Autumn Speakers Series: “Interface medicine”

Eva Kalmus has been working as Interface Medicine GP at Epsom and St Helier NHS Trust since February 2015 and previously looked after inpatient beds at New Epsom and Ewell Community Hospital. She was also a community ward GP in Wandsworth and virtual ward lead in Epsom. Currently her work is focussed on discharging patients for whom the acute hospital no longer offers net benefit as quickly and efficiently as possible and improving communication, aiming for primary, community and social services to pick up where secondary care stops. She will be speaking at the upcoming BGS Autumn Meeting in London.

“Interface medicine” has a number of definitions in different contexts—it seemed an appropriate title to describe primary care-trained doctors working in community or hospital settings whose aim is to maximise quality of life for older frail patients using skills and knowledge from both general practice and geriatric medicine.

On one side are Interface Medicine GPs now titled GeriGPs within BGS; on the other are Community Geriatricians but there is significant overlap in what we do. Working together we can best support our patients—and it is a very satisfying extension to our core business. Continue reading

Reflections of an Editor

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. He will be retiring as Editor in Chief of Age and Ageing at the end of 2018 and expressions of interest are invited from qualified candidates to succeed him in January 2019 after a period of handover. 

I am now coming toward the end of my 5 year tenure as Editor-in-Chief of Age and Ageing, having taken over this role from Roger Francis in February 2014.

Roger left the journal in terrific shape and so I was initially quite anxious about whether I would be able to ‘fill his boots’. However very quickly I realised that I was embedded in a fantastic team who are hugely supportive and great fun to work with. Continue reading

Tribalism Kills; The Journey Towards Genuine Integration

David Attwood is a GP with a Specialist Interest in Older People. He is a Committee Member of BGS’s GeriGP Group. He tweets @DavidAttwood12

“You have twenty-one children?!” I asked incredulously. The Fanta that was halfway to my mouth almost left my hand to land on my khaki coloured trousers.

“Yes, twenty-one.” William replied, between mouthfuls of Nile perch. After a pause to finish chewing he casually added, “and four wives.”

The Fanta fell out of my mouth to land on my trousers.

“Do they all get on well?”

He screwed his face and smiled mischievously “No! They are constantly arguing!!”

I had to laugh. Continue reading

Cardiovascular risk factors and frailty in a cross-sectional study of older people: implications for prevention

Professor Robert Clarke, Professor of Epidemiology and Public Health Medicine, University of Oxford and Angel Wong, MSc student in Global Health Science, examined the relevance of cardiovascular disease (CVD) risk factors for frailty in a recent report in Age and Ageing.  

This report adds to the growing body of evidence linking CVD risk factors with an increased risk of frailty.

A frailty index questionnaire (40-items) was used to screen for frailty. CVD risk factors were combined using three composite risk scores: European Cardiovascular Disease Risk Score (SCORE), American Heart Association Ideal Cardiovascular Health (ICH) and Cardiovascular Health Metrics (CHM). Continue reading

The link between pain and frailty revealed: it’s time to move towards more effective pain management in older people

Dr. Marcos Saraiva is a geriatrician from the Division of Geriatrics of University of São Paulo Medical School, Brazil. He and his co-authors recently published the paper Persistent pain is a risk factor for frailty: a systematic review and meta-analysis from prospective longitudinal studies in Age and Ageing journal.

Pain is a very common condition in older people, ranging from 40% in community-dwelling older adults to 80% in institutionalised individuals. It is known that pain, especially persistent pain (defined as a painful experience that continues for a prolonged period of time that may or may not be associated with a recognisable disease process), is associated with depression, social isolation, anxiety, insomnia, falls, higher health costs, weight loss, greater vulnerability to stressors and functional loss in older people. Continue reading

Managing Frailty and Delayed Transfers of Care in the Acute Setting: A call to get involved!

Debbie Hibbert  leads on the NHS Benchmarking Network’s community sector benchmarking projects, manages the Delayed Transfers of Care / Older People’s benchmarking projects, is the Project Manager for the National Audit of Intermediate Care (NAIC), and the National Audit of Care at the End of Life (NACEL). She tweets @Debbie_NHSBN 

In this blog, the Managing Frailty and Delayed Transfers of Care in the Acute Setting project is described. Clinicians are encouraged to get involved with this project, the outputs of which include a bespoke report for participants and access to an online benchmarking toolkit. To receive your log in details or for further information, please contact josh.davies@nhs.net.

Driving quality improvements in the care of older people remains a key issue for the NHS as the population of the UK ages. The NHS Benchmarking Network is back with another project following on from previous work on the care of older people, and delayed transfers of care.  The new project continues the Network’s six-year partnership with the BGS and will help our members to gather much needed data to inform service change and future strategic decisions. Continue reading

Department of Facebook Cats

Frazer Anderson is a Consultant Community Geriatrician in East Hampshire. He is Honorary Secretary of the BGS.

Now that the vote on the name of our Society has been concluded – and regardless of the result this was the most successful exercise in participatory democracy the Society has ever carried out – I would like to suggest another way of looking at the issue.

In John Gladman’s excellent Marjory Warren Lecture at the Spring Meeting in Nottingham, he presented some challenging statistics on what older people actually want and – more importantly – don’t want. In a nutshell, older people don’t want to be old if it involves disability, dependence and suffering. Continue reading

10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80

Dan Thomas is an ST6 working in Liverpool. He is the BGS Clinical Quality Group Trainee Rep and the Deputy Media Editor. He tweets @dan26wales

10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80’

I have lost count of the number of times I have quoted this fact, I use it when teaching on frailty, and I have used it when assessing people in the emergency department to explain the risks of hospital induced deconditioning. I regularly hear other Geriatricians use this fact. It is emblazoned across much of the #EndPJParalysis material, and is quoted (unreferenced) on the NHS improvement website. Continue reading

Improving Continence Care for Older People

Vikky Morris is Chair of the BGS Bladder and bowels Special Interest Group. She will be speaking at the upcoming event Improving Continence Care in Older People on 21 September in Manchester.

1 in 3 women and 1 in 7 men over the age of 65 experience urinary incontinence. It is a significant problem associated with falls, fractures, social isolation, depression, urinary tract infections and moisture lesions. Faecal incontinence affects up to 10% of the population, although its prevalence is much higher in older people, nursing home residents (up to 60%), patients with cognitive impairment and neurological conditions. Numbers are also likely to be an underestimate due to the stigma attached to incontinence. Both urinary and faecal incontinence are associated with great expense, both personal and to the NHS (more than 2% of the NHS budget). In addition, in older people, incontinence is second only to dementia as a reason for admission to a residential or nursing home. Continue reading

Yoga-based exercise can improve well-being for older people

This blog was first published on the National Institute for Health Research (NIHR) Dissemination Centre Discover Portal. Read the corresponding Age and Ageing paper Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials.

Yoga-based exercise offers a safe and accessible way to improve health-related quality of life and mental well-being for people over 60. Evidence for a moderate benefit of yoga in later life now extends beyond improved balance and flexibility.

Yoga includes stretches, poses, breathing routines and meditation. This review focused on the physical exercise/activity components. Most of the 12 included trials took place in Western countries and classes were all run by qualified yoga instructors as in the UK. Class attendance was high for eight weeks or more (50 to 96%). However, women outnumbered men by three to one, implying that yoga classes may need adapting to appeal to older men.

Yoga classes are widely available and could offer an accessible way to improve older people’s activity levels and well-being. The research was moderate to high quality, but it cannot yet show exactly how much yoga or which kind works best for particular groups of people. However, the good news is that these approaches seem effective.

Continue reading