Saudi Cultural Missions Theses & Dissertations
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Item Restricted Weight-Bearing and Mobilisation after Hip Fracture Surgery in Older Adults: A Mixed-Methods Exploration of Practices and Experiences within Saudi Arabia(Saudi Digital Library, 2026) Turabi, Ruqayyah; الصفيان, مريم عبداللهAbstract Background Hip fractures in older adults are a growing global health issue, with incidence increasing as populations age. Clinical guidelines recommend unrestricted weight-bearing and early mobilisation to improve outcomes. The extent to which these practices vary globally is unknown, as are barriers and facilitators to their implementation. Moreover, clinicians’, patients’, and carers’ perspectives on these practices are largely unexplored, particularly in non-Western contexts. Understanding how these evidence-based practices are delivered and experienced is essential to address unwarranted variation from guideline recommendations. Aims This thesis aimed to develop a practice-relevant understanding of postoperative weight-bearing and mobilisation after hip fracture surgery in Saudi Arabia, situated in relation to reported international practice. Methods This thesis used a mixed-methods design within a Thesis Incorporating Publications format. Four independent studies were undertaken: (1) A scoping review of published and unpublished sources, synthesising barriers and facilitators to weight-bearing into patient, process (surgical and non-surgical), and structural categories. (2) An international cross-sectional survey using a self-administered questionnaire distributed to multidisciplinary healthcare clinicians via professional organisations (e.g., Fragility Fracture Network), social media, and snowball sampling. (3) Qualitative semi-structured interviews with clinicians (orthopaedic surgeons and physiotherapists) from government hospitals in Saudi Arabia. (4) Qualitative semi-structured interviews with patients who received care in the Saudi Arabian healthcare system and/or their carers. The integration of the findings occurred at the interpretation level in the discussion chapter through narrative weaving. Results The scoping review (n=69 studies) identified 47 barriers and facilitators grouped into patient-, process-, and structure-related barriers/facilitators. Barriers included pre- and postoperative delirium, systemic sepsis, and structural constraints such as staffing shortages, whereas facilitators included early surgery, multidisciplinary care, and intramedullary fixation. The international cross-sectional study (n=389) showed that most respondents were orthopaedic surgeons (36.1%) or physical therapists (30.3%), worked in acute teaching hospitals (60.2%), followed by acute non-teaching hospitals (13.9%). Unrestricted weight-bearing was prescribed by 73.5% overall and was more common in high-income countries (86.3%) than low- and middle-income countries (41%). Early mobilisation was prescribed by 72.5% overall and was more common in high-income countries (79.1%) than low- and middle-income countries (56.3%). Overall, 50.4% reported achieving unrestricted weight-bearing 76-100% of the time, and 38.3% reported achieving early mobilisation 76-100% of the time. Structural barriers were reported more frequently in low- and middle-income countries, highlighting global disparities in implementation. The qualitative interviews with clinicians (n=20) showed strong support for unrestricted weight-bearing and early mobilisation. However, implementation varied and was influenced by surgery type, local protocols, and clinician training. Interdisciplinary collaboration was deemed essential, and patient and family buy-in was identified as crucial due to fear of injury affecting adherence. Clinicians also highlighted the lack of standardised protocols and the need for routine audits to improve practices and outcomes. The qualitative interviews with patients and carers (n=25) found that participants valued unrestricted weight-bearing and early mobilisation if prescribed by clinicians. Their experiences highlighted inconsistencies in clinical instructions and understanding, with implementation influenced by communication clarity, perceptions of safety, and physical or psychological conditions. Carers identified falls as barriers to mobilisation and supported the process by encouraging patients, adapting instructions, and ensuring continuity of care. Integrated findings across the four studies developed a practice-relevant understanding of postoperative weight-bearing and mobilisation after hip fracture surgery in Saudi Arabia, interpreted in relation to reported international practice. Five interpretive intersections were identified: terminology, protocols, professional roles and autonomy, structural conditions, and carer involvement, with communication playing an important role in how postoperative instructions were explained, understood, and implemented in practice. Conclusion This thesis demonstrates that despite guideline endorsement, unrestricted weight-bearing and early mobilisation after hip fracture surgery are inconsistently