Age and ageing最新文献

{"title":"Improving Management of Post-Operative Pain in Patients with Fragility Hip Fractures","authors":"C Atkin, L Satharasinghe, I Poomlai, S Muthupalackal, N Reed","doi":"10.1093/ageing/afag197.012","DOIUrl":"https://doi.org/10.1093/ageing/afag197.012","url":null,"abstract":"Introduction Analgesia is an important consideration in the management of fragility hip fractures and impacts post-operative mobilisation, delirium, length of stay and quality of life. Anecdotally, from feedback, post-operative analgesia is often sub-optimal, therefore a project was undertaken to assess current practice across 3 trauma and orthopaedic wards. Method Using the QI ‘6C’ methodology, baseline retrospective analysis of current practice was conducted. A fishbone analysis was completed to identify the potential causes of suboptimal pain relief. Prospective, opportunistic semi-structured interviews were then undertaken with staff. A clinical assessment was completed to confirm if analgesia was optimised, focusing on day 1 and day 5 mobilisation, type of analgesia prescribed, and patient’s cognitive status. Results A review of 20 patients demonstrated that only 40% had their analgesia optimised and only 25% of patients managed to mobilise with therapy on day 1 post op. Staff felt post-operative pain could, be improved, contributed to delirium and affected mobility. 45% of staff felt there was no consistency in the analgesia that was prescribed post-operatively. Interventions included the development of a new analgesic protocol which was embedded into the e-prescribing order set. A patient information leaflet was developed and local teaching sessions delivered. A re-audit was undertaken to assess the effectiveness of the changes. After the interventions (n=16), the number of patients receiving optimised analgesia improved from 40% to 69%, with 75% of patients mobilised out of bed day 1 post operation. Conclusions The implementation of a standardised analgesic protocol, and efforts to improve pain-relief awareness amongst health care professionals can have a significant impact and improve patients’ ability to mobilise post operatively.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"71 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safer Prescribing after Surgery: A Nurse-Led Strategy to Reduce Falls in Older Adults","authors":"Lisa Byrne, Lisa Cogan, Caitriona Tiernan","doi":"10.1093/ageing/afag197.031","DOIUrl":"https://doi.org/10.1093/ageing/afag197.031","url":null,"abstract":"Introduction Older adults undergoing surgery and fracture rehabilitation are highly vulnerable to falls due to frailty, polypharmacy and perioperative haemodynamic instability (Guasti et al., 2025). Optimising medications, particularly deprescribing falls risk-increasing drugs (FRiDs) and treating orthostatic hypotension (OH), is a modifiable and often under-addressed component of post-operative falls prevention (BGS, 2025). This audit examined the impact of introducing a Falls candidate Advanced Nurse Practitioner (cANP)-led service on prescribing practice in an inpatient rehabilitation setting. Methods A retrospective audit of digital prescribing records was conducted for all older adults admitted for inpatient rehabilitation over a 12-month period. Prescribing activity before and after implementation of a Falls cANP-led service was compared. Data collected included patient demographics, frailty status, FRiD deprescribing episodes and prescribing of pharmacological therapies for OH. Results Overall, 409 FRiD deprescribing episodes were recorded, with 63% occurring after service introduction, representing a 70% increase in deprescribing activity. Recognition and treatment of OH increased markedly, with midodrine prescribing rising from 20 to 141 episodes and fludrocortisone from 3 to 8 episodes. Length of stay across the rehabilitation programme remained unchanged and deprescribing activity did not influence discharge destination. Conclusion Introduction of a Falls cANP-led service was associated with substantial improvements in medication optimisation in a frail, predominantly post-surgical population. Enhanced deprescribing and targeted management of OH address key perioperative contributors to falls risk, including the downstream effects of acute post-operative hypotension, compounded by ongoing exposure to falls risk-increasing drugs. These findings support advanced nursing roles as an effective adjunct to multidisciplinary perioperative care, contributing to safer transitions back to community living and reduced future falls risk.