Oncogeriatrics, gaining momentum!

Dr Kirsty Colquhoun has been a consultant geriatrician, working in Glasgow, since August 2015. She works across a variety of hospitals, including Glasgow Royal Infirmary, Gartnaval General hospital and The Beatson. In addition she works with Macmillan, developing oncogeriatric services. She will be speaking at the BGS Oncogeriatrics Conference on 7 December 2017 at the Wellcome Collection in London.

Oncogeriatrics…it is a relatively new speciality but those of us involved in it can see it is an exciting one, gaining momentum. The BGS Oncogeriatric SIG was inaugurated in 2015, and our annual meeting this year is on the 7 Dec 2017.

Particularly since the Cancer Services Coming of Age Report there has been increasing recognition that the way in which we manage our older patients with cancer, could, and should be improved and tailored to their specific needs. The benefits of CGA extend to cancer care, with outcomes and tolerance of treatment improving with its use. Continue reading

Advanced Professionals supporting our frail patients, but how?

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

Nationally there is increasing recognition of the needs of frail older people in health systems, and  the UK’s rapidly ageing population will only increase in the years to come.

Dr Ram Byravan (Consultant and Clinical Director Heart of England Elderly Care) states that the prevalence of multimorbidity is on the rise, with 44% of people over 75 now living with more than one long-term condition –  geriatricians and GPs are uniquely suited to lead the response to the challenges of caring for this group. Continue reading

The GERIATRIC 5Ms – the 5 simple words every geriatrician needs to know (the new mantra)

Frank Molnar is a Canadian Royal College specialist in Geriatric Medicine who serves as the President of the Canadian Geriatrics Society and as the editor of that society’s Continuing Medical Education Journal. He tweets @FrankMolnarCGS

Those outside Specialized Geriatric Services have long had great difficulty understanding what specialists in Geriatrics do. We have contributed to this lack of clarity. As experts in complexity we often have difficulty communicating simply. In well-intentioned efforts to be inclusive and comprehensive we have employed long complex definitions that few outside our field can understand much less recall.

How often have you heard “what do you geriatricians really do?” Are you tired of explaining and re-explaining yourself? Are you looking for a better way to explain and sell our specialty? Continue reading

How older people move in bed when they are ill

Kenneth Rockwood MD, FRCPC, FRCP is Professor of Medicine (Geriatric Medicine & Neurology) at Dalhousie University, and a staff physician at the Halifax Infirmary of the Nova Scotia Health Authority. He tweet @Krockdoc  

The dangers of going to bed”, elaborated by Richard Asher in 1947 illustrates for just how long the hospital bed has been recognized as a hazard for older adults.  It can also be source of rich clinical information.  Understanding this through quantification and plain language descriptors offers one means to “geriatrize” routine care. Like many of such workaday skills, assessing how someone moves in bed is not that tricky, but it requires both the cognitive task of paying attention and the affective one of wanting to do so. Continue reading

Hidden Carers – sharing the stories of older male carers

Louise Bate is an Engagement and Communications Officer with Healthwatch Dorset. Healthwatch is an independent watchdog, working to help people get the best out of their local health and social care services. Healthwatch enables local people to influence the delivery and design of local services, by sharing their views with health and care commissioners and providers: www.healthwatchdorset.co.uk 

More than 51,000 carers in England are men aged over 85; a number that has more than doubled in the last decade. It’s such a huge number of people that it’s hard to imagine. We wanted to make the numbers real – so we’ve been working with Bournemouth University and the Carers Support Service to listen to older male carers, gather their stories and give them a stronger voice.

Carers over the age of 85 are the only demographic of carers where men outnumber women (59%). Men are more likely to become carers in older age than at other times in their life and usually as a result of caring for their partners. Continue reading

Old problems, new solutions

Alistair Burns is Professor of Old Age Psychiatry and Vice Dean for the Faculty of Medical and Human Sciences at The University of Manchester. He is the National Clinical Director for Dementia and Older Peoples’ Mental Health, NHS England. This blog was originally published on the NHS England website. He will be speaking at the upcoming BGS Autumn Meeting in London.

As now seems to be tradition, let’s start with some statistics.

Up to four out of ten people over the age of 65 experience mental health problems. Depression is both the most common and most treatable mental illness in old age, affecting one in five older people in the community. This figure doubles in the presence of physical illness and trebles in hospitals and care homes. Nor should we forget that older people also experience severe mental illnesses.

