The struggle for age-proof medical care in the Netherlands

Wilco Achterberg (1963) is an elderly care physician and a Professor of institutional care and elderly care medicine in Leiden, the Netherlands. His research focus is on the most vulnerable elderly, most of whom live in nursing homes, and is centered around two themes: pain in dementia and geriatric rehabilitation. He tweets @wilcoachterberg

The Netherlands have been very fortunate to have had a very good insurance system for long term care, which provided good funding for nursing home care. That is why in a typical Dutch Nursing home you can find, next to nurses, therapists like physiotherapists, occupational therapists, psychologists, dieticians and even physicians. In 1989, a 2 year post graduate medical training program started, and ‘nursing home physician’ became an officially recognised medical specialism.  The biggest challenge for Ageing Holland is not how to provide good care for older persons, but how to pay for that care. Therefore, for several years now government is trying to find other ways of caring for vulnerable and care dependent persons. Continue reading

Why the BGS Fringe?

Muna Al Jawad is a Consultant Geriatrician at Royal Sussex County Hospital in Brighton. Here she discusses the BGS Fringe which will be taking place at the BGS Autumn Meeting in London on 23 November. She tweets @OPWhisperer

The idea for the BGS Fringe comes from an emotion: Frustration, and a cause: Resistance. Frustration first. I realise this might be heresy (especially on a blog for the BGS) but the national conference really frustrates me. Geriatricians are the funniest, quirkiest and most humble of doctors. Lots of us chose geriatrics because we want to work with geriatricians. Of all the hospital specialists, we pride ourselves on being the most holistic, we see aim to see our patients as human beings, within their network of family and carers. “Aha!” the geriatrician will say on a ward round, “I know Mrs Jones, she loves Elvis and has a watch with a cat on it” (I actually said that last week).
Continue reading

Reflections on ‘NOT Forgotten Lives: Felixstowe 2017’

Liz Charalambous is a nurse and PhD student. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Here she reviews ‘NOT Forgotten Lives: Felixstowe 2017’ edited by Julia Jones and Bertie Wheen

‘NOT Forgotten Lives’ is a written record, produced for the 2017 Felixstowe Book Festival, which celebrates the lives of older people living locally in residential accommodation. This slim volume is organised by an overview of what life story work is about, followed by photographs and accounts of the life stories of residents living in nursing and residential accommodation in Felixstowe. It concludes with a personal reflection from the co-editor, Bertie Wheen.

Why is this book important?

In a world where dementia is on the increase there are political, economic, ethical and often personal reasons why society must wake up to the reality of the disease. Currently an estimated 50 million people worldwide live with dementia, with a forecast of 131.5 million by 2050.  In the UK there are 850,000 people living with the disease, estimated to increase to 2 million by 2050. These figures alone suggest that dementia is a disease which can no longer be ignored. Continue reading

The frailty journey so far: where are we heading?

Professor Martin Vernon qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England. Here he discusses the 3rd National Frailty Conference which will be held on 28 September 2017 in Leeds. He tweets @runnermandoc 

The 19th Century term ‘watershed’ refers to a ridge of high ground separating bodies of water flowing in different directions. With this in mind I believe the 3rd National Frailty Conference in Leeds this year truly does mark a watershed moment. It will provide a valuable and timely opportunity both to reflect and add clarity to the new direction of travel we are taking with routine frailty identification and intervention for older people on a national scale. Make no mistake: bringing frailty into the mainstream is game changing.

Over the last year I have been continually impressed by the enthusiasm, ingenuity and commitment around the country focused on improving care and outcomes for our expanding and ageing population.  As a health and care system collectively we have much to celebrate from the hard work already done. Continue reading

Retirees leaving sociable workplaces may experience accelerated cognitive decline

A study published recently in Age and Ageing, the scientific journal of the British Geriatrics Society, provides new evidence that workers retiring from occupations which involve high levels of social stimulation may be at greater risk of accelerated cognitive decline in later life.

