Why should we have a ‘geriatric’ emergency department?

5922817362_8fd01d909b_oRosa McNamara is a consultant in emergency medicine in London, with a special interest in geriatric emergency medicine. She tweets @rosamcnamara

So we all know that the world is growing older – it is now common for emergency department (ED) clinicians to spend the majority of their day looking after frail older adults. In emergency medicine (EM) we are going through a longish period of reflection on how best to care for older adults (EM is just over 40 years old, and for 30 of those years there has been discussion about this). Interest in the needs of frail older adults has widened and many solutions have been tried in EDs worldwide, with mixed results. These include rapid response teams, liaison geriatrics, interface geriatrics and the development of seniors EDs.

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The push to improve stroke services

14599057094_556c720cf5_oAdhi Vedamurthy is a consultant geriatrician with a special interest in stroke, and Chair of the BGS Wales Council.

It was a typical Monday morning in a district general hospital. Loads of elderly medical patients had spent the night in the emergency department waiting for a bed. About a dozen ambulances were outside the hospital unable to offload patients.

I had just done a third of my ward round with the foundation year one doctor when the bleep went off. A patient with potential need for thrombolysis had just arrived. Apart from the stroke nurse, there was no other suitable senior doctor available to assess the patient.

I abandon the ward round to assess the patient, organise the scan, push the trolley with the stroke nurse to take the patient to the stroke unit and initiate thrombolysis. This takes nearly an hour. During this time, the patients on the ward are still waiting for my assessment and management plan. Two discharges get delayed and a few scans were not booked on time and they had to wait for another day.

This scenario is very common in many hospitals where geriatricians have more than one role. Time is of the essence when treating stroke patients, but this comes at a cost if commissioners do not invest to improve services and expect existing services to stretch. This also applies to therapy services who are asked to prioritise stroke patients.

To meet targets, a patient with a suspected stroke (many do not have a stroke) must get a bed in a stroke unit within four hours. But it seems entirely acceptable for patients with heart failure, pneumonia, a fall, delirium, etc., who have far higher mortality, to spend hours on a trolley in the emergency department.

There is no argument that acute stroke is an emergency and should be treated accordingly. However this should not come at the expense of other services in geriatric medicine.

A majority of geriatricians in Wales felt that an improvement seen in stroke services has come at the cost of compromising services in geriatric medicine.

Is this the case in the other devolved nations? I would love to hear your views.

Top 10 things we can do to improve care for older people right now

Mitsuko Nakajima (CMT1), Mary Ní Lochlainn (FY1), James Maguire (Registrar), Myuran Kaneshamoorthy (CT2), Jen Pigott (CT2), James Manger (CT2), Elizabeth Lonsdale-Eccles (CT2), Nivedika Theivendran (CT2), Laura Hill (CT2), Maevis Tan (CT2), Thomas Bell (ST3), Mark Lethby (CT2) & Alvin Shrestha (Clinical Fellow).

On February 6th-7th the BGS (British Geriatrics Society) Trainees Weekend took place in London. At one of the workshops, a group of us looked at how we can influence our colleagues to improve care for older people and also how we can conduct QI projects in non-geriatric settings. The workshop aimed to empower doctors who were not yet on a geriatric medicine training scheme to make a difference, especially where patients were unlikely to be seen by a geriatrician.

At the end of the workshop, the group put their heads together to come up with a Top 10 list, of things we can do to improve care for older people right now. Here are the results:

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Book Review: Essential geriatrics (Third Edition) by Henry Woodford

Shane O’Hanlon is a geriatrician in Reading, and Digital Media Editor & Honorary Deputy Secretary at the British Geriatrics Society. He tweets @drohanlon

As a trainee I often dreamed of a single book that would cover everything a geriatrician needed to know! In reality, I had to consult a wide variety of volumes depending on my question so my shelf was weighed down with Lecture Notes, Case Histories, Law & Ethics, Physiology, Cardiology, etc.9781910227657

The first edition of Essential Geriatrics was published during my training, but somehow didn’t register on my radar. That text has since been updated and revised, and now a third edition has just been published.
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Improving cancer care for older people

Dr Shane O’Hanlon is a consultant geriatrician with the Macmillan COCOC team (Comprehensive Care for Older People with Cancer) at the Royal Berkshire NHS Foundation Trust. He tweets @drohanlon

Today is World Cancer Day, and is a good opportunity to take stock of where we are with cancer care for older people.