implemented, shaped by systemic, organisational, and relational factors rather than clinical considerations alone. Integrating international perspectives with in-depth insights from Saudi Arabia highlights the influence of local conventions, professional hierarchies, and the critical yet under-recognised role of informal carers. Addressing these challenges requires shared terminology, standardised protocols, interdisciplinary collaboration, and structured support for carers. These findings advance understanding of implementation barriers and inform strategies to embed best practices into routine care globally. This thesis contributes to the field by moving beyond identifying variation to exploring its underlying causes and offering practical strategies for improvement.22 0Item Restricted Investigating the Prevalence and Interrelationship of malnutrition, sarcopenia, and sarcopenic obesity in older care home residents with frailty(Saudi Digital Library, 2025) Ali, Rahaf; Slee, AdrianIntroduction: The older population is growing worldwide, leading to a higher prevalence of malnutrition, disability, and institutionalization. Frailty in this population is often exacerbated by overlapping conditions such as malnutrition, sarcopenia, and sarcopenic obesity (SO), each contributing to functional and physiological decline. Early detection through validated screening and assessment tools is essential for timely intervention. The study aimed to 1. investigate the prevalence of malnutrition, sarcopenia, SO, and frailty among older adults residing in care homes, 2. Raising awareness about sarcopenia through an educational video. Methods: This multi-component cross-sectional observational study assessed nutritional status using the Mini Nutritional Assessment Full Form (MNA-FF), the Global Leadership Initiative on Malnutrition (GLIM) criteria. Sarcopenia and SO were evaluated according to the EWGSOP2 algorithm. Screening for sarcopenia was conducted using the SARC-F questionnaire which assess Strength, Assistance with walking, Rise from a chair, Climbing stairs, and Falls. Muscle strength was measured using Hand Grip Strength (HGS), while muscle quantity and quality were assessed via Bioelectrical Impedance Spectroscopy (BIS). Results: Malnutrition prevalence was 11.5% and 46.2% by MNA and GLIM respectively. Sarcopenia prevalence was 80.8%, 96,2% and 73% as assessed by the SARC-F questionnaire, HGS and CC, respectively. 65% of participants had sarcopenia, frailty and malnutrition. An independent analysis of sarcopenia, obesity, and SO, revealed that 43.8% of residents had sarcopenia, 62.5% had obesity and only 37.5% were classified as having SO. Discussion: The high co-occurrence of malnutrition, sarcopenia and frailty underscores the need for integrated screening and intervention strategies within care home settings. The relatively low prevalence of sarcopenia among people living with obesity (PLWO), highlights the current challenges in identifying SO.15 0Item Restricted The supplementary effect of transcranial direct current stimulation during upper limb motor practice on consolidation in healthy older adults(Saudi Digital Library, 2023) Mazi, Aseel; Nieuwboer, Alice; Vandendoorent, BrittBackground: Ageing affects the consolidation of learned motor skills. Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex in conjunction with motor sequence learning (MSL) improves consolidation. However, the effects of tDCS of the primary motor cortex (M1) on consolidation are still unclear. Additionally, it seems that the conventional tDCS montage (CONV-tDCS) generates a relatively non-focal stimulation compared to high-definition tDCS (HD-tDCS). So far, it is unknown whether the effects of tDCS depends on its montage. Objective: First, to compare tDCS and sham of the M1 during MSL on dual task (DT) performance as a measure of consolidation. Second, to compare CONV-tDCS and HD-tDCS of the M1 during MSL on DT performance. We hypothesize that tDCS, particularly HD-tDCS, when added to MSL grants superior DT performance compared to sham in older adults. Methods: This study was a sham-controlled randomized double-blind trial with a crossover for tDCS montage. Fifty-two participants were allocated to the active or sham tDCS group. Two sessions of twenty minutes of 1mA tDCS or sham of the M1 were administered during a serial reaction time task (SRTT). DT performance on the SRTT (DT-SRTT) was evaluated by adding an auditory Stroop task. The primary outcome was the mean reaction time on the DT-SRTT after the intervention. Results: The linear mixed model revealed no effect of group (p=.570) or montage (p=.946) on the DT-SRTT. Nevertheless, the mean reaction time of the single task SRTT (ST-SRTT) and DT-SRTT showed a significant improvement over time (p<0.001). Conclusion: DT performance improved with practice in older adults, irrespective of applying tDCS. We conclude that tDCS of the M1 has no surplus benefit on consolidation.17 0Item Restricted SOCIAL AND ENVIRONMENTAL FACTORS LEADING TO CAREGIVER STRESS AND BURDEN IN SENIORS CARING FOR OTHER SENIORS(Florida International University, 