Why are we still not involving geriatricians in caring for our older cancer patients?

Dr. Fatou Farima Bagayogo is as a post-doctoral fellow who is currently interested in the organizational and professional factors that influence cancer care. This Fall, she is joining York University’s School of Health Policy and Management as an Assistant Professor in health management and global health. Some of her work is listed here. In her recent co-authored paper, she discusses creation in a hospital of a geriatric oncology clinic whose mandate is to facilitate the inclusion of geriatrics-based expertise in the care of older cancer patients.

aaSixty percent of new cancers are diagnosed in patients older than 65 years of age. Given the vulnerabilities of older cancer patients, cancer specialists increasingly need the inclusion of some geriatric competence in managing these patients. Geriatricians can help them with a better assessment of a patient’s condition and a more adapted handling of these patients’ vulnerabilities. Considering the ageing of the population and the fact that cancer care will have to be increasingly adapted to the age group that will make the bulk of cancer patients, we studied whether or not this adaptation is taking place and the associated reasons. We tried to identify and explain the patterns of referrals from cancer specialists to a clinic staffed by geriatricians who are interested in being involved with older cancer patient care. Continue reading

Translating Isaacs

Professor Kenneth Rockwood has published more than 300 peer-reviewed scientific publications and seven books, including the seventh edition of the Brocklehurst’s Textbook of Geriatric Medicine & Gerontology. He is the Kathryn Allen Weldon Professor of Alzheimer research at Dalhousie University, and a staff internist and geriatrician at the Capital District Health Authority in Halifax in Canada. 

chinaIn May 2016 I was honoured to speak about frailty at the Chinese National Geriatrics Conference in Beijing. The audience, not just geriatricians, was people who care for frail older adults. They recognized in geriatric medicine the tools and concepts needed to improve the care of those patients.

For that reason I found myself discussing how best to translate the great Bernard Isaacs’ nicely alliterative phrase “Geriatric Giants. In The Challenge of Geriatric Medicine (Oxford: OUP, 1980) Isaacs elaborates them, also alliteratively, as “instability, immobility, incontinence, intellectual impairment/memory and impaired independence”. These were key ways in which patients and their families understood that “something was wrong”. Continue reading

Kate Granger 1981-2016

Hello my name is Ali Cracknell. I have never written a blog before, but if there is one person who would say to me, “just to do it Ali, try new things”, it would be my friend and colleague Kate.

Kate Granger

Kate Granger receiving the BGS President’s Medal, accompanied by husband Chris Pointon

Kate Granger sadly died on Saturday 23rd July 2016 from a rare sarcoma.

I first met Kate, when she was an FY2 and I was a fresh faced elderly care registrar at Leeds General Infirmary. I remember in those days her values were strong, she provided first class care at every encounter, communication was a real strength and she loved to teach all members of the team. We shared a passion for patient safety and improvement. This was the old style “firm”, where I’m sure she started to steer her career towards geriatrics. We were guided by our wise and experienced consultant Peter Belfield, who became a friend to us both too. Kate and I learnt a lot together during that “firm”, gaining confidence in testing out new improvement methods and ideas, and a friendship based around our professional values developed. Continue reading

Challenging the depiction of delirium in the media

The media’s portrayal of vulnerable elder people as ‘perpetrators of assaults’ shows us just how far we still have to go.

Dr James Woods is a registrar in Geriatric and General (Internal) Medicine in South East Scotland. He tweets at @jmwoods87

Earlier this week BBC Radio 5 Live ran a piece with corresponding BBC website article reporting on figures obtained from an NHS Protect report on physical assaults against NHS staff in England. The headline and corresponding analysis focused on patients over 75 years old as the most frequent ‘perpetrators of assaults’ against NHS staff. If you care about the healthcare needs of older people and want to see them treated with dignity and respect (which if you are reading this blog you probably do) then this makes for distressing reading. Continue reading

Blue lights and sirens; A Paramedic’s perspective of caring for older people

Duncan Robertson is a Consultant Paramedic with the North West Ambulance Service. He has an interest in falls and frailty and a research interest in the lived experience of frailty in the 999 population. He tweets @NWAMB_Duncan

DuncanIf, like me, you spent your formative years watching Saturday night television on the BBC, you may have a particular view of the ambulance service.  Through popular dramas and fly on the wall documentaries more people than ever have an insight into the work of the Paramedic.  We deal in saving lives; we come to you when you have had a road traffic collision, a stroke or a heart attack, we perform heroic resuscitation, we treat stabbings, shootings, assaults and intoxicated revellers on weekend nights.  We use blue lights and sirens, arrive by ambulance, response car, motorcycle, bicycle or helicopter and we must see some sights…or so we are told! Continue reading

It’s Time to Reframe How We Care for Older Adults Facing Surgery

Dr. Ko is Director of the American College of Surgeons Division of Research and Optimal Patient Care and ACS NSQIP, and Principal Investigator of the Coalition for Quality in Geriatrics Surgery (CQGS) Project, based in Chicago, Illinois. He is a practicing surgeon, who serves as professor of surgery and health services at the UCLA Schools of Medicine and Public Health and holds the Robert and Kelly Day Chair in Surgical Outcomes.

