Framing the narrative of frailty differently will help to promote wellbeing

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field even cited in the Oxford Textbook of Medicine. He has a passionate interest in rights-based approaches which he accrued as part of his postgraduate legal training. He tweets at @dr_shibley.

It’s great that frailty as a ‘brand’ is getting so much publicity, but is it all the right kind of publicity? For example, “Our treatment of the frail elderly is a national scandal”, Sunday Express, 8 March 2011. (cited in Manthorpe and Iliffe, 2015)

But some of the copy has been to generate a “moral panic”, defined as a feeling of fear spread among a large number of people that some evil threatens the well-being of society. Continue reading

We talk a lot about delirium after hip fracture, but what can we do about it?

Dr. Susan Freter is an Associate Professor of Medicine at Dalhousie University, and a staff geriatrician at the Nova Scotia Health Authority in Halifax, Canada.  She has a special interest in delirium prevention and management in orthopaedic patients.  

Geriatricians talk a lot about post-operative delirium.  It is common after surgeries, especially in people with a lot of risk factors (or we could say, especially in the presence of frailty), and even with recovery it makes for a bad experience.  The occurrence of hip fracture, which mostly befalls patients who are older and frail, demonstrates this routinely.  We know that taking extra care with at-risk patients can help to prevent delirium.  Taking extra care can manifest in different forms: educating the caregivers, paying attention to hydration (is the patient actually drinking the cup of water that is plonked down in front of them?), paying attention to constipation (preferably before a week has gone by), making sure hearing aids are in the ears, and using medication doses that are geared for frailty, rather than for strapping 20 year olds. But how can what we talk about be translated into what we do? Does the ‘doing’ actually work in practice? Continue reading

Attitudes and opportunities: Medical students’ and doctors’ attitudes towards older patients

Dr Rajvinder Samra is a Chartered Psychologist working as a Lecturer in Health and Social Care at The Open University. She enjoys researching the influence of attitudes and personality in medical settings and tweets at @RajvinderSamra Read her Age and Ageing Paper.

Social psychologists have been interested in attitudes for about 90 years now. Debate rages on about how much of what we do can be predicted from our attitudes. No doubt, over the past year, you will have read newspaper articles about how much someone’s attitude to a prominent issue covered in the media predicted their likelihood to vote for Brexit or Trump. This is an example of the attitude-behaviour link and the media trying to establish patterns so we can understand society better. The influence of attitudes on healthcare are frequently overlooked, but doctors’ or patients’ cognitive reasoning, preferences, values and emotions (i.e. all the things that come together to make up attitudes) can have a significant and meaningful impact on how services can, or should be, delivered. Continue reading

Heatwave! Acting on the weather forecast to reduce morbidity and mortality in frail older people

Duncan Forsyth has been a consultant in geriatric medicine, at Addenbrooke’s Hospital, for 27 years. A believer in global warming, he noticed that staffing levels in hospital were often inadequate to ensure adequate hydration of his patients during any heat-wave and that admissions due to acute kidney injury were especially prevalent in care home residents and frail older people receiving substantial packages of home care. He advocates incorporating the weather forecast in to the risk stratification for hospitalised patients, care home residents and those receiving three or more home care calls per day; in order to promote a review of potentially nephrotoxic medication

As you look forward to enjoying the (hopefully) warm summer weather, spare a thought for those less fortunate than yourself, who are frail; less able to increase their fluid intake; who are dependent upon others for provision of drinks; and at risk of acute kidney injury due to the potentially nephrotoxic drugs that they are prescribed. A leader article in the BMJ 2009 (Olde Rikkert, et. al) highlighted the dangers of heat waves and dehydration in frail older people and the resultant excess mortality in this population. Continue reading

Time for the BGS to help in Africa?

