Dyson’s Law and the Medical Registrar: A frontline view

This is a follow-up to Dr Aroras’ earlier blog about the recent legislations surrounding Do Not Resuscitate [DNR] orders. Dr Suthahar, who is a final year geriatric registrar, reflects on the immediate impact of the legislation on the wards and the acute general take.shutterstock_139322513

They say change comes slowly to the NHS… Think of the time it takes for the latest NICE guidance, CQUINs, newest drug or quality measures to filter down to the frontlines of clinical work. However in one stroke Lord Dyson in his landmark ruling on DNR orders and the legal necessity to communicate the DNR order to the patient or family members, has effectively changed clinical practice overnight. Continue reading

Physician Associates in Geriatric medicine

Dr Natalie Powell is a Consultant in Acute and Geriatric Medicine at Surrey and Sussex Healthcare NHS Trust. She tweets at @NPowellNataliephysician assistants

Looking back I wonder how I ever coped without our Physician Associates (PAs).  Still a relatively new role in the NHS, PAs have been working in the United States for over 40 years.  They work to the medical model and are holistic practitioners with a variety of skills ideally suited to caring for older people. They are able to provide continuity for patient care on the wards; a familiar face for patients, relatives and ward staff to get to know.  They go that extra mile to make sure older people get the care and attention they deserve. Continue reading

Better care for older people

Niall Dickson is Chief Executive of the General Medical Council, sets out how the professional regulator is responding to the needs of doctors when treating older patients. Follow the GMC at @gmcuktaster week

Healthcare is very largely a business for the treatment and care of older people. This is a reality to which not many of us have really woken up.

While there is much talk of long-term conditions and co-morbidities, much of health service delivery and the public’s perception of what an effective healthcare system should be doing remains focused on heroic interventions, lives saved, and patients cured.

We bear some responsibility for this, as the regulator with responsibility for setting educational and professional standards. We have certainly overseen practice which has struggled to adapt to the different needs of a different generation of older people. All too often older people fall through the cracks of organisational and professional silos. We will always need specialist care but we also need to reinvent the generalist physician with the status and authority to co-ordinate care and treatment, and ensure that sufficient attention is given to patients’ mental health and well-being alongside their physical health. Continue reading

What actually is frailty?

Chris Beech is a Nurse Consultant at NHS Forth Valley, Falkirk. She is member of the BGS Specialist Nurse and Allied Health Professionals Special Interest Group.ANAM2B

Frailty is all around us, especially when you take a quick peek at the recent literature on working with older people. It is important that nurses working with older people in all care settings are aware of what frailty is, what the implications are if someone is identified as living with frailty and what, if anything, can be done about it.

We all have a picture in our head of a frail person, the problem is that there is a big chance that this picture is a different image to the one the person sitting next to you is thinking of. It is important therefore to have the ability to put an objective view point into play. Continue reading

July issue of Age and Ageing journal out now

The July 2014 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

  • Medical education and ageing
  • Organisation of acute hospital care for frail older people
  • Falls prevention in secondary care
  • Screening for delirium
  • Management of acute coronary syndrome

The Editor’s View can be read here.

This issue’s free access papers are:

Don’t let the glut of pilot projects distract from patient safety

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society. He recently wrote for the Health Service Journal blog on the subject of pilot studies, or what he calls “serial pilotitis”. A syndrome with a secondary complication leading to the long term disability: “projectitis”.

Commenting on Simon Stevens’ speech at the NHS Confederation conference, Nigel Edwards, chief executive of the Nuffield Trust, says: “His call for a systematic approach to evaluating new models of care was welcome in a system that relies too heavily on small, fragmented and one-off pilots.”

I couldn’t agree more. I have visited dozens of acute hospitals and health economies to advise or to learn.

Everywhere I meet committed collaborative individuals striving to improve care for their local population – though reflexively resorting to protecting organisational or professional interests under cost, performance and regulatory pressures.

Continue reading

Innovating the Delivery of Care for Older People – My Thoughts

Daniel Sommer is a Foundation Year 2 Doctor at Charing Cross Hospital in London. He is an aspiring Geriatrician. He tweets at @danielf90 Web

Another Monday morning at work, and I was looking forward to another week of inspiration with my fantastic boss in interface geriatrics as part of my hospital’s OPAL (Older Peoples’ Assessment & Liaison) team and in our Older Peoples Rapid Access Clinic. Before I got going, I undertook a cursory check of my e-mails and I saw something slightly out of the ordinary – an e-mail from Professor David Oliver (of British-Geriatrics-Society-President-elect fame). “What are you doing Wednesday?” he asks. “Come to my conference at The King’s Fund!” he beckons. My consultant’s response when I asked her permission was “You’d better have already said yes!”. Off I went. Continue reading

Frequent consumption of fruit and vegetables inversely associated with sarcopenia

Yunhwan Lee is a professor and Jinhee Kim is a research fellow in the Department of Preventive Medicine and Public Health of Ajou University School of Medicine, and the Institute on Aging of Ajou University Medical Center in the Republic of Korea. His paper was recently published in Age and Ageing journal.shutterstock_190449695

Sarcopenia, the gradual loss of muscle mass with age, is now widely recognised as a major health problem in late life. Older people with sarcopenia are prone to suffering from frailty, falls, and disability that negatively affects their quality of life. Because there is currently no effective treatment for sarcopenia, it is important to identify risk factors that have a modifiable influence on the condition. Continue reading

Improving Older People’s Acute Care in NHS Scotland

Penny Bond is Improvement Support Team Leader in Healthcare Improvement Scotland leading a national programme of work to improve older people’s acute care. She tweets at @opachis. Here she talks about a collaborative national approach to improving the identification and management of frailty and delirium in older people admitted to acute hospitals.

NHS Board Flash Reports

NHS Board Flash Reports

‘Improve care for older people in acute care by March 2014.’ This was the request made to Healthcare Improvement Scotland (HIS) in April 2012. From an improvement perspective this felt like an ‘end world hunger’ type of aim! Given that the vast majority of patients in hospital are over the age of 65 and these numbers are predicted to increase by 50% over the next 20 years we needed to really focus this work by identifying where there were shared priorities and opportunities for improvement. Continue reading

When Life is Academic

Marion McMurdo is Professor of Ageing and Health at the University of Dundee. She tweets at @NIHRCRNageingshutterstock_100411084

No, I’m not splitting the atom, I’m not fiddling with genes, and I categorically guarantee that no molecules have been harmed as part of my research.

I’m a clinical academic in ageing research, and I’m having fun.

Yes, I appreciate that having fun at work is somewhat unusual, and is viewed with deep suspicion in many quarters.  Like all my NHS colleagues in the Medicine of Old Age, I am a realistic optimist, and I have chosen to devote my academic career to clinical ageing research. Continue reading