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"59 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The FIT Factor: Optimising Trauma Recovery through Specialized ED Intervention","authors":"Sarah Allen, Aine O’Sullivan, Ellen Coakley, Fiona Condon, Maeve Scannell, Marian Lyons, Niamh O’Driscoll, Niamh Spillane, Therese Corry, Denis Curtin","doi":"10.1093/ageing/afag197.041","DOIUrl":"https://doi.org/10.1093/ageing/afag197.041","url":null,"abstract":"Introduction Frailty Interdisciplinary Teams (FIT) based in the Emergency department (ED) screen patients for frailty syndromes through the completion of a comprehensive geriatric assessment (CGA). The aim of this study is to identify the number of patients who presented with silver trauma to a level 1 trauma centre and were reviewed by FIT. 1982 patients were assessed by FIT in 2025. Methods Routinely collected data from a CGA was entered prospectively onto excel by a trained administrator. 4AT, discharge destination, clinical frailty scores (CFS) and presenting complaint was recorded. Results 1016 patients (51%) who were assessed by FIT presented with a fall. A quarter of this patient group sustained a fracture, shoulder dislocation or intracranial bleed post fall. 46 (18%) patients who experienced a fall with trauma had a 4AT score of 1-3 indicating possible cognitive impairment. 11 patients received a 4AT score greater than or equal to 4 indicating a delirium. 11 patients did not have a CFS recorded. Of the 239 who did 77% (n=185) had a score of 4 or more indicating frailty. 56 % (n=139) of this patient group were admitted, 36% (n=91) patients were discharged home. 41 % of those discharged home required community supports. Four patients were discharged separately to convalescence and rehabilitation in another hospital. 12 patients were admitted and converted to discharge with community support post FIT intervention. Conclusion This patient cohort are an extremely vulnerable group presenting with frailty and possible cognitive impairment. With specialist review it is possible to reduce risk and discharge patients’ home with community support avoiding hospital admission and prolonged wait times in ED.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"11 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Audit: Femoral Nerve and PENG Catheter Removal Rates in Hip Fracture Patients in a Tertiary Hospital in Ireland","authors":"Roisin Devane, Aoife Driscoll","doi":"10.1093/ageing/afag197.025","DOIUrl":"https://doi.org/10.1093/ageing/afag197.025","url":null,"abstract":"Introduction The annual incidence of hip fracture in Ireland is estimated at 3500- 4000 cases, with approximately 500 managed at our centre. Up to one third of patients sustaining hip fractures have pre-existing cognitive impairment, and postoperative delirium is common in this population [1]. Effective pain management is essential and is associated with improved clinical outcomes [2]. The European Society of Regional Anaesthesia (ESRA) recommends regional analgesia, including femoral or pericapsular nerve group (PENG) blocks, to optimise analgesia and reduce opioid consumption [3]. Standard practice in our institution involves placement of perineural catheters with continuous local anaesthetic infusion; however, a substantial proportion are removed prematurely (<72 hours). This audit evaluates early catheter removal rates and explores associations with postoperative delirium and pre-existing cognitive impairment. Methods Data were extracted from acute pain team ward round proformas, with supplementary information obtained from patient medical records where required. Results Over a six-week period, 43 emergency hip fracture surgeries were performed. Pre-existing cognitive impairment was identified in 18 patients (40%), while postoperative delirium occurred in 21 patients (49%). Of those with pre-existing cognitive impairment, 16 (90%) developed postoperative delirium. Early catheter removal occurred in 23 cases (59%), with 15 catheters removed by patients experiencing delirium. Additional reasons for removal included catheter blockage or inadequate analgesic effect. Conclusion This audit highlights a high incidence of postoperative delirium in a vulnerable patient cohort, particularly among those with pre-existing cognitive impairment. Further investigation into contributory factors is warranted. Given the high rate of early catheter removal in the cognitively impaired, careful consideration should be given to the benefits of perineural catheter placement in this cohort and this practice is currently under review in our centre.