lifecourse determinants of hospital admission and inform strategies to manage demand on the NHS. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable.This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods: Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity. Results: Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions. The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention. Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability. Conclusions: Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status. [ABSTRACT FROM AUTHOR]

Introduction: In contrast to other medical specialties, trainees in Geriatrics have historically provided an increased contribution to clinical workload in General Internal Medicine and a reduced output of academic achievements. More recently, development of non-clinical skills has been recognised to have similar importance to clinical skills and the South East (SE) London Geriatrics Training Programme has thus supported trainees in applications for Out of Programme (OOP) opportunities to optimise career progression. Methods: Doctors who had undertaken specialist registrar training in the SE London Geriatrics Training Programme at any time between 2011 and 2019 were sent a questionnaire to assess whether they had completed time OOP and whether they had been awarded research grants, published papers in peer-reviewed journals, had abstracts accepted for presentation at conferences, and/or published book chapters during their training programme. Chisquared and Wilcoxon rank-sum tests were used to compare data between registrars who had completed time OOP and those who had not taken time OOP. Results: 77 (24 male; 53 female) registrars completed training in the SE London Geriatrics Training Programme between 2011 and 2019. 71 registrars (92%) completed the questionnaire, of whom 31 (44%) completed time OOP. In total, registrars were awarded 15 research grants, published 86 papers in peer-reviewed journals, had abstracts accepted for 184 conference presentations and published 20 book chapters. A notably increased proportion of registrars who took time OOP had an output of research grants, papers published in peer reviewed journals, abstracts accepted for presentation at conferences and/or book chapters respectively compared with registrars who had not taken time OOP (23% vs 5% ; 61% vs 23%; 84% vs 33%; 45% vs 5%). This equated to a combined academic output in 94% of registrars who completed time OOP compared with 48% who did not (p <0.001). Conclusions: A very strong association existed between registrars in Geriatrics taking time OOP and academic achievement substantiating the training programme’s aspiration to support development of non-clinical skills that may be helpful to trainees in their future careers. It would be worthwhile further work being undertaken in this area in other regions. [ABSTRACT FROM AUTHOR]

Introduction: Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. However older people are both more vulnerable to changes in function and often prioritise function over survival. There is limited published research examining function outside of context of sexual or urodynamic function following gynaeoncology surgery but a large body or research exists examining health-related quality of life (HrQOL) both as a pre-operative risk factor for survival and as a post-treatment outcome measure in its own right. HRQOL tools may report on physical function as a subcomponent within composite tools. This systematic review and narrative synthesis describes functional recovery after gynaeoncology surgery with respect to baseline characteristics which - if identified – could enable pre- or post-operative risk reduction. Methods: Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974-2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria: • Mean/median age >60 • Gynaeoncological treatment includes surgery (RCTs, observational or mixed methods studies). • Any measure of functional ability as defined by WHOICF classification section D1–D7 inclusive, D855, D860-79 and D9 using validated tool. • Minimum pre-operative and one post-operative measure. Results analysed and presented using narrative synthesis. Results: Sixteen studies identified (7 Endometrial, 2 Ovarian, 2 Vulval, 6 mixed cancer types). 1/16 used a standalone functional assessment tool, 15/16 used Health-Related Quality of Life tools (EORTC QLQ C30 (10), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline (n=11) than incomplete recovery (n=5 including 2 reporting age as a negative association). Recovery was more likely and occurred faster in minimally-invasive surgery. 1 study demonstrated failure to recover baseline functional independence by 12 months. [ABSTRACT FROM AUTHOR]

Introduction: There are multiple drivers to move healthcare into community settings, including people’s own homes. Traditional healthcare training, particularly medical training, is largely hospital-based, and hospital-based models of care. Few professions have explicit training in how best to assess an individual at home, and the additional elements to examine when visiting an induvial in their own home. To meet this training need Croydon Health Services were successful in a bid for funding to develop training to meet this gap. With this funding, a programme was developed and after attempts at simulation home visits in the simulation centre, a virtual reality (VR) home visit scenario was devised and filmed in the community using a professional actor to simulate a housebound individual. The recording was then professionally edited by a specialist VR team tomaximise its effectiveness including interactive educational elements. Methods: A pilot study examining the acceptability of the virtual reality home visit scenario was designed. A user group of medical staff with limited community experience participated in undertaking the virtual reality scenarios, delivered via SamsungNote 8 devices combined with Samsung Gear VR headsets. Feedback was received from participants by standardised paper-based surveys. Results: 7 responses were obtained. 100% of respondents described the scenario as easy to use, as well as agreeing that the same experience could not be gained from watching a standard video of the same scenario. 100% of respondents felt that the on-screen information was helpful. Feedback on areas for improvement suggested a desire for greater interactivity of other aspects of home assessment, and a desire to improve interactivity with the simulated patient, including history taking. Conclusions: Virtual reality home visit simulations are an acceptable and effective tool to introduce new concepts to staff. Further development should aim to maximise interactivity in the scenario and explore options for greater interaction with the simulated patient. Further role out of the virtual reality is planned for local and regional training sessions. [ABSTRACT FROM AUTHOR]

