As I sit at my keyboard, I am looking at my calm and contented 3 year old calico cat, Tilly. Apart from the shaved area on her flank, you wouldn’t know anything had ever been different. Yet last week, she came close to dying from acute kidney injury.
I had come home after a long day spent running workshops for health services in Dorset. It didn’t take my physicianly training to realise that Tilly was in big trouble. Her legs couldn’t hold her up, she was probably delirious, and she could barely lift her head to drink.
It was 8 pm on a Thursday, and I knew that veterinary practices wouldn’t be open. But something had to be done. We found the one out of hours vet covering the whole of West Berkshire and called them for advice. By 10 pm, the cat was at the surgery and seeing the on call vet. She was highly professional, kept us informed, and was able to perform a range of blood tests on site and give us the results within minutes. Tilly had acute kidney injury, almost certainly due to volume depletion—a condition I manage several times whenever I am on call for acute medicine.
Dr Eileen Burnsis the recently elected BGS President Elect and is a Consultant Geriatrician at St James’s Hospital, Leeds.
“My Mum no longer recognises me or my sisters. She needs help with everything- washing and dressing, eating and drinking. She is incontinent. If she could see herself like this she would be distraught. We were very relieved when her GP met with us to discuss what we felt she would have wanted for herself in this situation. We don’t feel that there is anything to be gained for her by another hospital admission- unless she has a problem which is causing her distress which they can’t alleviate here in the home. We’d like her to die here with the dignity she has left in the place and with the carers she’s familiar with”
I’ll be honest: it was a slightly intimidating experience initially. The sheer weight of intelligence and experience in the room was something to behold, from senior NHS directors and media figures to the heads of numerous NGOs, thinktanks and specialist organisations. It was a room full to the brim with big names and heavy hitters; the only notable absentees were the major political parties, at least on the Commons side of things.
It immediately became clear why this was the case, on both counts. As Dame Kate Barker outlined the core recommendations of the report, I was struck by how bold and ambitious they were; surely the sort of thing which demands high-level attention and debate, but which could also give your average Whitehall spin doctor the odd heart palpitation.
10% of patients admitted to hospital as an emergency stay more than two weeks, using 55% of all hospital bed days, and 80% of that group are aged over 65 years.
The average age of a hospital inpatient is over 80. Good care for older people in acute care is a key priority for health services.
In 2012 Healthcare Improvement Scotland (HIS) was asked by the Scottish Government to “improve acute care for older people by March 2014″. A review of the published evidence plus the themes coming from the inspections of acute care services for older people suggested there were opportunities for improvement in the care of frail older people coming in to hospital, and that in particular delirium was often undetected with resulting poor outcomes for patients (including higher risks of death or institutionalisation).
In the patient list for the admissions unit – “acopia.”
In the nurse’s voice “Can you give her some lorazepam please?”
In the junior doctor’s tone “Another one admitted with falls. Nothing wrong with them.”
In the referral letter – “This lady has no (insert your own specialty here) -ological issues. Please could you take over her care”
Some healthcare workers do not enjoy dealing with older people. Part of me can understand why. It’s hard. Frail older patients place a lot of demands on staff. They need help washing and dressing. They need help with eating. They need help going to the toilet. They call out. They call out again. About the same thing you just reassured them about. And they don’t tell you what’s wrong with them. They come in “off legs” or confused, the same presentation hiding a multitude of diagnoses – from constipation to cord compression.
Katherine Walesby is an ST5 and is the BGS Trainees Committee Communications Representative. She tweets at @kewdoc
Over recent years, the popularity of social media has spiralled. Not merely amongst celebrities and news channels, but also within the medical profession. It is often wrongly associated as being of “no use to the medical profession” or something that “should be avoided”.
I hope to convince you, if not to embrace it yourself, that it can be a valuable asset within medicine and particularly within our speciality. It is something that many geriatricians and the British Geriatrics Society are harnessing professionally for education, learning and disseminating key messages promoting care for older people. Continue reading →
In March this year, the Supreme Court handed down its judgement on two cases which will have significant impact in determining whether arrangements made for the care and/or treatment of an individual lacking capacity to consent to those arrangements amount to a deprivation of liberty.
Key points of the Supreme Court Judgement: The Court ruled that there is a deprivation of liberty in terms of Article 5 of the European Convention on Human Rights if the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements. Whether the person objects to the arrangement or not is irrelevant, as is the ‘relative normality of the placement in the context of the person’s needs.’ Continue reading →
Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery. He blogs at Senior Moments and tweets at @sean9n and @gerisreg
I’m a big fan of Pharrell Williams. My housemates endured “Frontin” on repeat in the summer of 2003. That debut Justin album was dope. The Snoop and Jay-Z collaborations super fly. I love the man, but I’ve never heard him quite like this.
“It might seem crazy what I’m about to say Less is more can often be the best way”
These are words that sing directly to the heart of a geriatrician. In a “parody” of “Happy” by Pharrell, the Choosing Wisely campaign offers us great lines such as
“Antibiotics for a cold will do nothing but make you ill A routine screen for many things is often overkill”
You really should check out the whole video, full of people of all ages grooving here
The Choosing Wisely campaign originated in America from the American Board of Internal Medicine Foundation. They estimated that up to 30% of care delivered in America is duplicative or unnecessary and may not result in improved health. In response they worked with specialty societies to come up with “Things Providers and Patients should question” And now, as reported in the BMJ, they want to spread their campaign worldwide. Continue reading →
David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. Here he introduces two case reports from the latest issue of the journal.
The inclusion of case reports in Age and Ageing emphasises the clinical focus of the journal. Typically they illustrate either classic presentations of uncommon diseases or unusual presentations or aspects of common diseases in older people. At their best case reports provide a blueprint for high-quality clinical decision making and health care in ‘tricky’ cases. They often carry general lessons that can be learned from specific challenging circumstances. Case reports are generally valued by our readers, providing clinical education and giving balance to the journal’s content.