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"40 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delays in Documentation of Delirium Diagnosis Following Hip Fracture Surgery: Valuing the Physiotherapist’s Role – A Quality Improvement Project","authors":"Florence Bourne, Muhammad Aadil Aftab, Natalie Macgregor, Marcus Greatbatch, Abiodun Noah, Iain Moppett","doi":"10.1093/ageing/afag197.018","DOIUrl":"https://doi.org/10.1093/ageing/afag197.018","url":null,"abstract":"Background Delirium is a common complication following hip fracture surgery and is associated with adverse outcomes in older adults. Early recognition is critical for timely investigation and management. Physiotherapy sessions represent an early opportunity for delirium to become clinically apparent. We aimed to assess whether physiotherapists were identifying features suggestive of delirium and whether this led to prompt medical assessment and formal diagnosis. Methods A retrospective audit of 150 consecutive patients undergoing hip fracture surgery at a single centre was performed. Post-operative delirium diagnoses were identified, along with the professional group first suspecting delirium, time to formal medical diagnosis, and use of the 4AT screening tool. Where physiotherapists documented concerns prior to medical diagnosis, the time interval to medical diagnosis was recorded. Results Delirium was diagnosed in 10 of 150 patients (6.7%). Physiotherapists documented features suggestive of delirium prior to medical diagnosis in 28 patients, without using the term delirium. Median time from physiotherapist documentation to medical diagnosis was 16.5 hours (IQR 1.2–32; range 1–141 hours). No documented use of the 4AT tool was identified to assist delirium diagnosis. Interventions Multidisciplinary educational session, followed by introduction of a standardised delirium documentation sticker incorporating the 4AT, a PINCHME checklist, a management prompt, and a mandatory yes/no delirium diagnosis tick box. Conclusions Physiotherapists frequently identify features suggestive of delirium, but this does not reliably trigger timely medical review or use of validated screening tools. This ongoing quality improvement project aims to improve timely, standardised delirium diagnosis following hip fracture surgery, with post-intervention outcomes to be reported.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"243 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a National Digital Hub to Support Scale-Up of Perioperative Medicine for Older People (POPS) Services","authors":"Cameron Hendry, Lara Harrington, Judith Partridge, Jugdeep Dhesi","doi":"10.1093/ageing/afag197.006","DOIUrl":"https://doi.org/10.1093/ageing/afag197.006","url":null,"abstract":"Introduction Despite clear evidence supporting POPS services in cost-effectively improving outcomes, NHS implementation remains variable. This reflects challenges in mobilising knowledge into local practice. Knowledge mobilisation (KM) offers a structured way to bridge this evidence–practice gap. This project describes development of a national POPS resource toolkit on NHS Futures, designed as a KM platform supporting organisations to establish sustainable POPS services, translating evidence into practice. Methods The platform was developed using the NHS Knowledge Mobilisation Toolkit, emphasising the Knowledge-to-Action (K2A) framework and KM maturity model. Clinicians and patient and public involvement contributors co-produced and curated resources. Content was organised to support service implementation by linking POPS evidence to clear objectives, target audiences, and practical routes to action. Resources were structured across three domains: clinical, service development, and education/training. The toolkit supports an online network with a community of practice, facilitating peer learning, contextual adaptation of resources, and bidirectional knowledge exchange. Evaluation was embedded from inception via iterative reflection cycles using the KM maturity model, refinement of K2A approaches, and Futures analytics to assess reach and engagement. Results The POPS toolkit employs KM by translating evidence and experiential knowledge into accessible, actionable tools. Early engagement data show substantial reach, with 5,697 Workspace views since platform establishment (4 months). Feedback indicates increased confidence in service development, reduced duplication of work, and stronger connections between emerging and established POPS teams. The community of practice supports shared problem-solving and dissemination of tacit knowledge not routinely captured in formal guidance. Conclusions Embedding POPS resources within a structured KM framework enables scalable, adaptive, and sustainable implementation of POPS services.