Richard Walker is a Consultant Geriatrician at North Tyneside General Hospital, and Honorary Professor of Ageing and International Health at Newcastle University. He has a research interest in non-communicable diseases in sub-Saharan Africa (SSA) and is Associate International Director for SSA for the Royal College of Physicians, London. He is the Clinical Lead for the Northumbria / Kilimanjaro Christian Medical Centre health link and Chair of the Movement Disorders Society African Task Force. In this blog article he discusses the growing challenge of ageing in Africa.

The ageing population in Africa is exploding. In Nigeria alone, for example, there are now more than 6 million people aged over 65 years. Despite this, worryingly, services are particularly ill prepared to meet the needs of this group. Compounding this challenge is the fact that there’s a real lack of Geriatrics’ teaching in undergraduate medical curricula in SSA. Furthermore, we found that there’s very few ‘Geriatricians’ in SSA outside South Africa, with most countries having none at all. Continue reading

Walking now prevents dementia later, study finds

A new study published in Age and Ageing, the scientific journal of the British Geriatrics Society, suggests maintaining a higher level of physical activity during middle age may be a key strategy for the prevention of dementia in older age.

Past studies have suggested that physical activity such as walking can be a protective factor against dementia but this study suggests that maintaining a higher level of physical activity before older age is more important for the prevention of dementia than physical activity only in older age. Continue reading

Patients with vertebral fragility fractures treated in hospital – could we do better?

Terence Ong is a Research Fellow funded by the Dunhill Medical Trust at the Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust. He discusses his Age and Ageing Paper Characteristics and outcomes of hospitalised patients with vertebral fragility fractures: a systematic review. He tweets @terenceongkk

Vertebral fragility fractures have received much attention lately due to growing research interest and increased awareness driven by high-profile osteoporosis groups such as the International Osteoporosis Foundation (through its vertebral fracture initiative) and the National Osteoporosis Society.

There is growing literature to support how well vertebral fragility fractures predicts future fractures, morbidity and risk of mortality. However, what has been lacking is research exploring the specific cohort of people with vertebral fractures who are admitted to hospital. Continue reading

Who’s our jolly good Fellow?

The Editorial Board of Age and Ageing is delighted to announce the launch of a Fellowship attached to the Age and Ageing Journal.

This opportunity is intended for trainees who plan a career in geriatric medicine who are interested in medical publishing. The 2-year appointment will run concurrently with the Fellow’s usual clinical post (or during period out of programme for research).

The Fellow will learn about manuscript preparation, peer review, manuscript editing, and journal production.

Roles will include involvement in general Journal business including handling submissions (under the supervision of the Editor or Associate Editor). Continue reading

Designing safer systems of care delivery for older patients

A new study published in Age & Ageing, the scientific journal of the British Geriatrics Society, identified incidents when poor communication between secondary and primary care and failures within primary care led to patient harm and highlights how improved communications systems could help protect older patients from harm. Timely electronic transfer of information with standardised formats could reduce medication and clinical decision-making incidents. Electronic alerts and expanded use of bar-coding are examples of systems which could tackle drug administration incidents.

Older adults are frequent users of primary healthcare services and account for half of all 340 million general practice consultations in the United Kingdom each year.  The study was conducted by researchers at Cardiff University School of Medicine and examined 1,591 patient safety reports relating to patients aged over 65 in England and Wales over an eight year period. Continue reading

Depression among older people living in care homes – a call for good practice examples

Caroline Cooke is Policy Manager at British Geriatrics Society. Caroline is currently supporting a joint project being carried out by BGS and the Old Age Faculty at the Royal College of Psychiatry. Here she explains the aim of the project and how you can help to make it a success. 

In the UK 405,000 older people (65+) currently live in care homes. Older people living in care homes have complex health needs and most residents have multiple long-term conditions, significant disability and frailty which affect both their physical and mental health. Dementia affects the majority of residents in care homes to some degree and depression is common. Integrated provision is required to meet the needs of care home residents who require co-ordinated input from generalists and specialists in multiple disciplines, and partnerships are essential to integration.  Continue reading