Abstract Background/Aims Over three million people in the UK have osteoporosis; and are at a substantially increased risk of fragility fractures. There are approximately 536,000 new fragility fractures each year in the UK, with substantial associated morbidity and health service burden. Preventing fragility fractures is thus clinically and economically important and will result in substantial savings for health and social care. The aim of this audit was to assess and improve falls and bone health assessments in a high-risk patient group at a central London hospital. Methods Data was collected over a 2-month period (02/05/2019-28/06/2019) of consecutive patients over the age of 50 admitted to hospital following a fall and fracture. We used the 2017 National Osteoporosis Guidelines Group, NICE clinical guideline on falls in older people (CG161) and the local hospital osteoporosis screening policy as the audit standards. Patient notes were reviewed to assess for evidence of bone health assessment and key falls assessment domains having taken place. Results 43 patients were included; 8 of which had a neck of femur fracture (NOF). Table 1 demonstrates the different components that we included in the falls assessment. Only 5 (12%) of all of the patients had a full falls assessment recorded. In all domains, patients with a NOF were more likely to have a more complete falls assessment than patients with other fractures, especially fundamental components such as osteoporosis risk assessment. P014 Table 1:Number of patients who had each aspect of the falls and bone health assessment completedNOF (N = 8, mean age=80.3)Non-NOF (N = 35, mean age=75.3)YesNoPartialYesNoPartialFalls Assessment3 (37.5%)0 (0%)5 (62.5%)2 (5.7%)15 (42.9%)18 (51.4%)Medical diagnosis of aetiology7 (87.5%)1 (12.5%)18 (51.4%)17 (48.6%)Lying/standing BP3 (37.5%)5 (62.5%)5 (14.3%)30 (85.7%)Therapies assessment?8 (100%)0 (0%)24 (68.6%)11 (31.4%)Medication review?6 (75%)2 (25%)10 (28.6%)25 (71.4%)Osteoporosis assessment?8 (100%)0 (0%)9 (25.7%)26 (74.3%)FRAX completed3 (37.5%)5 (62.5%)3(8.6%)32 (91.4%)Referred to falls clinic1 (12.5%)7 (87.5%)1 (2.9%)34 (97.1%)Referred to post discharge falls prevention5 (62.5%)3 (37.5%)3 (8.6%)32 (91.4%)Referred to bone health clinic1 (12.5%)7 (87.5%)0 (0%)35 (100%)Patients divided into groups of neck of femur (NOF) and non-NOF fractures Conclusion Key aspects of falls and bone health assessment are simple and quick to do, yet often not done in patients admitted with a fracture following a fall. These measures are highly valuable in the long term to mitigate future fragility fracture risk. Our results show that post fall assessment, including bone health, are performed more often in patients with NOF than non-NOF fractures. There is large scope for improvement in practice for this at-risk cohort of patients. Therefore, going forward, our next steps are to create an education programme and embed a standardised, simple proforma into electronic healthcare records to guide post fall bone health assessment. Disclosure J. Kimpton: None. B. Wong: None. R. Amarnani: None. M. Loader: None. C. Fong: None. I. Mannan: None.

