Neuraminidase inhibitor use in the elderly: where are we?

BGS Logo CMYKDr Tristan Clark is associate professor in infectious diseases at the University of Southampton. Here he gives an update on neuroaminidase inhibitor use in older people, and invites readers to participate in a new survey of practice.

Influenza causes excess hospitalisations and 10,000 excess deaths every year in the UK and most of this burden falls on the elderly. Although the rate of hospitalisation in adults with influenza is 5-20 per 100,000 it is 1200 per 100,000 in those over 85 years old. Once hospitalised with influenza, 10-30% of adults are admitted to critical care units and 3-15% will die. Influenza vaccine uptake remains sub-optimal in the over 65s with only 70% accepting vaccination. Furthermore, whilst influenza vaccination is highly effective in healthy younger adults, protection decrease with age and high quality evidence for significant protection in the elderly is lacking.

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Senior Adventures in motion pictures: personal reflections on Geriatric Medicine and film

3306290895_7bdeeb5802_oKhalid Ali is a senior lecturer in Geriatrics, Brighton and Sussex Medical School, and Ageing Research Lead for the Kent, Surrey and Sussex Comprehensive Research Network

Back in the 70’s where I grew up in Khartoum, Sudan, the highlight of my week was Thursday movie-night, when my father took the family to watch Peter Seller’s “The party” or John Travolta’s Saturday Night Fever. In addition to pure sensory entertainment, I became aware of world politics; the Watergate Scandal in All The President’s Men, the Vietnam War in Coming Home, Apocalypse Now, and The Deer Hunter. Coming to the UK to pursue my postgraduate studies in medicine in 1999, I was lucky to be reminded of the magic and power of film to inspire, amaze and educate through world cinema on offer at the London Film Festival (LFF).

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Reusable Learning Objects in Dementia Care

UntitledSarah Goldberg is Associate Professor in older persons care at the University of Nottingham. Her research interests are the acute hospital care of cognitively impaired older patients, particularly those with dementia.

There is a need for more training in dementia care in the acute hospital but, with the pressure on hospital budgets, very little time or resources to deliver such training. Many dementia training materials have been developed in the community, but the needs of people with dementia in the acute hospital are very different to those in the community.

The hospital is a very busy, noisy, crowded environment where multiple healthcare professionals may be questioning the patient; there is little time for staff to get to know the patient, and for the patient to get to know and feel comfortable with staff.  On top of this, memory problems mean that much medical history is forgotten by the patient with dementia and cognitive problems can result in the patient misinterpreting staff behaviours and becoming agitated or distressed.

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‘A destructive vicious circle’: what does the future hold for health and social care?

age-ukJill Mortimer is Age UK’s Health and Care Policy Adviser and tweets at @Age_UK.

What’s really happening in health and social care services? Over the last few years, we used in Age UK’s Care in Crisis campaign to document the devastating budget cuts that meant fewer and fewer people were getting public support for help with their day to day activities.

But what about the NHS? Hasn’t it been protected through the last five years of cuts in public services? If so, what lay behind last year’s winter crisis? And why is Monitor, the health services financial regulator, now talking about the ‘worst financial crisis in a generation’?

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Person-centred care: fantasy, fad, or far-reaching in its potential?

4528269141_80d1594ac3_oJacquie White is Deputy Director for Long Term Conditions, Older People and End of Life at NHS England, and tweets at @jaqwhite1. In this blog, she discusses person-centred care and NHS England’s new “Our Declaration” campaign.

Person-centred care seems to be the latest thing the NHS has suddenly started to get excited about, but is it of value, will it last, or is it just another fad?

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Substance misuse in older people

aaIn this blog, Professor Ilana Crome offers an introduction to the Royal College of Psychiatrists’ new information guide on substance misuse in older people; an editorial about the guide  by Prof. Crome appears in the July issue of Age and Ageing.

In 2015 the Royal College of Psychiatrists produced an Information Guide on the management of older substance misusers. This is in recognition of the rising numbers of older people in our communities and the increase in their use of substances. Older people appear as motivated to reduce or abstain – if not more so – than their younger counterparts. The health care system is unprepared for this problem partly because it is an invisible epidemic.

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“Is your family worried about your forgetfulness?” Contrasting perceptions in the context of a dementia diagnosis

aaRachel Buckley is an Alzheimer’s Australia Postdoctoral Fellow, in the Melbourne School of Psychological Sciences at the University of Melbourne. Her study on mild cognitive impairment is published in the current issue of Age & Ageing. She tweets at @bucklr01

It is very common and quite normal to forget where you left your glasses. Although this might happen to you with relative and increasing frequency, concerns of this nature do not necessarily signal the starting point of a dementia. It is no secret that when it comes to your perceptions of yourself, an outsider’s perspective – particularly from someone who knows you well -can be very informative. When considering your concerns of your own forgetfulness, this is particularly the case.

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National Audit of Intermediate Care 2015

NAIC-LOGO2015Dr. Duncan R Forsyth is a Consultant Geriatrician at Cambridge University Hospitals Foundation Trust. Here he tells us about the report of the fourth National Audit of Intermediate Care (NAIC) which was released 11 November 2015.

The NAIC provides a unique assessment of progress in community services aimed at maximising independence and reducing use of hospitals and care homes. Three hundred and forty services contributed to the audit with over 12,000 responses from the service user audit and Patient Reported Experience Measure (PREM). Four service categories are examined: crisis response, home based intermediate care, bed based intermediate care and reablement services.

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Care home residents deserve the best care. The best care is integrated.

thirdSectorDr Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham.  He works as a community geriatrician and conducts research into models of care delivery in care homes. From 2013 to 2015, he was Honorary Secretary of the British Geriatrics Society.

Care home residents have complex care needs. Between 75 and 80% of residents have memory problems, 57% are affected by urinary incontinence, 42% have faecal incontinence and some 61% require assistance with mobility. The average number of medications per resident is 8 and the average number of medical diagnoses is 6.

Much of the health and social care provided in care homes is excellent, but it is not surprising that things break down from time to time given the complexity of the care problems seen. When things do break down, it is often the failing of multiple parts of the system at the same time. Recent scandals around hydration in care homes have seen residents cut down on their fluid intake because they were worried about accessing enough of the right continence supplies, whilst both health and social care staff failed to recognise the problem until the resident’s health had deteriorated to a critical state.

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Emotionally shattering & frustratingly unsettling: “The Father” reviewed

The Father  - Claire Skinner, Kenneth Cranham - Photo credit Simon AnnandShane O’Hanlon is a consultant geriatrician in Reading, and Honorary Deputy Secretary & Digital Media Editor at the British Geriatrics Society. Here he reviews “The Father”, currently playing at the Wyndham Theatre in the West End.

Deliriogenic. Emotionally shattering. Frustratingly unsettling. These are some of the ways to describe French playwright Florian Zeller’s uncomfortable study of dementia, “The Father”.

For Andre (Kenneth Cranham), life has begun to lose its rhyme and reason. We enter at an uncomfortable moment, where his family are trying to explain why he needs a carer. He certainly seems to lack insight, but our impression of what he was like before his illness is never clear – an all too real feature of dementia where we never get to know the person behind the disease.

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