Scientific Research

Abstract Content -

 Background/purpose: To prepare future physicians to care for a growing aging population, the Canadian Geriatrics Society (CGS) Education Committee formed a working group in 2019 to update the 2009 Core Competencies in the Care of Older Persons for Canadian Medical Students. The goal is to assist medical educators with developing relevant undergraduate medical curriculum. Methods: The working group chose 5Ms model and canMEDs framework to develop the competencies. A modified Delphi process was used. National participants were recruited and three rounds of Delphi surveys were conducted via survey monkey. A 7 point Likert scale was used for each competency statement.

Results: The first round was conducted in October 2019, n=72, identifying the importance and skill level of the components of the competencies under three headings; knowledge, skills and attitudes. The second round was conducted in September 2020, n=54, with proposed competencies under seven headings; aging, caring for older adults, (5Ms): mind, mobility, medications, multi-complexity and matters the most with > 70 % agreement for all. Based on the strength of the agreement and comments, minor revisions were made and the final survey was conducted in June 2021. The agreement level for competencies varied from 85 - 98 %. Thirty-three core geriatric competencies were developed under 7 headings. The CGS education committee approved the competencies in Dec 2021. 

Conclusion: The 2021 Aging Care 5M Competencies framework integrates new concepts and knowledge that inform current practice in the field of geriatrics. Thirty-three core geriatric competencies for the graduating undergraduate medical student were developed and classified under 7 headings. The framework was distributed to the accreditation and examination bodies and Canadian medical schools and was published in Academic medicine. 2024 Feb 1;99(2):198-207. doi: 10.1097/ACM.0000000000005475. Epub 2023 Nov 19. Currently we are working on implementation of the competencies. 

Introduction:

World Guidelines for Falls Prevention & Management for Older Adults[1] recommends medication review as part of multifactorial risk assessment for those at high risk of falling. Use of Falls Risk Increasing Drugs (FRIDs) [2], polypharmacy and anticholinergic burden are known to increase risk of falls in older people [3]. This prospective observational study was conducted to assess if polypharmacy, prescription of FRIDs and anticholinergic burden [4] improve after hospitalisation with a fall.

Method:

Data gathered from electronic medication records once necessary ethical approvals in place, for patients aged ≥ 65 years, taking ≥4 medicines, at hospital admission with a fall, at discharge, and 3 months after discharge included number of medications prescribed, number of Falls Risk Increasing Drugs (FRIDs) prescribed [2] and anticholinergic burden (ACB) score [4]. 

Results:

Patients were included from March 2023 until May 2024 (n=113). Mean age was 81±8.58 years and 80% of patients were female (n=90). The mean number of medicines per patient was 8.05±0.37(SE) at hospital admission, increasing by 32% to average 10.66±0.39(SE), three months after discharge (p<0.001). The mean number of FRIDs per patient increased by 7.8% from 2.44±.16(SE) at hospital admission to 2.63±.17(SE) three months after discharge (p=0.057).

Most common FRIDs were bisoprolol, furosemide, codeine, amlodipine and amitriptyline. Codeine was the most common FRID started after discharge (n=13; 12% of patients).

ACB score increased by 18% to 2.40± 0.21(SE) at 3 months following discharge compared to 2.04±0.21(SE) at admission (p=0.003). Furosemide, codeine, amitriptyline, sertraline and diazepam were the top medicines with anticholinergic burden.

Conclusion:

Three months after discharge from hospital following a fall, older people experience increased polypharmacy and anticholinergic burden and are prescribed more Falls Risk Increasing Drugs, compared to at the time of hospital admission.

1. Montero-Odasso, M., van der Velde, N., Martin, F.C. et al. (2022) The Task Force on Global Guidelines for Falls in Older Adults, World Guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing, 51, 9.
2. Saeed, D., Carter, G., Miller, R. et al. (2024) Development and Delphi consensus validation of the Medication-Related Fall (MRF) screening and scoring tool, International Journal of Clinical Pharmacy, 46, pp. 977–986 https://doi.org/10.1007/s11096-024-01734-w
3. National Institute Health and Clinical Excellence (NICE). 2013 Falls in Older People: Assessing risk and prevention Guidance. www.nice.org.uk
4. Anticholinergic Burden Calculator web app (ACBcalc®) created by Dr Rebecca King and Steve Rabino 

Introduction We recruited older adults with advanced Idiopathic Parkinson’s disease (IPD) to better understand their symptom burden and its impact on quality of life (QoL) in the predominately rural area of North Cumbria.

