A life-course perspective necessary to improve the health of older adults

Dorota Chapko is a PhD candidate in Public Health at the University of Aberdeen in Scotland, and a graduate from the Massachusetts Institute of Technology (MIT) with a double-major in Brain & Cognitive Sciences and in Anthropology. In this blog she discusses her recent Age & Ageing paper on the triad of impairment; she tweets at @dorotachapko

aaAlthough frailty is a central concept in clinical assessment of older people, there is no consensus definition. The concept is certainly multifactorial but physical components dominate. However, it is known that age-associated physical decline is likely to be accompanied by cognitive and emotional deficits. The ‘triad of impairment’ (triad) recognises the co-occurrence of cognitive, emotional and physical deficits in late-life and might be a useful alternative to ‘frailty’.

Identification of pathways to prolong healthy living and decrease the degree of frailty in old age will have benefits for individuals and society. Continue reading

Oral health; the gateway to hydration, nutrition, and medication

nunYasmin Allen @missdiplom and Nikki Patel @NikkiPatel_

Yasmin is currently working as a clinical fellow in leadership and management in the HEE, her work includes promoting collaboration between health care professionals and the dental team, unscheduled dental care and improving oral health for older people in community and hospital settings. Yasmin also works clinically in the out of hours emergency dental care service on weekends.

Nikki is a community dental officer who looks after the oral health of dependant elderly or medically compromised individuals. She is currently pursuing her Fellowship in Clinical Leadership at Health Education England in London, where she is involved with projects and strategies to overall improve the oral health of the population and develop new and improved ways of working.


Toothbrush_20050716_004Cast your mind back to when you opened your eyes this morning. Then think of how your mouth felt at that time; I bet it was dry, uncomfortable, had a horrible taste and you most likely felt some plaque roughening the surfaces of your teeth. Now think about how your mouth would feel if you hadn’t brushed your teeth after waking up. Or you didn’t brush them for a week after, or even a few weeks after. Your mouth and teeth will now almost certainly feel dirty, odorous, uncomfortable and in turn it may affect your confidence and well being. This is what happens to dependant elderly people far too regularly than we would like to admit. These are the people whose personal care, including their hair care, foot care, nails care and continence care is being delivered as part of their overall support. Yet there is often one part of personal care which is frequently overlooked- the mouth.

The mouth is the gateway to hydration, nutrition, and medication. The maintenance of which is critical to ensure the good health and well being of any individual. If you have an ulcer on the inside of your cheek how do you think this will this affect how likely and how much you are to want to eat? If you have loose teeth how do you think this will this affect your chewing? How is your health going to improve if your Adcal tablet foams instead of dissolves due to the dry nature of your mouth? What if your tablets get stuck underneath your denture and nobody realises, as it hasn’t been taken out to clean? These are all real life examples of what is happening in hospitals and care facilities in the UK today.

Our health and social care professionals deliver a fantastic service across all aspects of healthcare whilst contending with time constraints and workforce capacity issues. However, all too often mouth care is one of those responsibilities that falls off the long and never ending task list.

The consequences of not delivering this simple duty are drastic. Not only does poor mouth care lead to dental problems such as dental decay and gum disease, but studies have shown it is associated with aspiration pneumonia and heart disease. Not being adequately hydrated or not receiving a balanced nutritional intake can result in medications not being absorbed properly, which can in turn affect your recovery and consequently the length of your hospital stay.

When we are older, it may be the case that we or somebody close to us, may spend some time in a health and social care facility and there may be a time when we need to rely on others for our personal care. Would it not be preferable that our stay did not result in the deteriorating condition of our mouths and teeth? That oral cancer was not spotted as health care professionals did not look in your mouth? That you refused to see family and friends because your dentures had been lost during your stay?

Health Education England is working with teams in hospital and community settings to improve knowledge and awareness amongst health and social care staff of good mouth care. Equipping them with the advice and tools to enable them to deliver mouth care and providing resources and support can help avoid some of the issues that can occur if mouth care is not delivered. We have been working to raise awareness in all sectors about how and why mouth care is essential, in addition to how mouth care affects patient safety, length of hospital stay, deterioration in care settings, well being, hydration and nutrition, medicines management and overall health.

Many healthcare professionals are aware of the importance but are not aware of the potential impact that poor mouth care can have. I urge you all to ensure that those people who are relying on others for their personal care get adequate maintenance of their mouths by ensuring good hydration, nutrition and mouth care. If you would like to find out more about the importance of good mouth care and what you can do to help please follow this link http://www.iohopi.co.uk/

‘A welcome with tea and cake’: Making the most of your care home GP

Aileen Jackson is a senior project manager for the dementia and diabetes programmes at the Health Innovation Network (HIN), the Academic Health Science Network for South London @hinsouthlondon

AJ BLOG PICThe Health Innovation Network (HIN) for South London like the BGS has an active programme to work with care homes to learn about, share and spread and adopt good practice in South London. During our last biannual care home forum we held a quick fire Q&A session led by two South London GPs Dr Nwakuru Nwaogwugwu and Dr Charles Gostling asking the question ’How do you get the best out of your care home GP?’ Everyone agreed that a good common denominator was to ensure that the GP was welcomed with tea and cake hopefully prepared and baked by the care home residents.  The forum then set to work on developing the basis for really useful HIN guide for care and nursing homes to get the most out of their GP. It was acknowledged by all that sometimes the GP care home relationship can be quite fractured due to genuine pressures on both GPs and the care home sector and the lively and interactive discussion provided a platform to discuss problems for GPs and care homes such as time constraints, a lack of confidence, training issues, external pressures and staff retention. Continue reading

Collaborative Care and Support Planning: is it relevant to care for older people?

houseofcareDavid Paynton is RCGP National Clinical Commissioning Lead and can be contacted on david.paynton@nhs.net

A revolution is starting to sweep through clinical practice. Clinicians, exhausted as they are in dealing with a seemingly endless tide of demand, are testing out new ways of working: trying to move upstream, developing proactive care plans with the person with long term conditions and their carer and changing the conversation from “how can I help” to “what is important to you”.

