Uncontroversial truths; Discussing urgent care for older people

Stuart Parker is Professor of Geriatric Medicine at Newcastle University and a consultant physician at Newcastle upon Tyne Hospitals NHS Trust where he is helping to develop an acute inpatient service for frail older people. Here he discusses the Urgent care for frail older people – Hospital Wide Comprehensive Geriatric Assessment Meeting on 25 May in Leeds.

Frailty is now widely recognised as a key component of declining health and function in old age.  Older people with urgent care needs are particularly likely to experience frailty.  New acute illness can trigger the onset of frailty in an older person who, in whom the limits of their functional capacity may be urgently revealed. Older people are increasingly the main users of urgent care services. Accordingly, urgent care services for older people need to be able to recognise, evaluate and manage frailty. Continue reading

Health outcome measures for older people

Asangaedem Akpan (tweets at @asanakpan) is an Honorary Clinical Lecturer at the Institute of Ageing & Chronic Disease, University of Liverpool and Geriatrician, who was part of a global network of experts, including older people and carers, that developed a standard set of health outcome measures for older people.

The background to these set of health outcome measures has previously been discussed in a couple of previous blog articles accessible here: part 1 and part 2. Key partner organisations included the International Consortium for Health Outcome Measurements (ICHOM), NHS England and Age UK.

In a recently published open access article we describe how these health outcome measures were developed. In an era of increasing medical sub-specialisation with an increasing number of people with multimorbidity, that proportionately affects older people, a set of health outcome measures that can unify the agendas of health and social care providers, older people and those who pay for health and social care services has the potential to align health and social care services to what matters to people and their carers. Continue reading

The Wild Wild Southwest: BGS Regional Meeting, Bath

Alasdair Miller is a ST6 Specialist Registrar in Geriatric Medicine at Royal United Hospital, Bath.

In the warm spell between the two flurries of snow and ice which have buffeted the UK in recent weeks, Bath’s Kingswood School Sports Pavilion played host to the Southwest Regional Meeting of the BGS. The event attracted a wide variety of attendees from different walks of Geriatric Medicine across the southwest- a multidisciplinary crowd ranging from junior trainees to eminent seniors, and with strong representation from both community and hospital teams. The day’s remit: to share learning and innovation from across the patch, update ourselves on topical and important areas within Geriatric Medicine, and foster links, cooperation and friendship with colleagues. Continue reading

The link between frailty and losing teeth

Jess Walter is a freelance writer and mother. She loves the freedom that comes with freelance life and the additional time it means she gets to spend with her family and pets.

Bacteria accumulates in the mouth on a daily basis, and if patients don’t get rid of it by brushing and flossing twice a day, they could put themselves at risk of many health conditions. These include diabetes, aspiration pneumonia, and heart disease. According to stats published in Healthy Magazine, one in four adults in the UK don’t brush their teeth every day, while one in three have never flossed their teeth. Not cleaning between the teeth can leave up to 40 percent of the tooth exposed to bacteria. Imagine all that bacteria getting into the bloodstream where it can cause disease in the rest of the body. Now, a recent study has found that losing teeth could even result in frailty, which is especially a concern for seniors. Continue reading

Love makes the world go round but sex adds the sparkles: A review of “Dementia, Sex and Wellbeing”

Uruakanwa Ekwegh is a Specialty Doctor in Medicine for older people, with an interest in acute frailty and medical education. Her Twitter handle is @Kanwa10

Before I started to read this book, I asked myself, “what do you think of when you hear ‘dementia and sex’?” Two phrases leapt to my mind: “inappropriate behaviour” and “safeguarding issues”. The author acknowledges this perspective when she states that in this group of people, the issue of sex is only raised in the context of problems or concerns. She pointedly asks, “Why would we choose to ignore sex when so many adults consider it to be one of their activities of daily living?” Sex as an ADL? What a novel idea!

While reading this book, I was drawn into her conversational style of writing. She cleverly navigates the line between “stuffy” and “fluffy”. Just as I would start getting bogged down with the academic stuff, she would bring in a practical or true life example to liven things up again. And she expertly uses her words to paint the pictures of the people in her examples; you are present and witness the conversations that she references. Continue reading

Spring Speakers Series: Promoting Activity, Independence and Stability in early Dementia and Mild Cognitive Impairment (PrAISED)

Professor Rowan Harwood is a geriatrician at Nottingham University Hospitals NHS Trust, and the University of Nottingham, with particular interests in delirium, dementia and end of life care, who maintains an active portfolio of research. He tweets @RowanHarwood He will be speaking at the upcoming BGS Spring Meeting in Nottingham.

Why diagnose dementia? And why diagnose dementia early? Because we want to do something to make lives better? If so, what?

People living with dementia are vulnerable to a cascade of failing abilities, inactivity, deconditioning and crises from which they may not make a full recovery. Most people living with dementia are, by definition, frail – prone to deterioration and adverse events. The average age of diagnosis is about 85. Ideally early intervention should preserve activity and independence and reduce risk, including risk of the commonest adverse event, falls. Yet the ‘offering’ of health service in response to a dementia diagnosis is painfully thin – cholinesterase inhibitor drugs, cognitive stimulation therapy and a dementia advisor maybe. Continue reading

Book review: Visiting the Memory Café and other Dementia Care Activities

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. In this blog post he reviews the recently published book: Visiting the Memory Cafe and Other Dementia Care ActivitiesHe tweets @berrisfjord

Caroline Baker follows her previous publication, Developing Excellent Care for People Living with Dementia in Care Homes, with another informative and practical guide to asset-based and person-centred care.

Visiting the Memory Cafe and Other Dementia Care Activities has been developed by Baker and her colleagues at Barchester Healthcare as a framework for planning and implementing programmes of activity that optimise the wellbeing of people living with dementia.

The framework encompasses seven domains of wellbeing – identity, connectedness, security, autonomy, meaning, growth and joy – and aligns these with evidence-based activities that can be tailored to individual ability, history, and preference. Continue reading

“Doc, I read on the Internet that probiotics might help me. Is it true?”

Patrick Alexander Wachholz  is a Geriatrician, Research associate at Botucatu Medical School, São Paulo State University (UNESP). His paper Effectiveness of probiotics on the occurrence of infections in older people: systematic review and meta-analysis was recently published in Age and Ageing journal.

In 2001, an international Joint Expert Consultation of sci­entists working on behalf of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”.

Probiotics are intended to have health benefits, and in some countries we can find a huge variety of products sold as probiotics including foods (such as yogurt and fermented milk), dietary supplements, and products that aren’t used orally, such as skin or vaginal creams. Continue reading

Book review: ‘Memory’s last Breath’ – a written exploration of life, love and personhood

Rachel Manners is a speciality doctor in hospital based complex continuing care in Edinburgh.  She is a particular interest in end of life care and in complex dementia care.  Her twitter handle is @RachelMannes1 (due to an unfortunate spelling incident that she cannot figure out how to fix!).

Journeying beyond questions of how and why disease happen; to considering what they truly mean in the lives of individuals is one of the great challenges of clinical practice. Dementia brings out this challenge particularly strongly given the questions it raises about not only what it means to think and remember, but what it means to be.  That is it to say, it forces the practitioner to consider what it truly means to be a person. For those of us who work with and for those who live with dementia (or experience it in our personal lives) these are important questions. My own practice in recent years has led me to wonder not only what I have to offer people with dementia, but also to begin to consider what they have to teach and offer me .

Thinking about these ideas, I came to the book  ‘Memory’s last breath:  field notes on my dementia’ to help me develop my understanding. This is the autoethnographic study of Gerda Saunders’ journey with and into dementia. Continue reading

15 years of dementia treatment in 15 papers: an online themed collection in A&A

Elizabeta Mukaetova-Ladinska is Professor of Old Age Psychiatry at Leicester University and an Associate Editor at Age and Ageing journal. She has curated this free collection of papers on the theme of treatments in dementia.

Age and Ageing journal is delighted to be able to publish this free online collection of 15 papers to provide an update on the advances of pharmacological and non-pharmacological interventions in dementia over the last 15 years. The published studies reflect the efficacy of the current anti-dementia treatments, preventive treatments of cardio and cerebrovascular incidents (known to be risk factors for dementia), alongside the use of antidepressant medication and non-pharmacological interventions for treatment of behavioural and psychopathological symptoms of dementia (BPSD). We also address the future preventative steps and therapeutic strategies currently in development to combat the devastating consequences of dementia. Continue reading