2807 Lonely-less: a quality improvement project addressing loneliness in the elderly following neck of femur fracture

Loneliness affects nearly a third of adults aged >70. It increases the risk of conditions including depression, coronary artery disease and stroke. Lonely individuals are at increased risk of falls, hospital attendances and prolonged admissions. Following hip fracture, patients are particularly at risk and pre-fracture loneliness is associated with poorer outcomes. An inpatient stay offers the opportunity to screen for and address pre-fracture loneliness.

100% of patients to have a University of California Los Angeles (UCLA) 3-item loneliness score by day 5 post-operatively. A score of 6 or above necessitates referral for community befriending services.

Patients aged >70 admitted with femoral neck fractures to orthogeriatric wards.

The project followed a Plan-Do-Study-Act approach. Electronic records were reviewed weekly for documentation of loneliness scores and referral to community befriending.

1. Doctor education session on loneliness and the UCLA 3-item loneliness scoring. 2. Inclusion of the loneliness score in the pre-populated ward round proforma.

Of 102 patients, 63% of patients were female, mean age 85. At baseline, 0% had a loneliness score documented. This improved to 57% following intervention 1, returning to 0% after 2 weeks. Following intervention 2, this improved to 56% but fell to 25% after 6 weeks. Of 23 patients with completed scores, 5 (22%) had a high loneliness score and 4 patients were referred for befriending services.

High rates of loneliness were demonstrated, in line with national predictions. Assessment improved following interventions but was not sustained. Investigation suggested this was due to rapid turnover of doctors, and successive cohorts were unaware of quality improvement programmes before moving on. We believe this to be an important finding, with wider implications for research into improving patient care. Further steps include discussion of loneliness in weekly departmental meetings with the wider Multi-Disciplinary Team.