BACKGROUND: Acutely ill and frail older adults have complex social and health care needs. It is important to understand how this complexity affects acute outcomes for admission to hospital. We validated a frailty index using routine admission laboratory tests with outcomes after patients were admitted to hospital. METHODS: In a prospective cohort of older adults admitted to a large tertiary hospital in the United Kingdom, we created a frailty index from routine admission laboratory investigations (FI-Laboratory) linked to data comprising hospital outcomes. We evaluated the association between the FI-Laboratory and total days spent in hospital, discharge to a higher level of care, readmission and mortality. RESULTS: Of 2552 admissions among 1750 older adults, we were able to generate FI-Laboratory values for 2254 admissions (88.3% of the cohort). More than half of admitted patients were women (55.3%) and the mean age was 84.6 (SD 14.0) years. We found that the FI-Laboratory correlated weakly with the Clinical Frailty Scale (CFS; r(2) = 0.09). An increase in the CFS and the equivalent of 3 additional abnormal laboratory test results in the FI-Laboratory, respectively, were associated with an increased proportion of inpatient days (rate ratios [RRs] 1.43, 95% confidence interval [CI] 1.35-1.52; and 1.47, 95% CI 1.41-1.54), discharge to a higher level of care (odd ratios [ORs] 1.39, 95% CI 1.27-1.52; and 1.30, 95% CI 1.16-1.47) and increased readmission rate (hazard ratios [HRs] 1.26, 95% CI 1.17-1.37; and 1.18, 95% CI 1.11-1.26). Increases in the CFS and FI-Laboratory were associated with increased mortality HRs of 1.39 (95% CI 1.28-1.51) and 1.45 (95% CI 1.37-1.54), respectively. INTERPRETATION: We determined that FI-Laboratory, distinct from baseline frailty, could be used to predict risk of many adverse outcomes. The score is therefore a useful way to quantify the degree of acute illness in frail older adults.

To characterise symptoms, key findings and clinical outcomes in older adults with COVID-19. 12% of older individuals did not present with classical COVID-19 symptoms, though fever, dyspnoea, delirium and raised inflammation were associated with higher mortality. Compared with fitter older individuals, some measures of immune activity were lower in frailer patients. COVID-19 may present without cardinal symptoms as well as implicate a possible role for age-related changes in immunity in mediating the relationship between frailty and mortality. To describe the clinical features of COVID-19 in older adults, and relate these to outcomes. A cohort study of 217 individuals (median age 80, IQR 74–85 years; 62% men) hospitalised with COVID-19, followed up for all-cause mortality, was conducted. Secondary outcomes included cognitive and physical function at discharge. C-reactive protein and neutrophil:lymphocyte ratio were used as measures of immune activity. Cardinal COVID-19 symptoms (fever, dyspnoea, cough) were common but not universal. Inflammation on hospitalisation was lower in frail older adults. Fever, dyspnoea, delirium and inflammation were associated with mortality. Delirium at presentation was an independent risk factor for cognitive decline at discharge. COVID-19 may present without cardinal symptoms as well as implicate a possible role for age-related changes in immunity in mediating the relationship between frailty and mortality.

AbstractPurposeTo describe the clinical features of COVID-19 in older adults, and relate these to outcomes.MethodsCohort study of 217 individuals (≥70 years) hospitalised with COVID-19, followed up for allcause mortality. Secondary outcomes included cognitive and physical function at discharge. C-reactive protein and neutrophil: lymphocyte ratio were used as measures of immune activity.ResultsCardinal COVID-19 symptoms (fever, dyspnoea, cough) were common but not universal. Inflammation on hospitalisation was lower in frail older adults. Fever, dyspnoea, delirium and inflammation were associated with mortality. Delirium at presentation was an independent risk factor for cognitive decline at discharge.ConclusionsCOVID-19 may present without cardinal symptoms as well as implicate a possible role for age-related changes in immunity in mediating the relationship between frailty and mortality.Key summary pointsAimTo characterise symptoms, key findings and clinical outcomes in older adults with COVID-19Findings12% of older individuals did not present with classical COVID-19 symptoms, though fever, dyspnoea, delirium and raised inflammation were associated with higher mortality. Compared with fitter older individuals, immune activity was lower in frailer patients.MessageCOVID-19 may present without cardinal symptoms as well as implicate a possible role for age-related changes in immunity in mediating the relationship between frailty and mortality.

To describe associations between frailty, ethnicity, socioeconomic position and mortality in a cohort of older patients presenting to hospital with COVID-19. Frailty did not appear to be associated with mortality rates after COVID-19, though an interaction was evident indicating much larger excess mortality in fitter, compared with frailer patients. Frailty may not be a good measure of prognosis in COVID-19 and different mechanisms may underlie pathways to death depending on pre-morbid frailty. Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. Hospitalised patients aged ≥ 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93–1.12) and controls (HR 1.99, 95% CI 1.46–2.72), with an interaction term (HR 0.51, 95% CI 0.37–0.71) in multivariable models. Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients.