“The Emperor’s New Clothes”

Professor Martin Green OBE has had an extensive career in NGO development, both in the UK and internationally, and is Chief Executive of Care England, the largest representative body for independent social care services in the UK. He will be speaking at Living and Dying Well with Frailty event on 6 March. Follow the conference on the day via #bgsconf

We have now got a Department of Health and Social Care, what a difference that is going to make (I said sarcastically). With increasing regularity, the Government seems to think that messing about with the headed paper is a route to change. How much evidence do they need that changing titles and rejigging the logos is not going to deliver the transformational change that is required in order to deliver the route map to integrated services. If we had spent one tenth of the money we have spent on new titles, new structures and new logos on culture change, we would be in a far better position than we find ourselves today and the integrated services that citizens are crying out for might be a more attainable goal. Continue reading

Geriatric Oncology: Why older patients need a special approach

Anthea Cree is a clinical oncologist currently undertaking an MD in advanced radiotherapy at The Christie NHS Foundation Trust. She co-founded a group within the hospital to work towards better outcomes and experience for older patients.

I recently did a clinic during which the average age of the patients was over eighty and the oldest nearer to one hundred. This is probably not unusual for the readers of this blog but I’m an oncologist, not a geriatrician.

I’ve been an oncology registrar for six years and even over this short period of time, it seems like encountering octogenarians in clinic has changed from unusual to routine. This is a positive step as a third of cancer patients are over 75 years old and in the past many did not get a chance to see a specialist as they were automatically deemed to be too old for treatment. Continue reading

BGS Rising Star Awards: Ruth Law and Thomas Jackson

The BGS Annual Rising Star Award recognises young doctors, nurses and AHPs who have made exceptional contributions to the field of older people’s health care, early in their career. Two awards are available each year; one for research contributions that have translated into, or are in the process of being translated into, improvements to the care of older people, and the other, for a clinical quality project which improves the care of older people with frailty in the award holder’s locality.

In 2017, the award for quality went to Dr Ruth Law, Consultant in Integrated Geriatric Medicine, Whittington Health, for her work with the Integrated Community Ageing Team (ICAT) in Islington and to Dr Thomas Jackson for the work he has been doing in research.

Ruth trained mainly in and around London. She says that her training included a formative year as part of the stroke team at the National Hospital for Neurology and Neurosciences where she had the privilege of working alongside world-class researchers as they developed a new service. Continue reading

Can a National Frailty Education Programme be a driver of culture change in healthcare?

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital in Dublin, Ireland, and Deirdre Lang is the Director of Nursing, National Clinical Programme for Older People, Royal College of Physicians of Ireland and Health Services Executive

We all know that population ageing is occurring rapidly. Between 2015 and 2030 the number of people in the world aged 60 years or over is projected to grow by an extraordinary 56%. By 2050, the global population of older people is projected to more than double its size (United Nations, 2015). In Ireland, the population 65 years and over is projected to increase by between 58 and 63 per cent from 2015 to 2030. The older old population (i.e. those aged 80 years of age and over) is set to rise even more dramatically, by between 85 per cent and 94 per cent in this time period (ESRI 2017). Continue reading

What is “essential” about dementia care?

Dr Shibley Rahman is an academic physician interested mainly in dementia and frailty. He tweets at @dr_shibley

I have often wondered what ‘essential dementia care’ looks like. It must include treating people with respect and dignity.

Failures in dementia care, sustained for a long period of time, however obligate a more detailed response. The concept of personhood was first applied to people with dementia by Tom Kitwood (1997). The concept is used generally to describe what makes up the attributes of “being a person” (Dewing, 2008). According to Kitwood (1997), personhood is ‘a standing or status that is bestowed upon one human being, by others, it implies recognition, respect and trust’. Therefore “dementia care” is potentially a deceptively simple term because respecting personhood means that people are not defined primarily by their conditions. Continue reading

Making the most of our assets

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

The Reimagining community services report (Kings Fund 2018) highlights the need for strengthening community services with the aim of supporting our  older population, bringing to reality the vision set out in the NHS Five Year Forward View.

Unfortunately, the concept of reimaging services brings about concerns with growing financial and workforce pressures, these pressures could have a huge effect on the delivery of the recommendations. This could have a major impact on the ability of service providers to deliver services to meet the needs of the service user.

The Reimagining Community services report suggests that radical transformation of community services is required.  This would mean an additional share of the NHS budget. The NHS budget would be given to these services in order to make effective use of all the assets with our community.  Continue reading

Is this your first time?

Dawne Garrett is Professional Lead for Older People and Dementia at the Royal College of Nursing (RCN) Eleanor Sherwen is Professional Lead for Palliative and End of Life Care, and also works at the RCN. They will be delivering a workshop at Living and Dying Well with Frailty Meeting on 6 March in London. Please note this meeting has now sold out and there will be no on site registration. To join the waiting list please email registrations@bgs.org.uk

Approaching end of life care discussions with the patient for the first time…

Dawne and I have been asked to deliver a 60 minute workshop on this key and sometimes challenging area of practice. The importance of choice and the delivery of holistic person centred care is repeatedly highlighted in the literature, both from researchers and policy makers.  Yet how can we even begin to deliver person centred care when there is at times a reluctance to open up and initiate these essential conversations? Let alone when communicating with someone who has limited sight, poor hearing and cognitive impairment. The evidence says that professionals can feel more comfortable approaching conversations in relation to sex, rather than having conversions with patients and those that are important to them focused on death and dying.  Continue reading

Using a frailty index in the Emergency Department

Dr Audrey-Anne Brousseau is the first fellow in geriatric emergency medicine in Canada. She was recently appointed as assistant professor at the Université de Sherbrooke in Quebec. Her work focuses on developing best practices for older adults in the emergency department.

EDs are often the safety net of the health care system where the mission is to (rapidly) evaluate, intervene and organize transitions of care. With the aging of the population and the growing presence of older adults in EDs, this mission represents a significant challenge because older adults are complex on multiple levels.

How do we determine whether a patient is fit to go back home — or not?  Needs admission —  or not? Would benefit from rehabilitation, additional community services, further assessment — or not?  A comprehensive geriatric assessment will provide this answer, but is rarely readily available in most EDs. Moreover, human and material resources are often limited in public health care system preventing all older adults ED patients to get a geriatric assessment and appropriate interventions. Continue reading

Ward rounds – are they safe and effective for patients and doctors?

Dr Tarun Solanki is a Consultant Physician and Geriatrician at Taunton and Somerset NHS Foundation Trust.

Geriatricians are, in many hospitals, now responsible for looking after more than 50% of medical in-patients and are frequently required to look after outliers on non-medical wards. A recent article in the BMJ suggests that doctors’ way of working would not be accepted by businesses making decisions with far less impact and suggests that the old concept of the ward round is broken and needs to change[i].

Since we, as geriatricians are providing a substantial element of acute inpatient care, should we not be at the forefront of improving the ward round so that it is not only effective and safe for patients but also to ensure geriatricians do not suffer from undue work pressures and risk burn-out? Continue reading

World first study reveals admitting an older relative in temporary respite care can be a deadly mistake

A world first study into deaths of Australians admitted into aged respite care – usually to provide a planned or emergency break for their carer – reveals that older people in respite care are significantly more likely to die from preventable injury causes such as falls than those who are permanent nursing home residents.

The study found that preventable deaths from choking are twice as high as for long term residential care. Other preventable deaths such as from suicide are also higher in these temporary residents.

The research – published in Age and Ageing journal, by Monash University researchers – has serious implications for the 80% of older Australians who are cared for in the community by spouses, family members and friends. Of these more than 50,000 go into temporary respite care each year. Continue reading