2025) Altukhys, Abdulmajeed; Beaulaurier, Richard LThe role of informal caregivers remains critical for many older adults. Informal caregivers are unpaid individuals, including friends and family members. This research examined the primary factors affecting stress and burden levels among older adult informal caregivers. Specifically, it aimed to identify the main factors influencing stress and burden levels and to determine whether personal or environmental factors have the greatest impact, based on psychological stress theory and the stress process model. Data from the 2020 U.S. nationally representative survey on caregiving were used in this study (NAC & AARP Public Policy Institute, 2020). Two hierarchical multiple linear regression analyses (MRA) were conducted for RQ1 and RQ2. Three moderation analyses were employed for RQ3 to test the multivariate hypotheses regarding gender and support needs, examining their moderating effects on the association between caregiving stress and burden variables. This study consisted of two separate dependent variables stress and burden and controlling for demographic variables (age, gender, race and ethnicity, education, and income). This study included two sets of factors that comprise the independent variables: environmental variables (ADLs, IADLs, number of adult recipients, and number of health conditions of the recipient) and personal variables (caregiving hours and support needs). The sample size for this study comprised 659 informal caregivers. Males comprised 44% of the sample, while females comprised 55.7%. The results from multivariate testing indicated that approximately 21% of the variability in informal caregivers' stress levels is explained by the selected variables. The results revealed a statistically significant relationship between caregiver gender, support needs, burden, and stress. However, when examining gender and support needs as moderators of burden and stress, no moderating effect was observed. Among all predictors, caregivers' support needs emerged as the strongest predictor of both stress and burden. The study provided a discussion of the findings, including a discussion of limitations, implications for social work practice and policy, and directions for future research.32 0Item Restricted Heart disease, health outcomes, and healthcare utilisation among middle-aged and older Australians: a longitudinal study using HILDA survey data(The University of Queensland, 2024) Alkalabi, Meshal; Keramat, Syed AfrozSTUDY 1 ABSTRACT Background Heart disease is a major public health concern globally, with substantial impacts on health outcomes among middle-aged and older adults. Understanding its influence on general health, mental health, self-assessed health, and health satisfaction is crucial for developing effective interventions tailored to this demographic in Australia. The study aims to investigate the longitudinal burden of heart disease on self-reported health outcomes among middle-aged and older Australians, focusing on general health, mental health, self-assessed health, and health satisfaction. Methods This study utilised longitudinal data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey, focusing on individuals aged 40 years and older across four survey waves: 2009, 2013, 2017, and 2021. The study included 12,751 participants aged 40 and older, with 32,931 observations. Fixed-effects Generalised Least Squares (GLS) and fixed-effects ordered logistic regression models were applied to assess the association between heart disease and four health outcomes. Robustness checks were conducted using Generalised Estimating Equations (GEE) and random-effect GLS models. The analysis adjusted for sociodemographic, behavioural, and healthrelated variables. Results The results suggest that heart disease was negatively associated with general health, mental health, self-assessed health, and health satisfaction among middle-aged and older Australians. Specifically, participants with heart disease scored lower on general health (β = -4.67, 95% CI: -5.56 to -3.77, p < 0.001), mental health (β = -0.98, 95% CI: -1.84 to -0.12, p = 0.025), self-assessed health (β = -0.76, 95% CI: -0.94 to -0.58, p < 0.001), and health satisfaction (β = -0.50, 95% CI: -0.65 to - 0.35, p < 0.001) compared to those without heart disease. The heterogeneous analysis further revealed that gender differences influenced health outcomes, with females experiencing more pronounced declines across all health measures than males. Additionally, the marginal effects analysis indicated that heart disease reduced the likelihood of achieving the highest levels of self-assessed health and health satisfaction. Conclusion This study found that heart disease is linked to poorer health outcomes, including general health, mental health, self-assessed health, and health satisfaction among middle-aged and older Australians. To enhance the overall well-being of this population, communities, government and nongovernment organisations, and other stakeholders should prioritise routine healthcare prevention, targeted interventions, and treatment strategies, particularly