Too many older people falling due to poor eye sight

Kamlesh Chauhan is President of the College of Optometrists 

It may seem obvious to some that there is a strong link between how well you can see and your chances of suffering a fall, especially as you get older. Yet our new research has revealed that it’s not so obvious to almost a third (32%) of people in the UK with parents over the age 65.

Up to one in three people over 65 will experience a fall each year so it is not surprising that nearly half of those who took part in our research said they had an older friend, parent or relative who had fallen. However, it is surprising, and worrying, that fewer than three per cent of people questioned said their parents’ deteriorating eyesight was a cause for concern.

The financial and human repercussions of falls are significant: Age UK estimates that the cost to the NHS of treating older people who have suffered a fall is up to £4.6m a day, and suffering a fall can seriously reduce quality of life as the chances of a full recovery reduce with age. Tragically, in some cases a fall can be fatal. 

Looking after feet to reduce the risk of falling

Philip Hurst is National Development Manager – Health at Age UK

Anyone can trip or fall. If we are honest with ourselves, I wouldn’t mind betting that every one of us can remember an embarrassing moment where we stumbled in the street and carried on, pretending it didn’t happen and praying that no one saw. But as we age our risk of falling increases and the consequences can be devastating. We need to do all we can to reducing the risk of falling. An obvious, but curiously often overlooked, place to start is to look after our feet.

Falls Awareness Week, which this year takes place between 17^th-21^st June, is a wonderful way of raising awareness of the dangers of falling and what can be done to prevent it. It is not only people who are more at risk of falling who need to be more aware. All health and care professionals who come into contact with older people need to know what messages to give and how they can help .

Appraisal and doctors in court

A conference report from the BGS Belfast Spring Meeting, by Liz Gill.

The afternoon then turned from patient care strategies to professional conduct with a session on governance and risk management. In her talk entitled, “High Court Avoidance”, Dr Angelique Mastihi from the Medical Protection Society listed reasons doctors might find themselves in court: for clinical negligence, to appeal against a medical practitioners tribunal decision such as a GMC suspension or sanctions or for a judicial review. This was where an individual or a group could ask the court to review the decisions and actions of a public body if they felt, for example, that there had been an unfair decision in tendering or, if they felt a certain type of treatment should be available on the NHS, or where a trust or a patient asked if a proposed treatment would be lawful if given or withheld.

Unlocking gridlock in hospitals

Published in the June issue of the BGS Newsletter, we look at some startling results achieved through a couple of simple mechanisms as reported in to reports published by The Health Foundation.

The reports showcase programmes piloted in Sheffield Teaching Hospitals NHS Trust and South Warwickshire NHS Foundation Trust

The Flow Cost Quality improvement programme was set up to explore the relationship between patient flow, costs and outcomes by examining patient flow through the emergency care pathway and developing ways in which capacity can be better matched to demand.

The Technological Revolution and its place in teaching Geriatric Medicine

Laura Daunt is an ST5 from the East Midlands North Deanery and is Education and Training representative on the BGS Trainees Council

Much is written about the time pressures on modern medical student curricula. Geriatric medicine, in particular, has the challenge of conveying the complex needs of our elderly patients and the necessity of a problem solving approach. This type of complex decision-making is perhaps best taught face-to-face with real multi-disciplinary teams and the patients they serve. However, there is also a great deal of material to get through if students are going to develop a proper theoretical underpinning to the skills they need to manage older patients.

One way to use face-to-face teaching time more constructively is to use computer aided learning (CAL) in addition to traditional teaching methods. This frees up face-to-face teaching time so that it can be used where it is most needed.  The approach is known as blended learning.

BGS Belfast Spring Meeting – Conference Report

“All patients were by legal definition vulnerable, but older patients who might be confused, frightened and without family were even more so and any doctor who ignored that would be condoning institutional abuse.”

