The chasm of dementia; a carer’s perspective

Sue Newsome supported her Father during the last year of his life after he was diagnosed with Vascular Dementia. In this blog she shares her thoughts and feelings from a carer’s perspective.  

bench-forest-trees-pathSupporting someone with Dementia is a contradiction of what it is ok to feel and the guilt about those feelings. A whole raft of thoughts, feelings and behaviours that I continually checked and reviewed. My relationship with Dad changed, he had never said he was scared before and I was to hear this from him throughout his Dementia journey.

Initially in his phone call to me telling me ‘Sue I am scared I am having a Stroke’ which although slurred was articulate, to the same feeling the night before he died when despite his end stage Dementia and aspiration pneumonia, when he struggled to breathe, he managed to say ‘I’m scared’. His fear and mine punctuated our relationship for the last year of his life. Our fear of the future what it held and how we could adapt. It felt like I held my breath for a year. Living on adrenaline, the skipped heartbeat when the phone rang, what had happened to Dad this time! Continue reading

A poor work life balance in midlife may affect health and quality of life decades later

business-manA study published today in Age & Ageing, the scientific journal of The British Geriatrics Society, found that businessmen who worked more than 50 hours per week and slept less than 47 hours per week in midlife had poorer scores for physical functioning, vitality and general health in older age, compared to those with normal work and sleep patterns. It also found that businessmen with long work hours but normal sleep patterns still had poorer scores for physical functioning in older age. Even taking into account midlife smoking, and other unrelated health issues, the negative effect upon physical functioning remained significant.

The study, which was conducted by researchers at The University of Jyväskylä in Finland, studied a homogenous group of 1,527 white men born between 1919 and 1934 who were a part of The Helsinki Businessmen Study. Working hours, sleep duration and self-reported health issues were surveyed among the businessmen and executives in 1974 and then surveyed again 26 years later. Continue reading

Do studies of the weekend effect really allow for differences in illness severity?

For nearly 15 years from 1997 until 2011, David Barer and his stroke team colleagues kept a prospective register of all patients admitted to hospital in Gateshead with suspected acute stroke. This was used mainly for research but also allowed independent checks to be made on the official figures from the coding department, providing useful insights into diagnostic uncertainties, the reasons for coding errors and day-to-day and year-on-year changes in the numbers and clinical characteristics of stroke admissions.  In this study he analyses whether the apparent excess mortality among patients admitted at weekends might be due to differences in stroke severity or other factors which cannot be measured in studies relying on routine administrative data.

strokeThe long-rumoured but now notorious “weekend effect” recently received the seal of scientific respectability from two huge studies, analysing routine data on 20 million hospital admissions (and 1/2 million deaths) in England and Wales. They found a 10-15% increase in the risk of dying in the first month after weekend, compared with weekday admissions, even after adjusting for differences in overall “sickness levels” by sophisticated modelling of diagnostic and administrative data.  The authors of the larger study even included non-emergency admissions, despite the obvious imbalance between weekdays and weekends, arguing that their risk model could “explain” most of the mortality variation.  Continue reading

Geriatric conditions, are they recognized as relevant problems by community dwelling older people?

Marjon van Rijn is a PhD candidate at the department of Geriatric Medicine in the Academic Medical Center in Amsterdam and lecturer at the School of Nursing, Faculty of Health, Amsterdam University of Applied Sciences the Netherlands. In this blog she comments on her recent paper in Age and Ageing.

aaComprehensive Geriatric Assessment (CGA) is increasingly implemented in community care settings and involves an assessment of physical, psychological, functional and social geriatric conditions, such as urinary incontinence, memory problems, fall risk and loneliness.

In this study, CGA is part of a complex intervention to prevent disability in community dwelling older people. Older people with an increased risk of functional decline, according to the Identification of Seniors at Risk questionnaire that was validated for primary care, were invited for a CGA at home. A community care registered nurse visited older persons to conduct the CGA, and if necessary, made an individual care plan with several follow up visits. Continue reading

John’s Campaign Conference; Stay with me

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She was one of the speakers at the John’s Campaign Conference. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

johns-campaignI was proud to be invited to speak this week at the John’s Campaign Conference on 12th October. The conference proved to be an oasis of light, love, and hope in the often gruelling and lonely journey of dementia. Nicci Gerrard and Julia Jones, co-founders of John’s Campaign, who both have personal experience of caring for loved ones with dementia, pulled together a groundbreaking and heartwarming conference, which was nothing short of miraculous. Nicci and Julia began what they described as a ‘kitchen table revolution’ to campaign to change the draconian restricted visiting arrangements of adult hospital care, advocating that people with dementia should have the support of their loved ones while in hospital. Continue reading