About one fifth of all suicides happen in older people. Risk factors include: being male, being widowed, increasing age, social isolation, physical illness – present in up to 80 per cent of cases – pain, alcohol misuse and depressive illness past or present. Continue reading

Comprehensive Geriatric Assessment and the role it plays in improving care delivered to the older person

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital Dublin, and Clinical Lead for the National Clinical Programme of Older People in Ireland.  

Ms. Carmel Hoey is a Nursing & Midwifery Planning and Development Officer at the NMPD Unit, Galway, and HSE Service Planner for the National Clinical Programme of Older People in Ireland. 

Countries around the world are seeing significant growth in the numbers of people living longer and healthier lives. We all need to reflect proactively on how we can best maximise the intergenerational benefits this will undoubtedly bring and we must also address the challenges it will generate.

Ireland is no different, with a substantial growth evident in our older population. The number of people aged over 65 years increased by 14% between 2006 and 2011. An increase of 17% is predicted between 2011 and 2016, and a further 17% is expected by 2021 (Central Statistics Office, 2013). Continue reading

Is it time to redefine old age?

Vedamurthy Adhiyaman is a geriatrician working is North Wales. Here he discusses why we should redefine old age. He tweets @adhiyamanv 

Western literature arbitrarily defines old age as people above the age of 65 (Oxford textbook of geriatric medicine, Wikipedia etc). Few authors subdivide old age further as young old (65-74), old (75-84) and old-old (85+). This would make our reigning monarch ‘old-old’ and the next in line to the throne and our patron, old (not sure whether he would like to be called old…). And definitions of old age vary according to different parts of the world. For African countries, the United Nations set the age 60+ and the WHO defines 50+ as old. Dictionaries define old age as a later part of normal life without defining any numbers. Continue reading

New Horizons in multimorbidity

Dr John V. Hindle was appointed Senior Clinical Lecturer in Care of the Elderly, to the School of Medical Sciences, in 2009. He has also held an honorary appointment as Senior Lecturer in Bangor University’s School of Psychology, since 1998. Here he discusses his Age and Ageing paper New horizons in multimorbidity in older adults.

There is increasing political and clinical interests in the concepts of multimorbidity and frailty. For those of us working with older people in primary and secondary care we feel that intuitively we understand these concepts. After all, we have been working towards improvement in care people with multimorbidity and frailty for many decades, and in some ways this was the origin of the specialty of Geriatric Medicine. However, although I have been working as a geriatrician for over 30 years, armed with my intuition, it is only in recent times that I have begun to truly understand the complexities of these issues. In recent years the concept of multimorbidity and particularly frailty have been injected with scientific understanding and explanation. We have come to understand the great impact that these issues have on health and social care, and the pressures that they bring to bear. The complexity of multimorbidity in the context of frailty, dementia and polypharmacy particularly bears a substantial healthcare burden. If like me you struggle to understand the full picture of the relationship between frailty and multi-morbidity, it is worth reading the article on New Horizons on Multimorbidity in Older Adults [1]. This overview helps explain the link between the concepts of multi-mobility and frailty and their relevance to the healthcare of older people. Although many people live with multimorbidity in midlife, particularly contributed to by social deprivation, it is important to understand that complex multimorbidity increases with increasing age.  The majority of older people have two or more long term conditions with care home residents having significant levels of multimorbidity.    Continue reading

Antidementia medication may improve survival in Alzheimer’s disease

Dr Christoph Mueller is an Academic Clinical Lecturer at the Department of Old Age Psychiatry at King’s College London. He and his co-authors published a paper on the influence of antidementia medication on survival in Alzheimer’s disease in Age and Ageing. He tweets at @DrChrisMueller

At present Acetylcholinesterase inhibitors, as Donepezil or Rivastigmine, are the only medications available for treatment of the early stages of Alzheimer’s disease. They can slow down the progression of the illness and alleviate distressing symptoms. However, their benefits are modest and they can have side effects, such as a slow heartbeat, indigestion, weight loss or an increased risk of falls. Moreover, dementia and Alzheimer’s disease is the leading cause of death for men and women 80 years or older in England and Wales. We investigated whether being prescribed antidementia medication was associated with survival in patients with Alzheimer’s disease. Continue reading