for individuals affected by heart disease.. Keywords: Heart disease; general health; mental health; self-assessed health; health satisfaction STUDY 2 ABSTRACT Background Heart disease poses a significant burden on healthcare systems, particularly among middle-aged and older adults in Australia. Despite existing research on healthcare utilisation patterns, longitudinal studies focusing on how heart disease affects healthcare use over time among older Australians remain limited. The study aims to examine the longitudinal burden of heart disease on healthcare utilisation among middle-aged and older Australians, focusing on the number of doctor visits, hospital admissions, and nights spent in the hospital. Methods This longitudinal observational study utilised data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey, covering the years 2009, 2013, 2017, and 2021. The study included 12,857 participants aged 40 and older, with 33,822 observations. The primary outcomes were the number of doctor visits, hospital admissions, and nights spent in the hospital. Heart disease status was the main exposure variable, and random-effects negative binomial regression models were used to examine associations, adjusting for socio-demographic, behavioural, and healthcare access factors. Results Participants with heart disease had significantly higher healthcare utilisation across all measures. The rate of doctor visits increased by 24% (IRR: 1.24, 95% CI: 1.20–1.28, p < 0.001), while hospital admissions nearly doubled (IRR: 1.91, 95% CI: 1.76–2.07, p < 0.001), and nights spent in the hospital were significantly longer (IRR: 1.89, 95% CI: 1.75–2.04, p < 0.001) compared to those without heart disease. Older age (≥ 70 years), female sex, multiple chronic conditions, and not being in the labour force were significant predictors of increased healthcare utilisation, indicating a compounded healthcare burden in these subgroups. Conclusion Heart This study shows that middle-aged and older Australians with heart disease have higher healthcare utilisation compared to those without the condition. Heart disease is a significant public health concern that necessitates comprehensive, long-term management strategies focused on prevention. Inadequate management of heart disease could lead to worsening health outcomes and place further strain on the healthcare system. Keywords: Heart disease, healthcare utilisation, longitudinal study, older adults, HILDA survey, doctor visits, hospital admissions, Australia.42 0Item Restricted Is Fatigue Associated with Oral Health Outcomes Among American Adults?(King's College London, 2024-08) Alotaibi, Abdulmajeed; Sabbah, WaelBackground: Fatigue is a frequent problem in the American adult population, affecting every aspect of health, from mental to physical wellbeing. Although the negative effects of fatigue on general health are well documented, little research has been identified that investigated its effect on oral health. Among the adverse consequences of fatigue, bad oral habits like neglecting oral hygiene and regular dental check-ups can lead directly to negative outcomes with individual’s teeth, such as tooth loss, tooth decay and periodontal disease. Fatigue is described as the subjective sense of not being able to accomplish a task efficiently owing to decreased effectiveness. Objective: This study examines the correlation between fatigue and oral health among US population. Method: Data were gathered from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of adults aged 18 and above. The Patient Health Questionnaire-9 (PHQ-9) was used to assess and examine fatigue using a thoroughly validated assessment based on the Prime-MD diagnostic instrument. In NHANES, it is referred to as the Depression Screener Questionnaire (DPQ). The tooth count was established by clinical exams performed by qualified dentists. Logistic regression models were used to determine the relationship between tooth count and fatigue and adjusted for demographic characteristics, socioeconomic status, dental visits, multimorbidity and smoking status. Results: Of the 11,848 participants (mean age: 47.25 years), 52.94% experienced fatigue. The incidence of tooth loss was greater among individuals who reported being 3 fatigued. However, after accounting for demographic characteristics, socioeconomic status, mean poverty income ratio, and multimorbidity, the link between tooth loss and fatigue maintained its statistical significance (Odds Ratio ‘OR’ = 1.21, 95% Confidence Interval ‘CI’: 1.01-1.43). Model 3 found Participants who hadn't seen a dentist in over a year have more chance to experience fatigue (OR = 1.21, 95% CI: 1.04-1.39, p = 0.014). Conclusion: to conclude, having fewer teeth is linked to fatigue among American adults. To manage fatigue and its broader health effects, a multifaceted approach is needed, including regular dental care, reducing socioeconomic disparities, and assessing both physical and mental health. This integrated strategy can improve overall well-being and address the complex link between fatigue and oral health.20 0Item Restricted Is root caries more likely to occur among older adults with multimorbidity?(KING'S COLLEGE LONDON, 2024) Alyamani, Saif; Sabbah, WaelBackground: Root caries, a prevalent dental condition in the older population, substantially impacts oral health and overall quality of life. It leads to tooth surface loss, pain, and increased risk of periodontal disease, affecting nutrition, psychological well-being, and social interactions. Effective prevention and management are crucial. Multimorbidity, is prevalent in older populations and can influence various health outcomes. The aim of this study is to examine the relationship between multimorbidity and root caries in older American adults. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, this cross-sectional study focused on adults aged 60 years and older. The presence of root caries or root restoration was assessed through clinical dental examinations. Multimorbidity was identified by the existence of nine chronic diseases, namely, diabetes, asthma, cancer, heart attack, stroke, angina, chronic pulmonary disease, kidney diseases, and arthritis. Logistic regression models were used in this study to evaluate the association between multimorbidity and root caries, adjusting for sociodemographic factors, health behaviours, and dental care access. Results: Among the 2486 participants (mean age: 69.3 years), 23% had root caries, while 43% had multimorbidity (two or more conditions). Root caries prevalence was higher in individuals with multimorbidity. However, after adjusting for confounders, multimorbidity’s association with root caries did not show statistically significant results (OR = 1.02, 95% CI: 0.88-1.18). Significant associations were found between root caries and smoking (OR = 4.67 for current smokers vs. never smokers) and income to-poverty ratio, with lower ratios linked to higher root caries prevalence. Conclusion: While multimorbidity alone did not show a significant impact on root caries prevalence, lifestyle factors, particularly smoking and socioeconomic status, played critical roles. Addressing these modifiable risk factors and improving access to dental care are essential for enhancing oral health outcomes in older adults. Additional studies are required to investigate the intricate interactions of factors influencing oral health in this demographic.24 0Item Restricted The Association between Healthy Lifestyle Behaviors and Polypharmacy in Older Adults: The Loma Linda Longevity Study(Loma Linda University, 2024) Bardesi, Abrar; Dos Santos, HildemarIntroduction: Polypharmacy—defined as taking numerous medications that may not be clinically necessary—is becoming a significant concern among the older adult population. This study examined the associations between lifestyle behaviors and the number of prescribed medications in older adults (75 years and older) living in the counties of San Bernardino and Riverside. Methods: This study employed a cross-sectional survey to assess lifestyle behaviors and medication use in 611 older adults aged 75 or over. Bivariate correlation and linear regression analyses were used to assess potential relationships between lifestyle behaviors and the number of prescribed medications. Results: Fruit consumption (p=0.005), mild physical activity per week (p<.001), and lifestyle index (p=0.003) had a highly significant inverse association with the number of prescribed medications. Fat consumption had a direct positive relationship with the number of prescribed medications (p=0.02). Conclusion: Higher fat intake was directly linked to an increased need for medications, while regular physical activity, a higher fruit intake, and a healthy overall lifestyle were all associated with a lower likelihood of polypharmacy. Future research can explore the mechanisms linking these behaviors with medication usage.41 0Item Restricted Can Exergames be used to improve the physical abilities of older male care home residents in Saudi Arabia?(University of Mancheser, 2024-04-26) Zougar, Mohammad; Stanmore, Emma; Todd, Chris; Mcgarrigle, LisaBackground: MIRA-Rehab-Exergames activities are based on the OTAGO and FaME exercise programmes, which have been shown to minimise the likelihood of falling in older people. It’s applications are recognised as a practical approach to overcoming training barriers, which ultimately leads to advancements in older individuals' well-being. Aim: This study aimed to test the feasibility of Exergames for older men at a care home. Methods: Following the Medical Research Council (MRC) guidance and framework for complex interventions, A feasibility RCT recruited male older adults 65 years and older. They were randomised into two groups. The control group received a Chair-Based Training (CBT) booklet and the intervention group received MIRA-Rehab-Exergames sessions for six weeks followed by another six weeks for follow up. The outcome measures were related to feasibility outcome measures (recruitment, data collection, attrition, retention, adherence, resources, acceptability, and usability), in addition to other outcome measures (e.g. Berg Balance Scale, quality of life, functional