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

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

How to … be a jolly good fellow

Elinor Burn is a Department of Medicine for the Elderly (DME) and Quality Improvement (QI) fellow at the University Hospitals of Derby and Burton NHS Foundation Trust, in this blog article reflects on her year in post.

Taking a step off the conveyer belt of medical training can be a daunting move for trainees, who have become accustomed to the continued encouragement for career progression. It’s a choice that is not actively encouraged, but does allow(s) space to refocus through dedicated time doing a different kind of work.

After crawling to the end of my core medical training feeling exhausted, I took on this year as a chance to change gear, step back and remember why I enjoy and chose to do medicine. By filling this fellowship post I accepted the challenge of taking forward a service design programme. This has been in the form of a surgical liaison service, a project still in its infancy. It was a steep learning curve – service development is something that I’ve never actually been taught to do. Continue reading

Forging international links, sharing ideas and developing friendships to build research collaborations

Dr Jenni Burton (@JenniKBurton) from the University of Edinburgh and Dr Patrick Wachholz (@Patrick23711608) from Sao Paulo State University joined 12 researchers from across the UK and 17 from across Brazil to participate in a Newton Fund researcher links workshop: ‘Identifying and addressing shared challenges in conducting health and social care research for older people’, held between the 11th-15th of June in Botucatu, Brazil. The workshop was funded by the British Council and the Sao Paulo State Research Foundation (FAPESP) and organised by the University of Nottingham and UNESP.

Over the course of five days we worked together under the supervision of our Brazilian and UK mentors (Prof Alessandro Ferrari Jacinto, Prof Paulo Villas Boas, Prof Vanessa Citero, Dr Adam Gordon, Prof Tom Dening & Dr Jay Banerjee) to share ideas, learn from each other and work on developing new collaborative research projects.

To set the scene, Brazil is the largest country in South America with an estimated population of 16 million adults aged 65 and over. Sao Paulo State has a population of 41 million people and is the most economically and research active state in Brazil with 34% of the GDP. Amazing stat of the week was that for every four research papers published in Latin America, two will be authored in Sao Paulo State! Continue reading