Informal or family caregivers contribute significantly to individual care, and to the Canadian healthcare system, yet receive limited support from governments, institutions, and healthcare professionals in recognition of their role, or in response to their health and social care needs-often due to the negative consequences of caregiving. Learning about the diversity of others' experiences can positively influence personal decision-making, reduce feelings of isolation, as well as promote adjustment to a personal situation. For caregivers, however, few resources exist that provide reliable information on others' experiences. We collected the narratives of caregivers' experiences of caring for someone with a chronic physical illness and produced an evidence-based web resource. Through purposive variation sampling, 42 caregivers were recruited across Canada for interviews in their homes or alternate location using video/audio recording. Qualitative data analysis followed a constant comparison approach. 29 thematic pages were developed for the web site (www.healthexperiences.ca) featuring the diversity of lived experiences, and presenting topics important to the caregivers with illustrative video/audio clips, along with other sources of information. Key themes related to caregivers' perspectives on the negative consequences of caregiving included: the impact upon personal health; challenging interactions with professionals; inconsistent information, limited support from family and friends, and unhelpful societal views. These results contribute to existing evidence of caregiver burden, but uniquely in the voices of caregivers themselves-with constructive insights for understanding the causes of ill health related to caregiving burden and for informing policy and practice.

Measures of walking such as the timed 25-ft walk test (T25FWT) may not be able to detect subtle impairment in lower limb function among people with multiple sclerosis (MS). We examined bipedal hopping to determine to what extent people with mild (Expanded Disease Severity Scale ≤ 3.5) MS (n = 13) would differ compared to age-, gender-, and education-matched controls (n = 9) and elderly participants (n = 13; ≥ 70 years old). We estimated lower limb power (e.g., hop length, velocity), consistency (e.g., variability of hop length, time), and symmetry (ratio of left to right foot). Participants completed the T25FWT and, after a rest, they then hopped using both feet 4 times along the walkway. We found that although all groups scored below the 6 -s cutoff for T25FWT, the elderly group had significantly shorter hop lengths, more variability, and more asymmetry than the controls. The results of the MS group were not significantly different from the elderly or controls in most measures and most of their values fell between the control and elderly groups. Hop length, but not measures of walking predicted Expanded Disease Severity Scale score (R = .38, p = .02). Bipedal hopping is a potentially useful measure of lower limb neuromuscular performance.

This new timed hopping test may be able to detect both physical ability, and feed-forward anticipatory control impairments in people with mild MS. Hopping at a frequency of 40-bpm seemed more challenging. Several aspects of anticipatory motor control can be measured: including reaction time to the first metronome cue and the ability to adapt and anticipate the beat over time.

Introduction Delirium affects a up to 20% of medical inpatients1. Patients in the high-risk category include those over 65, pre-existing cognitive impairment, current hip fracture and those with a serious illness 1,2. Often delirium goes undetected but is often related to high morbidity and motility rates with complications of insitionalisation, increased risk of dementia, high risk of falls and prolonged hospital stays1,2, recognition is the first step to reducing these risks. NICE guidance suggests that those patients showing indicators of delirium should have a formal cognitive assessment and a tailor-made plan should be documented within 24 hours 2. The detection of delirium can be sort using licensed tools including the 4AT score with the 4AT being the most sensitive, specific and practical1. Due to the ongoing risks of delirium, high risk patients on the Geriatric medicine firm and poor detection rate a quality improvement methodology was used to increase the rates of detection of delirium. The aim to have 90% of Geriatric medicine patients screened within 24 h admission and within 24 h of arrival to COTE ward/first consultant ward round within 4 months. Method 4 PDSA cycles were designed to trial changes including education of the Geriatric medicine team, lanyard cards, introduction of 4AT on the frailty proforma and a non-intervention cycle to see if these changes were sustained. Data was collected from the care of the elderly ward not including outliers of 27 patients. Any formal cognitive assessment that was documented either on admission or on arrival to the ward was included. Not included was those patients who were assessed for delirium or change in cognition after first consultant ward round or after 24 h of being on the ward. Results The uptake of 4AT improved by 50% after education and the lanyard cards. This was largely as a shift away from other assessments rather than more cognitive assessments done overall. During service redesign an Older Person’s Assessment Unit was formed with a Geriatrician based at the front door. This will improve the use of the 4AT for older patients admitted to hospital in the near future and is the subject of the next PDSA cycle. Conclusion Our journey to embed the 4AT is ongoing and we will continue to improve uptake using QI methodology.

Introduction In September 2017 our frailty service was started within our medium sized DGH in North Wales. Working with our management team we secured a significant clinical resource including: We describe how resources, setting and staffing develop over a 2 year period in order to create a service which meets the needs of the local population. Method The service has been in a constant state of development since it has been in operation, utilising a PDSA model with regular meetings of clinical and managerial staff to analyse performance. Results With each new PDSA cycle the amount of patients reviewed has increased. With the move to AMU we increased the monthly number of patients reviewed from 29 to 172 patients reviewed, 97 of which were discharged directly from the unit. Conclusion Using QI methodology our Frailty Service has improved dramatically since its inception. We will continue to analyse how we work to improve patient outcomes and cost effectiveness.