Dr. Rosenthal is Chair of the Geriatric Surgery Task Force, Co-Principal Investigator, CQGS Project. She is professor of surgery at Yale University, and chief of surgery at the VA Connecticut Healthcare System. Specializing in geriatric surgery, Dr. Rosenthal is dedicated to helping older patients who have a variety of gastrointestinal and biliary diseases.

geriatricguidelinescover finalThe United States population is dramatically aging. The baby boom generation has reached 65. In fact, there are at least 10,000 people turning 65 every day. The U.S. Census Bureau projects the percentage of men and women 65 years and older will more than double between 2010 and 2050.

Now, more than ever, we see a demographic imperative to pay attention to the rapidly growing number of older adults.  Despite the fact that patients 65 and older make up only 13 percent of the U.S. population, they account for more than one-third of the operations we perform in the U.S. each year. Continue reading

Get healthcare providers to improve care together, that’s the challenge

Noor Heim is an assistant professor who currently works for the University Medical Center in Utrecht. In this blog, she discusses her recent Age & Ageing paper on research she has done in the Leiden University Medical Center.

aaIntegration of treatment and care from multiple disciplines is particularly critical in care for older people. Most older people admitted to a hospital suffer from more than just one (chronic) condition. As a consequence, coherent care for older patients involves more than just one discipline. Furthermore, the fact that patients are discharged from hospital quicker and sicker, with higher demands of care, increases the need for integration of (transitional) care between settings. Given the number of older adults who permanently lose the ability to perform one or more activities of daily living during and after a hospital admission, one has to conclude things need to be improved. However, it has proven challenging to accomplish improvements and maybe even harder to study (and to quantify) the benefits of the efforts taken. Continue reading

Committee Volunteers Wanted; Finance, Fundraising and Corporate Affairs

11528630884_18cfe92f26The BGS is seeking to appoint a number of new committee members to progress our work in the area of Finance, Fund Raising and Corporate Affairs. These are voluntary, unpaid roles, though travel costs and other expenses will be covered. The posts are open both to new candidates and to those who are already serving on BGS committees. The anticipated time commitment is one half day per month, but this may vary according to the demands of the role. Administrative support will be provided by the BGS secretariat. The term of office is three years. Continue reading

The British Geriatrics Society backs the CQC’s Call for Integrated Patient Centred Care

200x200-building-bridgesThe British Geriatrics Society welcomes the Care Quality Commission’s (CQC) Report ‘Building Bridges, Breaking Barriers’, which addresses how health and social care services work together to provide integrated care for older people. In response to the report Dr Eileen Burns, President-Elect of The British Geriatrics Society and Clinical Lead for Integration in Leeds, commented:

“The CQC’s report ‘Building Bridges, Breaking Barriers’ accurately shows that although there is widespread commitment among health and social care professionals to providing integrated care for older people, there is still a long way to go. Findings from the report indicate that barriers include a lack of common understanding about how to deliver integrated care, a lack of consistency and mainstream implementation, as well as services struggling to identify older people who are at risk of deterioration or unplanned hospital visits. This report correctly identifies the opportunity that the 5 Year Forward View Vanguards and Sustainability and Transformation Plans offer to plan for and embed a shared vision of the delivery of integrated care. Continue reading

Measuring up with ICHOM Part 2

Asan Akpan is a community geriatrician in Merseyside and research fellow for the Older Persons Working Group at the International Consortium for Health Outcomes Measurement (ICHOM).  In this follow up blog, he summarises ICHOM’s work on developing the first set of international health outcomes for older people. These outcomes included participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death.

ICHOMThe goal of the Older Person Working Group was to define a minimum set of outcomes for evaluating healthcare for older people. The group aimed to present a balanced and comprehensive review of measurement within a recommendation that was feasible to implement in routine clinical practice. An additional goal was to facilitate the creation of data that can be meaningfully compared for analysis, benchmarking and shared learning. Continue reading