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No Les, No Moore

5801631762_dd88709954_oPaula Shepherd is a University Practice Learning Adviser for Bournemouth University; supporting pre-registration health education in practice. @pshepherdBU

‘Here lies Lester Moore, 4 slugs, from A44, No Les, No Moore’

At the age of 14, I received the ‘A Small Book of Grave Humour’ in my Christmas stocking. It contains tombstone inscriptions which reflect characteristics of the person memorialised or, should I say, the person selecting the stone. An odd selection for a child, but even at that formative age I realised that we all live on in some form, what we do influences the way the world works; has an impact. So why, I wonder, do we seem so reluctant to incorporate life and death as unified progression? Continue reading

Forgotten wisdom: what happens when we die?

8376547873_822be9a7e4_oDr Kathryn Mannix is a Palliative Care consultant based at the Royal Victoria Hospital in Newcastle, who began the UK’s first dedicated palliative care CBT clinic.

‘We’re all going to die!’

No, not a scary action movie, but life. We have been dying for millennia and notwithstanding medical advances, the death rate remains 100%. And yet, despite so many opportunities to study the phenomena around dying, most doctors are unable to describe the process that takes people out of the world.

What a contrast with the processes of pregnancy and birth, to which magazines, shops and websites are dedicated; lessons are delivered in schools; couples are invited for ‘birth practice’ sessions as the due date approaches… Perhaps not all of these analogies are directly transferable to the process of dying, especially as 50% of candidates will expire suddenly, but dying is a recognisable process and modern medicine has largely forgotten it in the rush to postpone it.

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Why rehabilitation must be part of acute care

Kenneth Rockwood is Professor of Medicine (Geriatric Medicine & Neurology) and consultant geriatrician at Capital Health in Halifax, Nova Scotia, Canada and Honorary Professor of Geriatric Medicine at the University of Manchester.

Many older people leave hospital frailer than when they started. Some of that is preventable, but much of the damage done by acute illness is baked in to how frailty works. Some of it is reparable. That is why rehabilitation must be part of acute care: if we cannot prevent damage, we should at least treat it, especially damage that we inflicted unnecessarily.

The gist of it is easy enough. When frail patients are unwell enough to come to hospital, they typically are not thinking, functioning and moving like they were before they became ill.  That is usually why they come. That, and whatever other symptoms (breathlessness, pain, something red or swollen) signal a problem.  Even when fixing the precipitants, modern care often does nothing to address the worse thinking / mobility / function in which the problems were packaged.  Such complexity of need defines frailty.

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An Artist’s exploration into Frailty in older people

Katy Shorttle is a GP trainee in Cambridge and part time artist. She tweets @ArtistKaty. Here she tells us about her art project on frailty, using teacups to conceptualise case studies of older people with frailty.


teacupsMy frailty awareness art project comprises a set of 15 individual sculptures, each with accompanying case studies, with the primary aim of raising the awareness of the experiences of frailty in older people. I have been able to combine my GP training with the completion of a Masters in Illustration, and completed the project, my final MA Illustration project, after spending a year working as a GP trainee in the Department of Medicine for the Elderly in Addenbrooke’s Hospital, Cambridge. During this time and my previous posts in primary and secondary care I have observed how changes in the structure of families and communities can mean intergenerational relations are less common, or less well preserved, and the plight of a frail older person can go unseen. The factors contributing to frailty in older people, such as reduced mobility, shortness of breath, frequent falls and frequent hospital admissions have a huge impact on individuals, yet the resulting suffering often goes unspoken, or unrecognised outside the medical domain.

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A radical rethink of care: report from the Parliamentary Committee on Health

5674934647_17ed82f7a7_oDr Jackie Morris is currently Dignity Champion for the British Geriatrics Society, and a Trustee of the British Institute of Human Rights.

On 23 February, I attended a meeting of the Parliamentary Committee for Health on behalf of the BGS; this particular meeting focused on the challenge of delivering high quality, integrated and compassionate care for older people.

During, the meeting (chaired by Baroness Masham of Ilton), we heard from a varied panel of speakers including Lord Warner, Professor Martin Green, Roy James (President of the Association of Adult Social Services), Caroline Abrahams (Charity Director of Age UK), and Helen Birtwhistle (Director of External Affairs at the NHS Confederation).

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Better medicine reviews in care homes – a no brainer?

fotolia-8532456-m(7)Wasim Baqir is a Research & Development Pharmacist at Northumbria Healthcare NHS Foundation Trust.

There are currently 405,000 care home residents in the UK aged over 65 taking an average of seven medicines, with some taking double or treble this amount. Research shows at any one time 70% of them have an error with their medication which can occur during prescribing, dispensing or administration. That’s a lot of errors.

I’m a clinical pharmacist working in Northumbria and although these figures are quite well known, they are still pretty shocking.

Medicines use in care homes is problematic: over-prescribing, lack of structured review and little or no resident involvement in decisions are common themes. Despite the evidence (think CHUMS report) and guidance (think NICE guidelines) medicines use in care homes remains generally poor. That’s why I’m backing a new campaign from the Royal Pharmaceutical Society to improve the situation.

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