The study, which was conducted by researchers at University of Liège, in collaboration with the Universities of Bordeaux and South Florida, surveyed 1,048 individuals over the age of 65 from Bordeaux. Participants were evaluated at 2 year intervals for a period of 12 years. Psychologists’ evaluations included detailed assessments of subjects’ mental cognition, general health and information about their former occupation. Three independents raters were asked to evaluate the level of social and intellectual stimulation for each occupation. Continue reading

Why I’m Fine with “Frailty”

Professor David Oliver is a Past President of the BGS, clinical vice-president of the Royal College of Physicians, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon? He tweets @mancunianmedic

Dr Steve Parry’s recent blog here, “The Frailty Industry. Too much too soon” certainly generated a great deal of hits and online responses. He is a well-respected geriatrician, has done sterling work for our speciality and we are friends in a speciality where solidarity and mutual respect are wonderfully the norm.

The more I reflect, the more I realise that none involved in the debate are a million miles apart in any case. We have all devoted our professional lives to the skilled multidisciplinary care of older people, especially those with the most complex needs; to the speciality of geriatric medicine; to the leadership of local services; to the education of the next generation of geriatricians and to developing the evidence base for practice.  Continue reading

If frailty is viewed by some as a “commissioning Trojan Horse” this should be admitted

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field, even cited in the Oxford Textbook of Medicine. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?  He tweets at @dr_shibley.

In response to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?, I would simply in this article like to set out some of the strengths and weaknesses in the conceptualisation of frailty, with some pointers about “where now?

There is, actually, no international consensus definition of frailty (although there is one of a related term “cognitive frailty”).

In a world of fierce competition for commissioning, and equally intense political lobbying in health and social care, the danger is that a poorly formulated notion becomes merely a “Trojan Horse” for commissioning.

I must humbly depart from the views of some colleagues – for me, frailty is not just a word. I could likewise point to other single words which cause gross offence, which are unrepeatable in my blogpost here. Continue reading

Old People’s Home for 4 Year Olds

Dr Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. In this blog she discusses the recent Channel 4 programme in which she appeared, Old People’s Home for 4 Year Olds. She tweets @geri_baby

I’ve always had a soft spot for care homes. As a child I would occasionally go into work with my Mum and meet some of the old ladies she talked about. When I was older I started work in the same nursing home as a kitchen girl on Saturdays, and then later progressed to health care assistant. I remain proud of my training record from that time, showing I am competent to deliver personal care, clean dentures and cut nails.

This is why I was excited when an approach came from CPL productions, who were looking for geriatricians to be involved with a television programme they wanted to make about introducing children to a care home environment. Continue reading

The Frailty Industry: Too Much Too Soon?

Steve Parry works in acute medicine and older people’s medicine. He has a special interest in investigation and treatment of falls and blackouts in adult patients of all ages. He is BGS Vice President – Academic and Research.

Fashions come and go, in clothing, news and even movie genres. Medicine, including geriatric medicine, is no exception. When I was a trainee, falls and syncope was the next big thing, pursued with huge enthusiasm by a few who became the many. But when does a well-meaning medical fashion become a potentially destructive fad? Frailty, quite rightly, has developed from something geriatricians and allied professionals always did to become a buzz word even neurosurgeons bandy about. No bad thing for all professionals who see older people to have awareness of the recognition and management of this vulnerable and resource intensive patient group. Continue reading

Person-centred care in a sustainable system

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President of the BGS. She is currently Clinical Lead for integration in Leeds. She tweets @EileenBurns13 This blog originally appeared as part of Independent Age’s Doing Care Differently series. You can join the debate here.

We warmly welcome Independent Age’s new project, Doing care differently. Our members are passionate advocates for person-centred care. The role of geriatricians and specialist health care professionals starts with identifying the care and treatment that best suits an older person’s individual needs and wishes, and those of their families and carers.  Delays in access to social care, and also in intermediate care, for example, occupational and physio therapy, create unnecessary barriers to person centred care, leading to poorer health outcomes, an increased likelihood of presenting at A&E, and people having to stay on acute hospital wards for longer than necessary.  For older people with frailty the negative impact when this occurs is significant, and their health deteriorates with every additional day spent on an acute hospital ward. Continue reading