Ruth Houson 💙

Nurse NHS Ayrshire & Arran. Love the great outdoors - ski, horse, bike or foot. Interests-frailty, ortho,hip #, advanced practice

[Alasdair MacLullich @A_MacLullich]

Emergency Department (ED) staff: screen ALL patients over 65 for delirium.

Emergency departments are where it's most missed and most dangerous.

Make it as routine as checking blood pressure.

[Australian & New Zealand Hip Fracture Registry @ANZHFR]

💉 Regional nerve blocks for hip fracture pain relief

A recent randomised trial compared femoral nerve block (FNB) and pericapsular nerve group (PENG) block in older adults with hip fractures.

Both blocks provided similar pain relief and opioid reduction, but PENG better preserved early quadriceps strength — supporting faster mobilisation after surgery.

🔗 Read more: https://t.co/AVPDh0FUd5

#ANZHFR #HipFracture #PainManagement #Orthogeriatrics

[Alasdair MacLullich @A_MacLullich]

Physical activity for adults & older adults

[Alasdair MacLullich @A_MacLullich]

Every hospital should have a delirium champion. We have stroke and sepsis champions - why not #delirium?

#PatientSafety

[Hospital at Home @NHSaaaHatHome]

Well done to our ANP Clair Adair on her poster presentation demonstrating collaborative working for Advanced Practice CPD within NHSAAA and on winning the Judges Choice poster

[Sean Ninan @sean9n]

Incredibly valuable and fits with what we see in practice. An abnormal 4AT score is not normal. I see many patients with moderate or even severe dementia with 4AT scores 1-3

[Alasdair MacLullich @A_MacLullich]

⚠️ People with dementia in hospital have a high risk of severe distress. Keep family present if possible & provide frequent reassurance and explanation.

[Alasdair MacLullich @A_MacLullich]

#delirium
#hypoactive delirium

[Alasdair MacLullich @A_MacLullich]

As a doctor caring for hip fracture patients, I'm often struck by what a special thing it is that we've created systems where dozens of professionals with diverse expertise come together in purpose-built facilities to help someone who's fallen and broken their hip. Relieving pain, providing surgery, and guiding rehabilitation.

This kind of "coordinated compassion" represents humanity at its best and we should always be inspired by these kinds of staggering achievements.

#hipfracture

[Alasdair MacLullich @A_MacLullich]

New Research: Delirium in Hip Fracture Patients Associated with Doubled Mortality Risk

I'm pleased to share our new study on delirium and hip fracture, led by @rosespenfold.

91% of all hip fracture patients attending Scottish hospitals had a 4AT delirium assessment tool performed at presentation (N=16,476 ). N=3,386 (21%) had delirium.

Key findings:
- Delirium was associated with important adverse outcomes including 2-fold higher mortality risks as an inpatient and at one year, and a lower likelihood of returning home following hospital admission.

Key implications:
- Delirium assessment on initial presentation is feasible at national scale.
- Delirium assessment should be performed on presentation of hip fracture.
- Hip fracture care without delirium assessment is deficient care.

***Background***
Previous studies have focused primarily on postoperative delirium. This is the first large scale study using routine data to examine delirium ascertained directly with a real-time clinical assessment at the time of hospital admission.

***Methods***
We analysed data from the Scottish Hip Fracture Audit, which covers over 99% of people aged 50+ years hospitalized with acute hip fracture in Scotland.

Delirium assessment: 4AT (https://t.co/XMJpy4ZmOx), which is embedded into routine care and performed by clinical staff.

***Results***
Delirium was present 21% of patients.

Patients with delirium were older (mean age 85 vs. 78 years), more likely to be in care homes, and had higher ASA grades.

After adjusting for age, sex, pre-fracture residence, and ASA grade, patients with delirium had a 2-fold increased risk of inpatient mortality (adjusted OR 2.26, 95% CI 1.79 to 2.84).The same pattern was observed for one-year mortality (adjusted OR 2.05, 95% CI 1.83 to 2.29).

Patients with delirium were less likely to return to their original residence within 30 days (adjusted OR 0.27, 95% CI 0.24 to 0.30)

***Conclusions***
Delirium at hip fracture presentation is a powerful prognostic indicator that can inform shared decision-making with patients and families. Identifying delirium early allows clinicians to address potentially reversible causes and implement appropriate management strategies. Recognition of delirium can help in planning post-acute care needs.

Another crucial implication is that we have definitively demonstrated that delirium testing using a validated tool is *feasible in routine practice* in this population.

Hip fracture patients must have delirium assessments, and these must be done pre-operatively as well as post-operatively.

***Call to action***
Let's move forward and make good delirium care the norm in hip fracture patients.

Let's make system-wide groupthink that it is okay to neglect delirium a thing of the past.

Study: https://t.co/itCy5o4zoF

#delirium #hipfracture

[Stuart Gaw @stuartgaw]

This can’t be stressed enough! If we can’t keep our frail older people at home H@H, then let’s build front door hospital frailty services to get them home safely as soon as possible

[Ruth Houson 💙 @RHouson]

😳😳 we must get better at this. SQiD and 4AT testing for all frail admissions

[Alasdair MacLullich @A_MacLullich]

🚨 1 in 4 hospitalised older people have #delirium - yet >80% of cases are missed in most hospitals.

Demand mandatory delirium screening in ALL hospitals.

#WDAD2025

[Ruth Houson 💙 @RHouson]

@GeriSoc @suziesmith2608 @JKDhesi Absolutely 💯. H@h do a fantastic role in preventing many admissions 🙌

[Ruth Houson 💙 @RHouson]

@DrRajivsankar @gcampb48 @pumpinghearts @NHSaaa @AAAcuteAdvPrac @jenniferPN10 @Crawfordmcguff3 @ScottishHFNF @XHcardiokogyda1 @StirUni Well done Gaynor. So well deserved 🤩

[Alasdair MacLullich @A_MacLullich]

Delirium is a very strong predictor of mortality.

But it is not perceived as such by most practitioners.

It's a weird gap in modern healthcare.

Study: "A call to action for delirium research: Meta-analysis and regression of delirium-associated mortality."

🔗 https://t.co/2UZyp4PZFl

[Ruth Houson 💙 @RHouson]

@A_MacLullich @KarenAdam13 💯 agree. Thorough review takes time

[Alasdair MacLullich @A_MacLullich]

🤔 Delirium treatment is actually pretty complex.

When we say 'delirium treatment' what do we mean?

From finding & triggers, to maintaining physiological stability, to treating symptoms & reducing long-term complications, there is a lot to think about.

I've cared for people with delirium for many years now, & it takes me at least 20 mins to work through all the variables, make a plan, & communicate it.

[British Geriatrics Society @GeriSoc]

‘Use whatever time you have before your surgery to get yourself as fit as possible’ - @JKDhesi. @thebodycoach has created 10-minute routines boost activity & improve outcomes for patients awaiting surgery @GSTTnhs @CPOC_News. https://t.co/Byu7tBZXFs

[Kirstie Stenhouse @Kirstieahp]

Great post about daily acute care. Seeing & trying to support this best we can whilst meeting the needs of those with a need to be in hosp takes it toll.
#Acopia is such a misleading term, if we’re going to use it it should be to describe services not patients & unpaid carers.

[Stuart Halliday @StuartHalliday6]

Our Gaynor setting the scene for a good day ahead learning more about the use of Point of care (POC) testing and it's benefits within health care in Scotland, well done 👏