Methods Records were taken from an IPD prevalence study. Those identified with advanced IPD, defined by Hoehn & Yahr stage 4 or 5, were invited to participate, consultee was contacted for those unable to consent. Quantitative data were collected using validated questionnaires. These included the Movement Disorder Society Non-Motor Symptoms (NMS) Questionnaire and the Parkinson’s Disease Questionnaire. Data were collected electronically with the participant, with assistance from a relative or carer if asked, or consultee as appropriate. Rural areas were defined as living in a settlement of less than 10,000 people.

Results All 62 recruited participants experienced NMS, the number ranging between six and 17. Most frequently reported symptoms were sleep disturbance and physical fatigue. Physical fatigue was the most severely reported symptom. Mean NMS score for those living in a rural area (207.8 ±87.9) was higher than that for those living in an urban area (180.0 ±62.1), although this did not reach statistical significance (p=0.17). In rural areas, mental fatigue was the most frequently reported symptom, while those living in urban areas reported sleep disturbance most frequently. Mean NMS score was higher in males (198 ±85.5) than females (189 ±67.4), although this did not reach statistical significance (p=0.67). Mean PDQ-39 scores, an indicator of QoL, were similar in rural (40.6 ±10.9) and urban (39.4 ±10.4) areas and similar in males (39.6±10.1) and females (40.5 ±11.2).

Conclusion Sleep disturbance and physical fatigue were frequently and severely reported NMS. Despite a higher NMS burden described in rural areas, QoL was similar between rural and urban areas. This could suggest possible protective factors improving QoL in rural areas.

Background: Ireland has the highest rates of loneliness among EU countries, with those aged 80+ particularly vulnerable. Loneliness is a significant risk factor for various negative health outcomes. To address this, the Loneliness Research Network (LTRN) was established in November 2022 to ensure policy recommendations from Ireland’s national Loneliness Taskforce are informed by robust research. The LTRN’s first initiative aimed to identify research priorities, particularly in gerontology, to guide the future of loneliness research in Ireland.

Method: The study was conducted in two phases. Phase 1 involved a roundtable event in April 2024, attended by approximately 50 stakeholders, including NGOs, health professionals, individuals with lived experience, academics, private sector representatives, and government officials. Discussions at seven tables covered various loneliness research topics, with two tables focusing on loneliness in older adults. In Phase 2, LTRN members ranked 5–12 research priorities across different topics.

Results: The roundtable revealed diverse priorities, with limited overlap between outputs. Older adults were identified as a key group for research. Priorities included:

• Exploring the impacts of financial challenges in later life (e.g., rising living costs, housing insecurity) on loneliness.
• Developing a "universal toolkit" or service directory based on evidence of effective loneliness interventions.
• Understanding emotional or existential loneliness that persists despite social engagement improvements.

Conclusion: This study underscores loneliness as a critical issue in Ireland, highlighting the need for targeted research across demographics and contexts. The findings will inform the National Loneliness Taskforce’s efforts to develop, fund, and implement a cross-Government national strategy to reduce loneliness.

Introduction 

Older people can commonly experience reduced appetite and it can be assessed very simply by questionnaires such as the Simplified Nutritional Appetite Questionnaire (SNAQ). Decreased appetite is associated with sarcopenia and frailty, which in turn are related to falls. The aim is to assess if screening for poor appetite might aid in predicting risk of future falls by exploring association between appetite score and falls at three and six months in older people with upper limb fracture. 

Methods 

A secondary data analysis. Baseline appetite was assessed using the SNAQ, with score <14/20 defining poor appetite. Descriptive statistics summarised characteristics associated with poor appetite. Association between baseline characteristics and the presence of falls at 3 and 6 months were measured using logistic regression. 

Results 

100 participants (80% females and 20% males, median age 73 years (IQR 9.75)). 9% had poor appetite. Sarcopenia (SARC-F score ≥4), frailty (FRIED phenotype) and a higher number of comorbidities and medications were more prevalent in individuals with poor appetite. Appetite at baseline was not related to occurrence of falls at 3 and 6 months (P = 0.627, P = 0.698 respectively). Sarcopenia, number of comorbidities, EQ5D5L mobility, EQ5D5L self-care and EQ5D5L activities were associated with occurrence of falls at 3 months. There was no relationship between baseline variables and falls at 6 months. In multivariate analysis, the association between EQ5D5L activities and the presence of falls at 3-months remained (OR 3.485 (95% CI 1.463, 8.302), P= 0.005). 

Conclusion 

In this study population, poor appetite was related to higher prevalence of sarcopenia and frailty but was not predictive of future falls. Sarcopenia, comorbidities, EQ5D5L mobility and self-care were associated with falls at 3 months. Identifying individuals with sarcopenia and difficulty in performing routine activities continues to be imperative to minimise the risk of future falls.

Background

Geriatric medicine in the Emergency Department (ED) represents an advancing field that integrates the principles of geriatric care into urgent care settings. Several studies have evaluated the impact of geriatrician consultations in ED’s on reducing hospital admissions, promoting safe discharges directly from the ED, and ensuring timely admissions to geriatric wards when necessary. However, to our knowledge, there have been no studies to assess the effectiveness of this intervention amongst those patients presenting after falls.

Aim

To evaluate the impact of geriatrician reviews in ED amongst older patients presenting after falls in reducing ED 30-day readmission rates, length of stay (LOS) and disposition.

Methods

A single-centre case control study was undertaken at Monash Medical Centre ED, Victoria. Participants included patients above the age of 65 that presented after a fall from February to August 2022. A total of 1029 patients were identified, out of which 66 cases were seen by geriatricians and 139 controls who received usual care were randomly selected. Retrospective data regarding patient characteristics and outcomes were collected from electronic medical records.

Results

Most patients seen by geriatricians were multi-morbid, frail and had polypharmacy. There was a trend towards reduction in 30-day representation in the geriatrician group compared to control group (6% vs 13%, p>0.05). The geriatrician cohort had a longer LOS in ED (p=0.002). On discharge, 85% of controls were only referred to their primary care providers, whereas 35% of the geriatrician cohort were referred to hospital-led services, 18% to community-led services and 9% to ambulatory admission programmes (p<0.001). 47% of geriatrician cohort were referred to care coordinators compared to 18% of controls (p<0.001).

Conclusions

This study demonstrated that positioning geriatricians at the hospital’s front door enabled early specialist assessment for the more complex and multi-morbid older patients presenting after falls. It also demonstrated effective utilisation of out of hospital-based services and allied health referrals, which is likely to improve patient outcomes and ultimately reduces burden on primary care providers. 

Background: Laboratory-based frailty indices (FI-Lab) offer potential alternatives to manual assessment in emergency care settings, but how should we select features and time-frames to find the best balance between coverage and performance? We evaluated multiple FI-Lab configurations to determine the optimal configuration requirements for reliable automated frailty assessment.

Methods: We analyzed 74,493 ED visits from 54,075 patients aged ≥70 years across two London hospitals (2017-2021), comparing five FI-Lab configurations and a drug-adjusted version against nurse-assessed Clinical Frailty Scale scores. Configurations varied in observation windows (12-36 months), minimum data requirements (1-10 months of data), and calculation approaches. Outcomes included 90-day mortality, length of stay, and readmission risk.

Results: Nurse assessments consistently showed superior outcome discrimination (c-statistic 0.726 for 90-day mortality), though automated measures performed strongly (best FI-Lab c-statistic 0.718). FI-Lab measures demonstrated effect sizes comparable to age for mortality prediction (HR range 1.37-1.55 per standard deviation), indicating clinical relevance. The mean-type FI-Lab showed the strongest automated performance (HR 1.29, 95% CI 1.22-1.37), but notably, even configurations requiring minimal data maintained similar predictive validity. Information criteria suggested automated measures provided more consistent scoring (drug-adjusted AIC=-45,984 vs nurse assessment AIC=116,715), though with some loss of predictive power.