Dementia friendly communities; compassionate and collaborative

Dr Fiona Marshall is a neuroscientist working on treatments for Alzheimer’s disease and other conditions. Dr Marshall also volunteers as an Alzheimer’s Research UK Trustee and is Founder and Chief Scientific Officer of Heptares Therapeutics.

dementiaIn recent years there have been major initiatives to change the way that society is able to respond to the growing number of people with dementia – we are aiming for “dementia friendly societies” where people with dementia and those who care for them are not alienated, or even merely tolerated, but enabled to sustain their local connections and lead meaningful lives. Living with dementia is often full of many challenges and can leave families isolated, lonely and exhausted; as a society we need to minimise these ongoing issues and promote valued connections within local communities. Continue reading

Time to move: Get up, Get Dressed, Keep moving

Dr Amit Arora is a Consultant Physician and Geriatrician at University Hospital of North Staffordshire, Stoke on Trent and an Honorary Clinical Lecturer at Keele University.

deconditioning-1Many years ago I was subject to restricted mobility following an emergency appendicectomy. It took me a surprisingly long time to regain my strengths and abilities- I noted that despite the youth and the will, my muscles would not move and it took a while to recover back to normal!

When I co-relate this to the frail older people that I see in hospitals, I can understand why someone who was able to function well before they came to hospital takes longer to regain their pre-admission functionality.  Prolonged hospital stay, bed rest and attendant risks may lead to loss of muscle power, strength and abilities. This is something we surely need to avoid. It should help achieve a shorter length of stay, better outcomes for patients and better ability at discharge. Continue reading

Inaugural BGS Eastern Region Geriatric SpR Research & Audit Presentation Day

Katie Honney obtained her MBBS BSc (Hons) at University College London. She completed her foundation and core training in the eastern deanery and is currently working at the Queen Elizabeth Hospital, King’s Lynn, as a specialty registrar in geriatric medicine.

cambridgeOn the 24th June 2016 the inaugural BGS Eastern Region Geriatric SpR Research & Audit Presentation Day took place at NAPP Pharmaceuticals, Cambridge Science Park. The wealth of excellent research and audit work conducted by trainees within the region prompted the need for an opportunity in which this work could be shared among colleagues.

The day commenced with an informative presentation from Prof John Potter relating to blood pressure control and cognitive function. Prof. Potter told the audience about the rising prevalence of hypertension with age, as well as discussing how cognitive impairment is associated with the extremes of blood pressure. Continue reading

Choosing the right care for people from nursing homes: Hobson’s Choice, Morton’s Fork or Buridan’s Ass?

Glenn Arendts is Associate Professor in Emergency Medicine at the University of Western Australia and Chair of the Geriatric Special Interest Group of the Australasian College for Emergency Medicine. He writes about his Age & Age paper. 

donkeyHobson’s Choice: A choice where there is really only one option
Morton’s fork: A choice between two equally unpleasant alternatives
Buridan’s Ass: A hungry donkey placed equal distance from two identical bales of hay cannot use reason to choose between them, and so dies of hunger

Take a straw poll of hospital emergency department (ED) staff and you will find majority support for the following statement: “too many people from nursing homes are sent to the ED”. That your poll results may say something about the views of some hospital staff toward nursing home (NH) residents is immaterial. Acute medical care of dependent people with life limiting illness is an area of legitimate concern, and the prevailing orthodoxy is that ED is a less than ideal place to deliver it. For decades, health services have invested in a variety of programs and interventions to reduce the transfer from NH to ED. Continue reading

Perioperative Assessment at the BGS Autumn Meeting

Dr Jugdeep Dhesi is Chair of the BGS Perioperative Care of Older People Ungergoing Surgery SIG (POPS) and is consultant physician and clinical lead for the POPS service at Guy’s and St Thomas’ Hospitals. She will be Chairing the POPS Session at the BGS Autumn Meeting.

perioperative-nursing-300x199Older surgical patients are presenting us geriatricians with challenges. How should geriatric medicine fit into the national agenda for perioperative medicine? Which models of care work best in improving outcomes for this complex multimorbid group of patients? Do different surgical subspecialties require different approaches? How should these services differ between the district general and teaching hospital? Should elective and emergency older surgical patients be given equivalent geriatric medicine input? How can we balance the frequent calls to involve geriatricians in the care of older surgical patients against the numerous unfilled consultant posts in ‘traditional’ geriatric medicine that already exist? These issues will be explored in the POPS SIG session at the BGS meeting in Glasgow (Friday 25th November). Continue reading