Many people are surprised to hear that the majority of cancers are now diagnosed in people over the age of 65 years – this group is 11 times more likely to develop cancer than young adults. The incidence of cancer generally has been increasing since the 1970s, but the largest increase has been among people aged 75 years and older.

So we really should be offering excellent care to this group, and outcomes should be constantly improving. Is that what is happening?

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Why Geriatric Medicine?

Y4-ewZBYDr James Fisher is a final year Geriatric Medicine trainee working at Northumbria Healthcare NHS Foundation Trust; he tweets @drjimbofish. Here he describes an ongoing project that seeks to understand more about career choices and recruitment to Geriatric Medicine.

Geriatricians of tomorrow: We need you! As the number of people living with frailty grows, geriatricians are increasingly in demand. Already, in terms of consultant numbers, Geriatric Medicine is the biggest hospital medical specialty – but to meet the needs of the ageing population, further expansion in numbers will be needed.

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British Geriatrics Society comments on provision of GP services in Care Homes

BGS Logo CMYKFollowing today’s news that GP representatives of the British Medical Association have voted for a change in contractual arrangements, which may adversely affect their provision of services to care home residents, BGS President Professor David Oliver has made the following comments on behalf of the Society:

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Social Gerontology: How important is it for medical students?

aaSebastian Zaidman, Labib Hussain, Jack Lilly D’Cruz and William Yee Seng Tai all graduated from King’s College London in Summer 2015. In this blog, they discuss their recent Age and Ageinarticle, co-authored with Professort Anthea Tinker of KCL’s Institute of Gerontology, on the importance of social gerontology.

During our pre-clinical teaching at medical school, the rapidly escalating rates of age-related pathologies, Alzheimer’s Disease in particular, were a regular feature in lectures and tutorials alike. However, it wasn’t until our first clinical placements that we realised that a biomedical perspective of ageing would not suffice: to fully understand older patients’ medical conditions and to discuss best management and care options would necessitate a holistic view beyond the realm of a biomedical paradigm.

It is for this reason that we decided to take a year out of our medical studies to enrol on the Intercalated BSc programme at King’s College London.

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Is there ever a case for shared rooms in hospitals?

aaJacqui Close is a consultant in Orthogeriatrics at the Prince of Wales Hospital in Sydney, Director of the Falls and Injury Prevention Group at Neuroscience Research Australia and President of the Australian and New Zealand Society for Geriatric Medicine. Her research interests range from injury epidemiology, to intervention studies and implementation research.

The days of the Nightingale ward are thankfully gone. No longer do we see two long neat rows of beds with starched sheets.  Whilst the occupants of the bed were rarely encouraged to roam freely, the close proximity of the beds allowed for easy spread of highly mobile viruses and bacteria. Even in the absence of an understanding of infection risk, many complained about the lack of dignity and privacy resulting from this ward design.

Time has moved on and there is recognition of the multiple benefits of single rooms for all patients including older people. Single rooms allow for the delivery of health care which minimizes infection risk, respects privacy, promotes dignity and on the whole reflects with wishes of those people unfortunate enough to require a period in hospital. But is a single room right for everyone and can we be flexible in the way we deliver care?

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January issue of Age & Ageing out now

The January 2016 issue of Age and Ageing, the journal of the British Geriatrics Society, is out now!

aaA 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:

  • Integrated care planning in general practice
  • Yoga to improve balance and mobility
  • Improved process and outcomes in orthogeriatric units
  • Obesity and risk of dementia
  • Curriculum for advanced nurse practitioners

The Editor’s View can be read here.

This issue’s free access papers include: