Writing, music and geriatric medicine

The Secret Life of a Geriatrician

 This new BGS blog series shows how passion for a career and extra-curricular activities can share fascinating qualities.

Desmond (Des) O’Neill is a geriatrician and cultural gerontologist in Dublin. He is also the local lead for the IAGG-ER Congress in 2015

 

Last week was even more fun than usual. In addition to my current day job in the Acute Medical Unit, I was involved with a concert of works by our composer-in-residence; my first time speaking at a book festival; a talk to emergency physicians on traffic medicine at IAEM 2014; sitting in on a cracking competition in geriatric medicine between Irish medical schools, the Jack Flanagan Prize; and attending a study day on architecture, design and medicine.

 

Working as a geriatrician is fun in general: it remains one of life’s mysteries to me that this seems counter-intuitive not only to the general public but also to some (albeit increasingly fewer) of our medical colleagues, especially since entry to training in geriatric medicine has become so highly competitive in Ireland.

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Seeing The Whole Picture

The Secret Life of a Geriatrician

This new BGS blog series shows how passion for a career and hobby can share fascinating qualities.

Philip Braude is an ST6 in Geriatric Medicine, specialising in perioperative medicine

There is a flash of knowing and relief as I click the shutter capturing a distinctive moment of the natural world. I take a moment to flick on the camera’s display screen to reassure me that everything has gone to plan, or not, and I make corrections for the next picture. Creating a cohesive image from the complex order and behaviour of wildlife takes planning, patience and perseverance.

My passion for nature photography grew from a need to relax away from long general medical on-calls. Many twilight evenings I would use my camera as an excuse to roam London’s outer green spaces. However, my understanding of this art form has developed alongside my medical career.

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Many older adults still homebound after 2011 Great East Japan Earthquake

A new study, published online in the journal Age and Ageing today, shows that the homebound status of adults over the age of 65 in the aftermath of the 2011 Great East Japan Earthquake is still a serious public health concern. Of 2,327 older adults surveyed, approximately 20% were found to be homebound.

A team of researchers led by Naoki Kondo of the University of Tokyo’s School of Public Health studied data from the city of Rikuzentakata, an area that was seriously damaged by the disaster. Of its total population of 23,302 before the events of 2011, 1,773 people died or are still missing. Of 7,730 houses, 3,368 (43.6%) were affected with 3,159 “completely destroyed”. Much of the population had been concentrated in flat coastal areas, and since the community infrastructure was totally shattered, many people who lost their houses insisted on moving to areas in the mountains. Continue reading

What I do is who I am – the importance of activity in care homes

Lorraine Bridges is the Senior Communications Manager at the College of Occupational Therapists. She tweets at @L_BridgesLivingWellThroughAcitivityinCareHomesToolkit

Occupational therapists help people to carry out essential occupations – the activities that make up our daily lives – from washing and dressing, the weekly shop, visiting friends and all the things we enjoy in life.  For older people occupations are vital for health, social inclusion, and mental wellbeing, but become more difficult due to increasing frailty. Geriatricians will be all too familiar with the serious risks of immobility.

The College of Occupational Therapists, like the British Geriatrics Society, firmly believes in equal access to health and social care and developed the Living Well Through Activity in Care Homes Toolkit to ensure that people living in care homes have the same access to occupational therapy as those living in their own home.  The resource is part of the College’s wider aim to champion dignity, choice, respect and control for older people, recognising occupational therapists’ unique skills in enabling occupation and understanding how dementia, co-morbidities, and other factors such as poor vision, impact on activity participation. Continue reading

Good Vibrations: whole body vibration treatment

Falls are common in older people and are the direct cause of many osteoporotic fractures. There are limited treatments available to help frail older people who are at risk of falls. A study funded by the National Osteoporosis Society and the British Geriatrics Society on the potential benefits of whole body vibration for frail older people has now been published in Age and Ageing.shutterstock_83367871

The collaborative work between the University of Loughborough and Nottingham University Hospitals NHS Trust showed that older people attending a falls prevention programme are able to tolerate whole body vibration.

