Dr Niamh Ni Nidh is a graduate of Manchester Medical School and ST7 Trainee in Geriatric Medicine in the North West.
A City United, the place where the atom was first split, home of Emily Pankhurst, Coronation Street, Alan Turing and computer science, The Hacienda, The Smiths, Oasis, Take That . . . . and the 2018 BGS Trainees Weekend!
The BGS National Trainees Weekend is organised by trainees for trainees. Back in February this year, myself and 6 other local trainees got together to take on the mantel of organising the 2018 meeting. After some fallow years the now annual event was revived here in Manchester back in 2009 and we are proud to bring it back to its spiritual home once again! Continue reading →
In 2013 Professor David Oliver wrote a blog, the Geriatrics “Profanisaurus”, a list of words and phrases that should be banned, he encouraged other ‘BGS-ers to join in the fun and add their own “unutterables”.
My contribution to this list is some frequently encountered diagnoses that should be approached with scepticism.
‘Bilateral cellulitis’: If both legs are infected then the person should be unwell. Usually red legs are caused by a combination of underlying pathology; acute lipodermatosclerosis, venous hypertension, venous stasis dermatitis, lymphoedema or panniculits. The legs are hot and swollen but in the context of someone who is afebrile with minimal inflammatory response. The reason they are not responding to antibiotics is because they do not have an infection. Continue reading →
Jenni Burton is a Clinical Research Fellow in Geriatric Medicine funded by the Alzheimer Scotland Dementia Research Centre and the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh. Here she discusses the results of two linked systematic reviews of predictors of care home admission from hospital. She tweets @JenniKBurton.
Care home admission from hospital has long been recognised as an area of significant variation in practice (Oliver D et al. 2014. Making our health and care systems fit for an ageing population) and one which remains a strategic target to reduce across the UK. However, more than half of care home admissions each year in Scotland come directly from hospital settings. It is therefore important to explore the predictors of this life-changing transition to help inform prognostication, communication with individuals and their families, service planning and the extent to which we can intervene to prevent or modify this outcome. Continue reading →
World AIDS Day is dedicated to fighting stigma and discrimination, and raising awareness of the HIV/AIDS pandemic. We mark this day by, in turn, raising awareness of older people with HIV.
Incidence and prevalence of HIV in older people is increasing. In the UK one in five adults with HIV is aged over 50. This is a consequence both of the expansion in uptake of HIV testing and diagnosis and major improvements in treatments which are helping people with HIV to live longer.
The fact that older people with HIV are living longer where there is access to treatment is a cause for celebration but it also brings challenges for geriatric medicine. Older people with HIV commonly experience co-morbidities such as cardiovascular disease, osteoporosis and dementia. Medical management of HIV in older people requires considerations of complex drug interactions and co-morbidities.
Early diagnosis of HIV is key to improving prognosis. Treatment with highly active anti-retroviral therapy (HAART) significantly prolongs life expectancy, however it is associated with an increased risk of side effects in older patients. Continue reading →
John’s Campaign advocates for the removal of all restrictions on family carers supporting their relatives in hospital and a positive attitude of welcome and collaboration throughout the health and care system. It places no duty on informal carers and imposes no specific procedures on professionals – other than making their welcome explicit. Dementia is a disability as well as an illness: access to this additional level of support (if available) should be a right for people living with dementia. Information, contacts and resources can be found on the John’s Campaign website www.johnscampaign.org.ukContinue reading →
The President of the British Geriatrics Society commented that the budget ‘failed to address the critical issue of delayed transfers of care for older people by increasing funding for social care’ at the Society’s national conference.
At the BGS national conference on Wednesday (22 November), Dr Eileen Burns, President of the British Geriatrics Society, called for the Chancellor to provide interim funding for social care to help medically fit older patients stranded in hospital wards return to their homes.
Dr Burns commended the government on its additional 10 billion pound capital investment in the NHS and the recent announcement that a Green Paper identifying long term solutions to the social care crisis will be published in the summer of 2018. Despite these measures healthcare professionals remain concerned that the ongoing limitations on social care funding will continue to put intense pressure on the NHS. Continue reading →
Melanie Dani is a trainee in geriatric medicine in the North West Thames deanery. She is also completing a PhD at Imperial College London studying biomarkers in Alzheimer’s Disease, and has an interest in cognition and dementia.
It is well-recognised that delirium is associated with increased mortality. It’s less clear, though, whether this is the case across the spectrum of frailty. There is an idea that delirium might have bimodal outcomes – worse in frailer people, but may be protective in fitter individuals by highlighting an underlying problem early and (potentially) prompting earlier treatment.
While past studies have accounted for chronic diseases and acute illness severity, few have accounted for both. We wanted to see whether the associations of delirium with mortality remained so even after accounting for acute and chronic health factors, so we modelled both these together in a frailty index. This included 31 variables encompassing chronic disease, acute illness parameters, and functional status and was applied in a large cohort of acute medical older inpatients. Continue reading →
There is no doubt that people from countries all over of the world are living longer, but there is little evidence to suggest that older people today are living healthier than their predecessors did at the same age. This is a major cause of concern for many governments around the world because if the added years of people today are dominated by chronic diseases and functional disabilities, there will be negative implications (e.g., extended treatment for older people which increases the health and social care cost to society). Continue reading →
Agnes Jonsson is a graduate of University College Dublin in 2013 and is currently working as a Registrar in Orthogeriatrics in St. Vincent’s Hospital in Dublin. Her areas of interest are dementia care and quality improvement. She wrote this blog with input from Dr. Yasser Aljabi, Orthopaedic Registrar. Together they are working to create a pathway of care for vertebral fractures in St. Vincent’s Hospital.
Osteoporotic fragility fractures have an estimated annual cost of 2 billion pounds in the UK. This includes the cost of acute hospital stay, rehabilitation and social care. Only a very small proportion of the cost is invested in pharmacological management and secondary prevention of osteoporosis. The National Osteoporosis Foundation recommends treatment with antiresorptive agents for patients with confirmed osteoporosis on DXA and for patients with neck of femur or vertebral fractures. Vertebral compression fractures have recently started to attract increasing amounts of attention, similar to that shown for hip fractures years ago prior to the implementation of hip fracture pathways of care. Continue reading →
Dr Anthony James is a Consultant Physician at Princess of Wales Hospital.
There have been many changes in recent years. The patients are older with more frailty, multiple comorbidities and a mixture of social and medical issues. These patients are often described as ‘complex’, making them sound as if they are something special. The reality is that they are now the norm and everybody should be able to deal with the norm. These problems are recognised by Royal College of Physicians in Hospitals on the Edge? The time for action (2012);
‘All hospital inpatients deserve to receive safe, high-quality, sustainable care centered around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.’ Continue reading →