Introduction Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 7.00, CI 5.27–9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

BackgroundPreoperative fasting is performed to reduce aspiration risk during general anesthesia. Recommendations are that patients should fast for 6 hours from solids and nonhuman milk, 4 hours from breast milk, and 2 hours from clear fluids. However, previous studies have shown that children fast far in excess of these times, which can result in perioperative complications and unnecessary discomfort for the child.AimsThis prospective, mixed‐methods study aims to explore the experiences of pediatric patients undergoing preoperative fasting in Leeds General Infirmary. It also aims to investigate fasting durations of these patients and factors which influence these.MethodsOver 2 weeks, surveys were distributed to all parents of elective pediatric patients and completed prior to their child being called to theater. Children over the age of six were offered a child survey, which had been specifically developed for the study, with visual Likert scales and an area for free text. The gathering of children's comments about their experience of preoperative fasting is unique to this study.ResultsSeventy‐one parent surveys and 48 child surveys were completed, with a mean patient age of 8.3 years (SD 4.1). The mean preoperative fasting time for food was 11.7 hours (SD 4.4) and 6.9 hours (SD 5.0) for fluids. Fasting times were far in excess of the minimums recommended, negatively impacting patient experience with 34% reporting being hungry/very hungry and 19% thirsty/very thirsty. Most children's comments suggested that they coped well with the fasting; however, several children reported feelings of sadness and anxiety.ConclusionPreoperative fasting times in pediatric patients far exceed the durations set by international guidelines. Given that many children reported extreme feelings of hunger and thirst or emotional effects from the fast, these durations need to be optimized in order to improve patient experience.

Background: People living with frailty account for a significant proportion of hospital inpatients and are at increased risk of adverse events during admission. The understanding of frailty remains variable among hospital staff, and there is a need for effective frailty training across multidisciplinary teams. Simulation is known to be advantageous for improving human factor skills in multidisciplinary teams. In situ simulation can increase accessibility and promote ward team learning, but its effectiveness with respect to frailty has not been explored. Method: A single-centre, multi-fidelity, inter-professional in situ frailty simulation programme was developed. One-hour sessions were delivered weekly using frailty-based clinical scenarios. Mixed-method evaluation was used, with data collected pre- and post-session for comparison. Results: In total, 86 multidisciplinary participants attended 19 sessions. There were significant improvements in self-efficacy rating across 10 of 12 human factor domains and in all frailty domains (p < 0.05). The common learning themes were situational awareness, communication and teamwork. Participants commented on the value of learning within ward teams and having the opportunity to debrief. Conclusion: In situ simulation can improve the self-efficacy of clinical and human factor skills related to frailty. The results are limited by the nature of self-reporting methods, and further studies assessing behavioural change and clinical outcomes are warranted.

Falls are a common presenting complaint, particularly in older patients, and are associated with significant morbidity. Inpatient falls also have financial implications for healthcare systems, including litigation costs. This article provides an approach to assessing a patient presenting with a fall, encompassing the cause and consequence of the event. It also highlights the need to consider both the acute and chronic factors that predispose a particular patient to fall. Chronic factors such as frailty, sarcopenia, cognitive impairment, and continence issues are often under-recognised and, as a result, not managed optimally. A comprehensive geriatric assessment is an ideal structure to identify modifiable risks. Practical interventions that can be of benefit to minimise a patient's risk of falling include a medication review, assessment of their mobility and their environment. In addition, continence review and visual assessment may be appropriate.