Patients were recruited at The Nottingham University Hospitals Rehabilitation Unit and all of them took part in the NICE recommended falls prevention programme, which includes exercise. They were split at random into three groups. One group used a vibration platform that moved vertically up and down; one used a vibration platform with a “see-saw” action and one group stood upon a stationary platform whilst a buzzing noise was played so that they thought they were receiving vibration (sham vibration). The vibration training involved visiting the unit three times per week over 12 weeks, and standing on the plate during several short bouts of vibration, for a maximum of 6 minutes in total. Continue reading

Empowering Allied Health Professionals – opportunity to attend valuable conference

Empowering allied health professionals to transform health and care services

 

THIS OPPORTUNITY HAS NOW CLOSED – a successful applicant has been chosen.

Thanks to everyone for getting in touch!

See here for this conference, which is of interest to all AHPs

 

The British Geriatrics Society is offering a free place at the above conference for an allied health professional, as an opportunity for personal development and to help share the learning from this important meeting. Continue reading

Improving bone health and reducing fractures in Parkinson’s Disease

Celia Gregson (@CeliaGregson) is an academic at University of Bristol who combines bone research with clinical work as a consultant in the Hip Fracture Unit at the Royal United Hospital Bath (@RUHBath). She and her colleague Veronica Lyell, who has also a special interest in Parkinson’s disease, have written a review article on bone health in Parkinson’s disease, and here they describe the work as recently published in Age and Ageing journal.parkinsonsFracture

A collaboration between the Royal United Hospital Bath NHS Trust and the University of Bristol has recently published the first suggested guideline regarding the assessment and management of bone health and fracture risk in patients with movement disorders for whom to date no specific guidelines exist. The full paper can be seen here and below we outline the key points.

Parkinson’s Disease (PD), affecting almost 127,000 UK adults, is the second most common neurodegenerative condition after Alzheimer’s disease. Prevalence is increasing within our ageing population, affecting an estimated 1% aged >60 years. PD is primarily a neurological disorder; causing tremor, slowness of movement and muscle rigidity. However, it is less commonly recognised that people with PD have substantially higher fracture risk. Continue reading

Societal changes to the way we perceive death

Anthea Gellie and her co-authors form an eclectic team of researchers from diverse backgrounds including Medicine, Psychology, Science, and Humanities. Their paper Death: A Foe to be conquered? Questioning the paradigm reflects on changing attitudes to death and the need for a change to the current paradigm. Anthea tweets at @AntheaGellie

Whittington on his death bed - Thomas Brewer. Courtesy of the Mercers’ Company.  Photograph by Louis Sinclair.

Whittington on his death bed – Thomas Brewer. Courtesy of the Mercers’ Company. Photograph by Louis Sinclair.

There are few certainties in life—death is one of them. It is worth reminding ourselves of this age old maxim in a time when medical knowledge and technology have extended the possibilities of medical care; and when most people survive to advanced age and die in hospital, not at home. Our views on death have become skewed.

We sit at an unparalleled juncture in history, in which most of us can expect to live to old age. Compare this to medieval Britain, where life expectancy was just 30 years. It is not uncommon now, however, to survive to middle age before personally experiencing the death of a loved one. Advances in modern medicine allow us to live well with chronic illness, but we also run the risk that the lives of frail older people are prolonged to the point where life becomes a burden. Dying people often fear ‘lingering on’ unnecessarily, and have priorities such as retaining a sense of control and not being a burden on their loved ones. Yet in the medical setting, we can often overlook the wishes of a patient to have a peaceful death. Continue reading

Frailsafe – “All share, all learn”

logoZoe Wyrko is the BGS Director of Workforce Planning; she’s previously blogged about Frailsafe, the British Geriatrics Society project funded by the Health Foundation to improve the acute care of older people being admitted to hospital, and tweets @geri_baby.

Frailsafe is starting to happen! It’s been an exciting (and exhausting) week for the team, with the first learning session taking place over three days in Sheffield.

In addition to multidisciplinary teams from the 12 sites chosen to take the project forward, we have had stakeholder involvement with Tom Gentry from AgeUK, patient involvement with Olive and Ron who attended a couple of sessions on day 2, but more importantly an overwhelming sense of enthusiasm to make the Frailsafe checklist for admissions work. We’ve been immortalised in art by our illustrator, and we’ve been interviewed and filmed for a Frailsafe promotional video.

The learning environment has been truly multidisciplinary, (doctors, nurses, physiotherapists, OTs, pharmacists and hospital managers) and the team from Sheffield Microsystems Coaching Academy have been sharing their extensive skills and knowledge with us. Some of the concepts have been totally new, but in other areas I’ve been left thinking ‘Why on earth haven’t we been doing that already? It seems so logical.’ And I’m not the only one: another colleague is relieved because he now understands why his managers keep trying to make him do things with Post-it notes.

BydHrrGIAAATddsAn element of cynicism is likely when doctors are presented with timetables which include a ‘paper aeroplane factory’ and ‘the marshmallow challenge,’ but with hindsight it is impossible to argue with the practical illustrations delivered by these training sessions. Why are we as clinicians so reluctant to adopt proven messages and systems learned by industry to improve quality and consistency? Even the ice-breaker – asking delegates to arrange themselves in a line according to distance travelled – was a lesson in systems and complexity. We have learnt about the psychology of improvement, how to understand and appreciate systems, and how even at a relatively basic level of knowledge we can improve the patient journey while bringing colleagues along with us.

We’ve also been able to speak about how Frailsafe got to where it is now; the reasoning behind the questions we chose for the checklist, and (probably more importantly) why certain areas are not included. The unveiling of Frailsafe version 8 was a big moment, and emphasised  the importance of having professional designers involved in a project such as this!

Byc4dqlIgAAZ7suThe final day of the session was used for planning, with  each hospital team working with the microsystems coach who will be supporting them closely throughout the Frailsafe project. The sites each left with an individual plan of how they will start to use the checklist immediately, using the mantra of ‘start small, get bigger,’ but, more importantly, reassurance and understanding of what to do if success isn’t immediate.

Our continued thanks go to the Frailsafe partners, especially The Health Foundation who have made this work possible. Please look at our website, as many of the learning materials will be available there soon.

And if anyone is interested – Glasgow and Craigavon jointly won the paper aeroplane factory, and Sandwell were the ‘Mr Potato Head’ champions!

Start With Why

Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery. He tweets at @sean9n and @gerisreg shutterstock_114405178

Here Sean writes on his blogs, Senior Moments, about why he has chosen to specialise in geriatric medicine, and how he wants to inspire junior doctors as they begin their rotation in his department.

Start With Why.

Welcome to the older people’s ward. My name is Dr Sean Ninan.

I hope you enjoy your time on the ward. You will certainly learn lots. By the end of your time here you will see patients with classic geriatric syndromes, sepsis, malignancy, acute kidney injury, neurological disorders and much more. We will teach you to become very good at assessing patients with delirium, falls, blackouts, immobility, Parkinson’s disease, dementia as well as general medicine topics like sepsis, acute kidney injury and acute coronary syndromes. You will learn what frailty really means and what it means to perform comprehensive geriatric assessment. I expect you to learn about these topics because you will be looking after patients with these problems, but wherever possible, we will try to tailor learning to your chosen career, whether that is general medicine or general practice. If you are going to be a surgeon, obstetrician or something else, then bear with us! It is still important that you learn about geriatric medicine in order to provide a good quality of service, and hopefully you will still enjoy it, and take some of what you have learned into your future career. I also hope that we can convince some of you along the way to join us in geriatric medicine in the future.

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