Conclusions: While nurse assessments predicted outcomes best, the similar performance across FI-Lab configurations suggests that complex data requirements may be unnecessary for effective automated frailty screening. Given their complementary strengths - clinical insight from nurse assessment and scoring consistency from automated measures - a combined approach could enhance frailty screening in emergency care. Additionally, automated frailty screening could help triage nursing assessments. Further work is needed to identify the minimum feature set that ensures maximum population coverage, while maintaining consistent results regardless of the number of features available to provide reliable automated adjuncts to clinical assessment.

Title: Unseen Spine: A Case of Infective Discitis masked by diverticulitis in older patient

Introduction:

Spinal infections include vertebral osteomyelitis, septic discitis, facet joint septic arthritis, and spinal epidural abscesses. The common presentation usually involves back pain, fever, and elevated inflammatory markers, with signs of neurological deficits implying presence of spinal epidural abscess. Spinal infections are infrequent (0.2–3.7 per 100,000 hospital admissions for spondylodiscitis), with relatively higher incidence in older patients.

Case presentation:

We present a case of an 80-year-old female patient with a complex past medical history, including chronic back pain, osteoarthritis, bladder cancer, breast cancer, and lymphedema. She presented to the emergency department with a 3-day-history of lower back pain radiating to the abdomen. There was no history of trauma. Examination revealed no signs of intra-abdominal infection. There was a significant elevation of white blood cell count and C-reactive protein (CRP). The initial CT scan identified acute, uncomplicated sigmoid colonic diverticulitis, which was treated under the surgical team conservatively with antibiotics, following which the patient was discharged. Thirteen days later, the patient represented again with the same symptoms with additional pain radiation to the right leg affecting mobility. There was lumbar spinal process tenderness on examination with persistently high inflammatory markers in blood. Blood cultures resulted positive for Streptococcus agalactiae. An MRI spine revealed infective discitis with a right paravertebral abscess, causing thecal sac compression evident on CT scan also with bilateral psoas abscess. Following starting an appropriate antibiotic course guided by the cultures, and CT-guided drainage of the abscess, the patient improved symptomatically and clinically.

Conclusion:

Spinal infections are uncommon, yet significant aetiology of back pain. They should be considered a differential diagnosis in anyone with new or increasing back pain. The investigation and treatment approach must be guided by history taking and clinical examination.

Introduction: With an aging population, the number of patients living with frailty will rise. Thus, there is a growing recognition by educators that medical students must be adequately prepared to meet the needs of this population group. To achieve this, one Scottish medical school is carrying out curriculum redesign, including exploring how to add frailty to the curriculum. Informing this process, and education on frailty more widely, this research aimed to explore how educators within this Scottish Medical School perceived frailty and determine how teaching on frailty should be approached. 

Method: A qualitative research approach was used. Semi-structured interviews were conducted with participants who worked with patients living with frailty and delivered teaching to students on frailty. Data were analysed using thematic analysis to generate key themes. 

Results: Eleven interviews were conducted, with participants working across a range of specialties including geriatrics and emergency medicine. Key themes that emerged included frailty – definitions and perceptions; student understandings of frailty from a teacher’s perspective; why frailty needed to be added to the curriculum and how teaching on frailty should be approached – including optimal environments for student placements and what teaching methods are most effective.

Conclusions: There was a lack of consensus on how frailty was defined and perceived. All participants agreed that frailty is a difficult concept to teach, with current teaching being delivered on an opportunistic and informal basis. Participants agreed frailty needed to be formally added to the curriculum as a standalone, overarching theme in the existing spiral curriculum. Applying a range of teaching methods, including case-based learning, and simulation, was proposed as the best way to approach teaching on this topic. Participants agreed the onus to teach on frailty should not lie with geriatricians but should be a shared responsibility across multiple specialties and roles across the MDT. 

Introduction

Despite the UK’s increasing life expectancy, and increase in the older population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8,031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality. 

Methodology

The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

 Results 

Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly. 

Conclusion 

The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.