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"37 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SipTilSend: Sustainability of a Quality Improvement Initiative to Reduce Pre-operative Fluid Fasting in Orthopaedic Patients – A Re-audit PDSA Cycle","authors":"Margaret Kapotolo, Sarah Rafar, Mohamed Ali, Caolan Abrahams, Evelyn Hannon","doi":"10.1093/ageing/afag197.039","DOIUrl":"https://doi.org/10.1093/ageing/afag197.039","url":null,"abstract":"Introduction Orthopaedic patients frequently undergo prolonged pre-operative fasting due to unpredictable emergency theatre scheduling. Excessive fasting contributes to dehydration, delirium and peri-operative complications in this frail population. Guidance recommends fasting for 6 hours for solids and 2 hours for clear fluids. Our unit previously introduced the SipTilSend initiative, permitting clear fluids until transfer to theatre, demonstrating reduced fasting duration. We performed a further PDSA cycle to evaluate sustainability of this practice change. Methods A closed-loop re-audit was conducted in a tertiary university hospital. Consecutive hip fracture patients undergoing operative management were included. Fluid fasting time was defined as the interval between last documented oral fluid intake and arrival in theatre reception. Following the initial project, interventions were reinforced through staff education, ward prompts and multidisciplinary engagement with nursing, orthogeriatric and anaesthetic teams. Fasting times were re-measured and compared with previous audit cycles. Peri-operative aspiration events were recorded as a safety outcome. Results Forty patients were included (mean age 74.1 years; 25 female, 15 male). Mean fluid fasting time was 11.2 hours (median 9.75 hours; range 0–36 hours). Compared with the previous PDSA cycle (average 3h45min), fasting duration increased, indicating reduced adherence to the pathway over time. Several patients were allowed fluids close to theatre transfer, demonstrating partial adoption. No peri-operative aspiration events occurred. One patient developed post-operative hospital-acquired pneumonia without clear association to fluid intake. Conclusions Re-audit demonstrates deterioration in compliance with SipTilSend despite prior improvement, highlighting challenges in sustaining quality improvement interventions. Ongoing education, visible prompts and theatre engagement are required to embed practice change. Liberalised clear fluid intake remains safe and should be reinforced as standard peri-operative care for hip fracture patients.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"261 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Proactive SLT Care Pathway for Older Adults with Thoracic Trauma","authors":"Sinead Brosnan, Emma O’ Driscoll","doi":"10.1093/ageing/afag197.048","DOIUrl":"https://doi.org/10.1093/ageing/afag197.048","url":null,"abstract":"Introduction Thoracic injuries in older adults significantly disrupt breathing-swallow coordination. Research indicates dysphagia prevalence reaches 30% in this cohort (Kraus 2019), with impaired cough strength increasing pneumonia risk five-fold (Smithard 2016). In patients aged ≥65, the presence of ≥3 rib fractures exponentially increases mortality and pulmonary morbidity (Battle 2012). Current referral models are often reactive; this project adapted an Acquired Brain Injury (ABI) clinical care pathway to create a dedicated Thoracic Trauma Speech and Language Therapy (SLT) Pathway. Methods The pathway was designed using a \"Referral-Assessment-Management\" framework. SLT assessment triggers identified were based on respiratory mechanics/injury severity. Inclusion criteria were defined as patient’s ≥65 with multiple rib fractures or chest wall trauma. Results The resulting pathway prioritises three pillars: Referral: Automatic SLT screening triggered by injury mechanism, high pain scores (>7), or oxygen requirements (>4L/min). Assessment: Clinical focus on respiratory rate (>25), postural stability, and the impact of analgesic-related sedation. Management: Tiered interventions including positioning to optimise lung expansion, pacing to coordinate breathing & swallowing and early texture modification to minimise the work of breathing during meals. Conclusions Adapting a structured pathway for thoracic trauma ensures that swallowing safety is addressed alongside surgical management. This proactive model aims to mitigate the risk of secondary pneumonia in the older surgical population by intervening before clinical aspiration occurs, supporting safer recovery trajectories.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"97 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delving Deeper into Audit to Co-Design a Digital Solution to Improve “Time to Bed” – Irish Hip Fracture Standard","authors":"Eve Stanley, Toni O’Keeffe, Eoin Fogarty, Liviu-Coriolan Misca, Vlad Urtila, Alexandru Iliescu, Sinead Boran","doi":"10.1093/ageing/afag197.040","DOIUrl":"https://doi.org/10.1093/ageing/afag197.040","url":null,"abstract":"Introduction The Irish Hip Fracture Standards (IHFS) comprise seven evidence-based clinical standards audited through the Irish Hip Fracture Database. Collectively, adherence to these standards improves patient outcomes. However, IHFS 1 (“time to bed”) remains a national laggard tariff, with compliance significantly lower than other standards, all of which exceed 75% compliance. Methods & Results A two-month audit in 2025 at a Model 4 Trauma Centre examined compliance with IHFS 1. Fewer than 41% of patients with hip fracture reached a dedicated orthopaedic bed within 4 hours of Emergency Department (ED) arrival, marginally above the national average (36%). Process mapping identified delays predominantly occurring prior to diagnosis (X-ray) and orthopaedic review, with a mean time of 3 hours from arrival to specialist assessment. This left approximately 1 hour to secure a dedicated bed under existing workflows. Stakeholder engagement and cross-disciplinary review of admission and referral processes identified significant duplication between digital and paper documentation. This duplication contributed to referral delays, incomplete paperwork, and inefficiencies impacting IHFS 1 compliance. Conclusions This service improvement initiative facilitated shared understanding between ED and Orthopaedics of key process bottlenecks. A co-designed digital admission proforma is now being developed to streamline documentation and automate orthopaedic referral. Following pilot testing, this intervention has potential for wider implementation across trauma centres, supporting improved compliance with IHFS 1 and enhancing early care for hip fracture patients nationally.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"1 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an Integrated Older Persons Assessment and Liaison (iOPAL) Service on Geriatric Assessment and 30-Day Mortality Following Emergency Laparotomy","authors":"Jay Acharya, Jits Dols, Amir Manzoor, Emma Wilkinson, Peter Enwere, Kamal Soliman, Arvin Lingeswaran, Radcliffe Lisk, Keefai Yeong, Clarence Chikusu, Fizza Hassan, Agustin Aranda-Martinez","doi":"10.1093/ageing/afag197.029","DOIUrl":"https://doi.org/10.1093/ageing/afag197.029","url":null,"abstract":"Introduction Older patients undergoing emergency laparotomy have high rates of postoperative complications and mortality, particularly those who are frail. Historically, geriatric involvement in perioperative care has been inconsistent. The Integrated Older Persons Assessment and Liaison (iOPAL) service was introduced to improve multidisciplinary assessment and management of frail surgical patients. This study evaluated its impact on 30-day in-hospital mortality and rates of geriatric assessment in eligible patients at a local hospital in Surrey. Methods A retrospective analysis of National Emergency Laparotomy Audit (NELA) cases was undertaken. Mortality trends were assessed using Exponentially Weighted Moving Average (EWMA) charts comparing observed versus predicted 30-day in-hospital mortality, focusing on March-May 2021 and September 2021-February 2022. Rates of geriatric assessment were calculated across four consecutive audit periods for patients aged ≥65 and frail or ≥80. Results From 1 March-31 May 2021, 45 NELA patients were treated; 6.7% received geriatric review. From 1 September-30 November 2021, 35 patients were treated, with geriatric assessment rising to 46.7%. From 1 October-31 December 2021, 34 patients were treated, with 75% assessed by geriatrics. From 1 January-31 March 2022, 33 patients were treated, with 93% receiving geriatric input. WMA charts demonstrated a sustained reduction in observed compared with predicted 30-day in-hospital mortality following iOPAL implementation. Conclusion Implementation of the iOPAL service was associated with substantially improved geriatric engagement and a sustained reduction in 30-day in-hospital mortality after emergency laparotomy, supporting integrated perioperative care for frail older adults. Further evaluation in larger cohorts is warranted.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"71 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}