Introduction: Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes, yet 30–50% of prescribed medicines are not taken as recommended [1]. Polypharmacy and medication errors are common. Evidence suggests that there is a linear increase in medication errors with the number of medications a patient is prescribed. This paper describes an approach to identity and address inappropriate polypharmacy and safety concerns in Buckinghamshire care homes. The workforce used was: primary care and care home pharmacists, technicians and geriatricians. Methods: A successful business proposal enabled a new interdisciplinary model of care to be established. This was delivered in 2768 Buckinghamshire care home beds (63% of Bucks ICS bed capacity). The CCG pharmacists, GPs and pharmacy technicians reviewed medication for all residents followed by a medication and clinical review by a geriatrician for the most complex individuals. Other community specialist teams were included as part of a Multidisciplinary team as needed. Data on reviews, medicines stopped and safety were collected from 2013–2018. Results: Overall 2134 medications were stopped for 1268 residents of 2102 reviewed, with 505 interventions to reduce falls risk. 942 safety issues were identified and resolved. Total savings on medicines optimisation, waste and non-elective admission prevented was £619,000. System wide safety included: community psychiatric nurse to support dementia diagnosis, specialist enteral feeding nurse reinstated and a new website to share and disseminate good practice standards. Conclusions: Future direction of this work focuses on system wide improvements to promote multi-organisational interdisciplinary healthcare and social services professionals work in care homes. NHSE Pharmacy integrated funding has provided extra pharmacists and technicians to support the 37% of the care home beds not yet covered by March 2020. [ABSTRACT FROM AUTHOR]

Introduction: Constipation has a high prevalence of 30-40% in those aged over 65. It can lead to complications including delirium, faecal impaction, stercoral ulceration, and bowel obstruction. Although stool charts are used in geriatric wards to monitor bowel movements to guide management of constipation, they are often inconsistently recorded. Similarly, regular laxatives are often not prescribed for constipated patients due to ward pressures or unawareness regarding their importance. Aims: Our aims were to audit the rates of recording on stool charts and laxative prescription in a geriatrics department, and to assess whether amultifactorial intervention aimed at both doctors and nursing staff improved these rates. Methods: Two independent assessors audited the recording of stool charts, and rates of constipating medications and laxative prescription in two geriatrics wards in a tertiary UK hospital. A multifactorial intervention was implemented, consisting of didactic sessions for doctors and nurses, healthcare assistant champions to promote the recording of stool charts, and consolidation of bowel movement recording onto a single paper stool chart by the bedside rather than multiple charts. After the intervention, the data was re-audited on the same wards. Descriptive statistics and frequency tabulation were used for data analysis. Results: Data was collected from 33 patients. Pre-intervention, stool charts were recorded daily in 13 patients, 10 patients had no stool chart record, 20 patients were on at least one constipating medication, 12 patients were prescribed at least one laxative, and 5 out of 7 patients with opiates had laxatives co-prescribed. Post-intervention, stool charts were recorded daily in 21 patients, all patients had a stool chart record, 20 patients were on at least one constipating medication, 23 patients were prescribed at least one laxative, and 2 out of 4 patients with opiates had laxatives co-prescribed. Our intervention improved daily recording on stool charts by 24%, resulted in all patients having a current stool chart and improved prescription of regular laxatives by 34%. Conclusions: A multifactorial intervention based on educational sessions, healthcare assistants acting as champions, and consolidation of recording of bowel movements into a single chart, improved stool chart recording and prescription of regular laxatives in a tertiary geriatrics department. Future auditing will extend the sample size and generalise the intervention to other hospital departments. [ABSTRACT FROM AUTHOR]