reach test, geriatric depression scale, timed up and go test, fear of fall, and short physical performance battery test) at three point assessments. Results: Thirty older male participants were randomised into CG (n = 16) and IG (n = 14). The mean age was 78.70 (SD 10.63). No male participants withdrew during the data collection period. However, due to Covid-19 outbreak, the researcher cancelled the last week of the Exergaming. On one hand, the recruitment and attrition shows no male participants withdrew during the first six weeks. The retention rate was high. Regarding the data collection, all the male participants in both groups successfully completed the three assessments. Adherence was measured based on the attendance of the planned Exergames sessions. Adherence to the IG seems low compared to the adherence to CG. The Exergames seem to be safe, feasible, usable, and acceptable. On the other hand, the statistics showed that only balance, fear of falling, and quality of life were improved through three points scales. Later, the male participants provided some insights and opinions related to the usability and suitability of Exergames for some required modifications. Conclusion: MIRA-Rehab-Exergames was investigated for the older men population in the context of a single care home centre in the KSA. It shows the possibility of applying such novel technology in this fast developing country.40 0Item Restricted An Exploration of the Association Between Polypharmacy and Frailty Among Hospitalized Older Adult Patients(The University of North Carolina at Greensboro, 2024) Yasin, Reham; Kennedy-Malone, LauriePurpose/Objective The study's main purpose is to explore the association between polypharmacy and frailty among hospitalized older adults. Significance Polypharmacy is considered a matter of concern in many U.S. geriatric healthcare settings. Frail older adults are at special risk of experiencing higher rates of medication-related complications, such as drug–drug interactions, worsening morbidity, falls, delirium, and rehospitalization due to physiological changes. Most studies investigated the relationship among community-dwelling older adults. However, the relationship between polypharmacy and frailty among hospitalized older adults has not yet been well described. Design/Methods This retrospective cross-sectional study offers a secondary data analysis of the EHR in adults aged 50 years or older (N=46,645) hospitalized in medical-surgical units in a healthcare system between 2013 and 2017. Polypharmacy was defined as the concurrent use of seven or more prescribed medications. Potential Inappropriate Medications/High-Risk Medications (PIMs/HRMs) were classified using AGS Beers criteria® 2023 and HIDES, and then grouped into 10 classes (Lekan et al., 2022). A Frailty Index (FI) was created based on the accumulation of a deficit theoretical framework (Mitnitski et al., 2001). After a detailed review of components contributing to frailty, the FI was constructed following the guidance provided by Searle et al. (2008) and Theou et al. (2023). This study’s FI was unique because it included indicators from nursing flowsheets, ICD-10 codes, laboratory blood biomarkers, as well as indicators more customarily used, including comorbidities, and functional status, activities of daily living, and psychosocial indicators. The indicators were coded as “1” for present and “0” for absent. FI-35 was calculated by dividing the number of indices in an individual by the total number of indices measured, with frailty defined by a cut-off point of ≥ 0.25. Findings/Outcomes The average age of patients upon admission was 70.0 years (SD=11.4). The prevalence of polypharmacy was 49.6% (n=19,072). Out of the total number of patients included in the study (25,961), 42.0% were identified as frail. The study showed a significant association between polypharmacy and frailty with 54.5% of individuals with polypharmacy classified as frail. The multivariable logistic regression yielded a significant association between polypharmacy and frailty. The odds of frailty were 53.1 % higher for those in the polypharmacy groups relative to non-polypharmacy groups, adjusting for age and ECI score (AOR = 1.531, 95% CI = [1.437, 1.631], p < 0.001). The study found a significant association between 8 PIMs/HRMs classes and frailty (P<0.001) and with using one or more PIMs/HRMs. However, no significant association was found between genitourinary or anti-infective PIMs/HRMs class and frailty (P > 0.05). Conclusion/Implications for Practice By using EHR data, nurses can identify patients at high risk of adverse outcomes. Including measures of frailty and polypharmacy in assessments can aid in reducing these risks and guide interventions by nurses to prevent negative health outcomes. Identifying frail older adults with Frailty, polypharmacy and exposure to PIMs/HRMs is important, emphasizing the need for specialized care, medication review, de-prescribing, and frailty screening. Post-discharge care plans for frail patients with complex medication regimes help ensure recovery and prevent hospital readmission.23 0