Chris Miller

❗️NHS ENGLAND POLICY ↳ "Patients aged over 65 presenting to hospital as an emergency should be assessed by a competent clinical decision-maker within 30 minutes of arrival using the Clinical Frailty Scale (CFS) & the 4AT tool for delirium." #delirium #MedTwitter #frailty

This 2005 study by Andrew, Freter & Rockwood was one of the first to show that when doctors didn't recognise delirium, outcomes were significantly worse. 68% of patients had poor outcomes at 6 months. But the most striking finding: poor recognition by the treating team was associated with 18x higher odds of death or functional decline. Twenty years on, under-recognition remains the single most fixable problem in delirium care. Are we any better at it now? #delirium #geriatrics

@geriatricgiant 💯 agree. But the aim here isn't discharge (flow & system benefit). Instead enabling person centred care, listening to preferences of where they want to be & enabling those preferences to be delivered (patient benefit) whilst recognising/being open & honest about risks

Frailty musing: (unfortunately) in present systems, once you realise that your frail patient has a 50:50 chance of improving vs worsening in acute care - you can start discharging many more patients

When screening rates hit 91% completion across an entire country's hip fracture population & people still try to tell you delirium screening can't be done at scale. 18,040 patients 🙌 The evidence has entered the building.

⭐ New delirium resource: 50 free clinical cases to practice 4AT #delirium scoring 12 healthcare settings. 3 difficulty levels. Read the case, note your score, then click 'Show Worked Solution'. No login. No ads. Just learning. Please RT & share with colleagues! Link 👇

"You can't properly assess for delirium when someone already has dementia." Wrong. New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations. 5 studies. 1,304 patients. International data. #delirium #dementia

Have you ever wondered about the components of the 4AT delirium assessment tool? This video of <3 mins walks through each element of the 4AT. Also available on YouTube - link below. --> If useful, please share with colleagues who screen for delirium. #delirium

When Delirium Unmasks a Silent Myocardial Infarction. #geriatrics agsjournals.onlinelibrary.wiley.com/doi/10.1111/jg…

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.

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.

Older person confused. Urine dipped. 'Positive'. Antibiotics. Feeling of "job done." Except: delirium missed, true causes not found, patient discharged still confused. 🫥🫥🫥 ➡️ New confusion = delirium. Same attention needed as chest pain or acute kidney injury. 👍👍👍

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.

Our Integrated Systems resources are here to support you in creating frailty and age-attuned systems. These include top tips, template job descriptions, video conversations, and blogs. So, steal with pride, and take advantage of what others have learned. buff.ly/egxd25N

To support prescribing decisions for older people with moderate to severe frailty, we recently published our Pragmatic Prescribing guidance. Endorsed by the @rpharms, the @rcgp, @RCPEdin, and the @RCPhysicians, this document was an instant hit. buff.ly/n33nYtM

Interface roles are becoming more common across the country, with more consultant geriatricians working across community and acute settings. Our Integrated Systems resource has a top tips page for recruiting to Interface Consultant posts. buff.ly/GbOwsqo

All these informal terms - avoiding saying "delirium" - makes care FAR less effective. Use #DELIRIUM.

In May, we celebrated our inaugural #ChooseGeriatrics week, during which we shared blogs and videos from people across the MDT celebrating their choice to work in older people’s healthcare. Read our blogs here: buff.ly/gA2LTjM

On the second day of BGS… In August, we co-produced the report “Hospital at home for frailty” with @UKHaHSoc. Hospital at Home, also referred to as virtual wards, enables people to remain at home while receiving the diagnosis and treatment they need. buff.ly/XU6WI2X

Welcome to the 1st day of BGS! Over the next 12 days, we'll be celebrating our highlights of 2025. July saw the launch of a brand new BGS resource hub on Comprehensive Geriatric Assessment. CGA is the cornerstone of good quality care for older people. buff.ly/E16MLYD