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Introduction Early assessment of frailty in older major trauma patients is important to providing appropriate care that goes beyond chronological age. Guidance exists that this assessment should be completed as early as possible in the Emergency Department (ED). To increase rates of frailty screening in this group the measurement tool needs to be quick to complete and easy to use. This study aimed to ascertain the preference of nursing staff completing frailty assessment in older major trauma patients in the ED. Method This prospective multi-centre study recruited from five UK MTCs between June 2019 and March 2020. Eligible patients were aged 65 or over requiring 'trauma team activation' and admitted to hospital. Patients were assessed for frailty by nurses trained to use three different frailty screening tools—the Clinical Frailty Scale (CFS), the PRISMA-7 tool, and the Trauma Specific Frailty Index (TSFI). Completion rates for each of the tools were calculated and nurses were asked to rate their preference for each of the tools and the reasons for non-completion if relevant. Results Data were analysed from 370 patients. Completion rates for each of the tools varied with highest degree of compliance using the CFS (98.9%). TSFI was least likely to be completed with 'lack of available information to complete questions' as the most cited reason. Nurses showed a clear preference for the CFS with 57.3% ranking this as first choice (PRISMA-7 32.16%; TSFI 10.54%). Both PRISMA-7 and CFS were both rated highly as 'extremely easy to complete' (PRISMA-7 58.5%, CFS 59.61%). Conclusion User acceptability is an important consideration in the selection of a frailty measurement tool for use in major trauma patients. Our study shows the Clinical Frailty Scale has high rates of completion and acceptability and can be implemented in practice for assessment of frailty in major trauma. [ABSTRACT FROM AUTHOR]

Introduction Major trauma is a substantial health burden for older patients with a significant proportion having ongoing functional and psychological difficulties long after their injury. Frailty impacts adversely on outcome after trauma but the longer term effects are unknown. This study aimed to determine differences in health related quality of life (HRQoL) and change in dependence for frail and non-frail patients aged 65 or over discharged from Major Trauma Centres (MTCs) following injury. Methods This prospective multi-centre study recruited from five UK MTCs between June 2019 and March 2020. Eligible patients were aged 65 or over requiring 'trauma team activation' and admitted to hospital. Follow-up data was collected via questionnaire at two time points: on day of hospital discharge and at 6 months. Primary outcome at follow-up was patient reported health-related quality of life (HRQoL) using the EQ-5D-5L measure. Results Data were analysed from 181 patients. 54 died in the follow-up period and HRQoL data was available for 127 patients. Of these 16% were identified as frail during the trauma hospital admission using the Clinical Frailty Scale. On average, frail patients were older (82 years) compared to non-frail (77 years). HRQoL was rated similarly at discharge in both groups (Non-Frail: 60, Frail: 65, p = 0.137), but at follow-up non-frail patients reported improvement whilst those who were frail had deteriorated from the discharge base-line (Non-Frail: 70, Frail: 50, p = 0.01). At 6 months post injury, half of the frail cohort (49%) were more dependent on care than pre-trauma compared to less than a third of non-frail patients (29%). Conclusion Patients who were frail in-hospital had worse HQRoL than non-frail patients 6 months after discharge from hospital, with increased dependence. Understanding the impact of injury on quality of life is important in planning for, and supporting, the ongoing care of frail older trauma patients. [ABSTRACT FROM AUTHOR]

Introduction Major trauma is a significant health burden for older patients, with worse clinical outcomes when compared to younger people. Various clinical models exist however it is not clear which have most benefit for older patients. This study aimed to map the current provision of clinical pathways and services for older people with major trauma in the United Kingdom (UK). Methods A cross-sectional online survey was undertaken. Case vignettes designed to reflect 'typical' older major trauma patients were embedded within the survey. The survey was distributed via trauma network managers and social media, inviting responses from all UK hospitals receiving trauma patients in 2020. Fixed choice questions were analysed with descriptive statistics and free text responses categorised into themes. The survey was not deemed to be research using the UK Health Regulatory Authority tool. Results Responses were received from 20/27 Major Trauma Centres (MTCs), 33 Trauma Units (TUs) and two local emergency hospitals. Older patients were defined by age (range 55 to 82 years) or frailty status. Frailty assessment was routinely performed in more than two-thirds (69.1%) of locations. Availability of trauma-specific guidance for older patients varied, and was greater in TUs than MTCs. Analysis of the vignettes showed wide variability in the admission and subsequent interventions for older major trauma patients across hospitals. Qualitative data showed pre-injury health status, staff availability, and day of the week were factors leading to variation within individual hospitals. Conclusion There is wide variation in the processes of care and pathways for older major trauma patients in the UK. Whilst lack of standardisation may be a result of local service configuration this has the potential to impact negatively on quality of care, multi-disciplinary working and outcomes. Understanding the range of variation in practice provides opportunity to identify good practice and areas for improvement. [ABSTRACT FROM AUTHOR]

In this presentation we will introduce the politics of blame-avoidance and credit taking. We will also conceptualize centralization between and within governments and lay out the conceptual frameworks which have guided this research. It is almost axiomatic in political science that politicians seek credit and avoid blame. If there is something that will be popular, they try to take credit for it; and if there is something unpopular, they will try to avoid blame and, if possible, cast blame for it onto opponents. If good or bad outcomes cannot be traced to their actions, they will try to change the subject and opt for ‘position-taking’ in which they declare their fidelity to what they see as popular positions. This was the strategy adopted by many politicians of the populist radical right around the world during the pandemic, though as the pandemic wore on the ones out of power increasingly focused on blaming incumbent governments for public health measures. Centralization between governments means an increase in the power of the central government vis-a-vis other ‘subnational’ governments such as regions, states, provinces, or municipalities. ‘Command and control’ is a common recommendation in public health emergencies and central governments do often take powers over or away from subnational governments in crises. This is most politically contentious in federal states such Spain, Canada, or Germany, but can happen even in countries where there is a history of only local government (such as Ireland, Portugal, or the Nordic states). [ABSTRACT FROM AUTHOR]