The hard hitting message was delivered to the BGS’s Spring Meeting by guest lecturer Robert Francis QC, chairman of the Mid Staffordshire inquiry, who told us: “We know that most of the issues were nursing ones but medical leadership is the key to solving them. All doctors should be in a position to take the lead.”

Doctors in Mid Staffordshire had failed to intervene for a variety of reasons including a sense of disengagement, a reluctance to rock the boat or make a fuss, fears about discretionary payments or pensions. The result was a catalogue of horror stories, some of which he described to his audience to whom he issued a plea, “Remember these stories and don’t ever fall into those categories. The future is in your hands.”

Time to get end of life care right?

Kate Granger is an Elderly Medicine Registrar at Pinderfields Hospital in Yorkshire. She tweets at @GrangerKate and blogs at drkategranger.wordpress.com

As Geriatricians I strongly feel one of our most important roles is providing Palliative Care in the acute hospital and within other settings such as nursing homes. We only have one opportunity to get this right and getting it wrong can cause lasting, irreparable damage to those left behind.

As a terminally ill cancer patient, diagnosed at the age of 29 with a rare and aggressive sarcoma, these aspects of care have been brought into even sharper focus. Death is not an abstract concept for me; it is a reality in my foreseeable future. For the moment, though, I remain well enough to work part-time as a Specialist Registrar in Geriatrics.

June issue of the BGS Newsletter out now

The June issue of the BGS newsletter is available here.

Highlights include:

• Osteoporotic vertebral compression fractures – new NICE guidance by Opinder Sahota and Nasir A Quraishi
• Patients First and Foremost. The goverment’s response to Francis and what it could mean for us and our older patients by Professor David Oliver
• Letter to the Editor: Francis cannot define compassionate care but we can still practise it by Iain Wilkinson
• BGS Belfast Spring Meeting Conference Report by Liz Gill
• The Pearl programme – a specialised dementia service
• Unlocking gridlock in hospitals – a digest of two reports published by The Health Foundation, as part of the Foundation’s “Flow Cost Quality Programme”

Recognising delirium in frail hospital inpatients

Kathy Whittamore is a clinical researcher working as part of the Medical Crises in Older People programme at the University of Nottingham. She recently completed her MPhil looking at ways of recognising dementia in acute hospital inpatients. 

Before becoming a clinical researcher, I worked for some time as a health care assistant on a psychiatric assessment unit. Despite working at  the ‘coal face’ of a mental health ward, I was never told what delirium was, its risk factors, its causes and – perhaps most importantly – how to recognise it.

Since 2008, the Medical Crises in Older People (MCOP) research programme at the University of Nottingham has led a workstream devoted to better understanding the mental health problems of older patients on acute medical wards. When I began working as a researcher on the project I was educated in how to identify both delirium and dementia, but the more I learned the more I realised how many other healthcare professionals where not aware of what delirium was or how to recognise it. Delirium can be difficult to identify in older patients because it presents in a variety of different ways and can be difficult to distinguish from more long-term cognitive impairments such as dementia.

Vitamin D and bone health: A practical clinical guideline for patient management – National Osteoporosis Society Guideline

Dr Terence Ong is a Research Fellow at Nottingham University Hospitals NHS Trust.

Professor Opinder Sahota is Professor of Orthogeriatric Medicine and Consultant Physician at Nottingham University Hospitals NHS Trust

image by epSos.de

Vitamin D is not, in the truest sense, a vitamin because it is not exclusively obtained through diet alone. It is a secosteroid, mostly obtained intrinsically by the effect of ultraviolet radiation on previtamin D compounds and subsequent hydroxylation in the liver and kidneys.

Vitamin D plays an important role in calcium and phosphate homeostasis through its effect on gut and bone metabolism. Besides that, it also plays a key role in muscle function. In recent years, our understanding of vitamin D has expanded and we are starting to appreciate its much broader role in areas such as the immune system, cancer and cardiovascular disease.