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

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

September 2017 issue of Age and Ageing journal is out now

The September 2017 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.  A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more.  

Hot topics in this issue include:

  • The future of Comprehensive Geriatric Assessment
  • Causes of unsafe primary care
  • Improving medication adherence after hospital discharge
  • Oral health in hospitals and care homes
  • Research methods: how to do a systematic review

    The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here. Continue reading

    Age and Ageing papers featured in the OUP Public Health collection

    The latest journal Impact Factor results were announced in July and we were delighted to see Age and Ageing continue to grow in impact with a higher score of 4.282.

    Our thanks go out to our valued authors who contribute such strong work, and to our army of peer reviews who are essential to the high standard of published material. We are also grateful to all of our readers who share, cite and make use of this work and disseminate research for the improvement of the health and care of older people.

    To celebrate improving Impact Factor scores across several of its journals, Oxford University Press has released a collection of the highest cited papers on the theme of Public Health. Continue reading

    Smoking linked to frailty in older adults

    A recent paper published in Age & Ageing, the scientific journal of the British Geriatrics Society, finds that current smoking in older people increases the risk of developing frailty, though former smokers did not appear to be at higher risk.

    Smoking increases the risk of developing a number of diseases, such as chronic obstructive pulmonary disease (COPD), coronary heart disease, stroke and peripheral vascular disease, all of which can potentially have negative effects on people’s physical, psychological and social health.

    Frailty is considered a precursor to, but a distinct state from, disability. Frailty is a condition associated with decreased physiological reserve and increased vulnerability to adverse health outcomes. The outcomes include falls, fractures, disability, hospitalisation and institutionalisation. Continue reading

    Geriatric co-management: where is the evidence?

    Bastiaan Van Grootven is a PhD researcher at the KU Leuven – University of Leuven in Belgium. His paper Effectiveness of in-hospital geriatric co-management: a systematic review and meta-analysis has recently been published in Age and Ageing. He tweets at @accentvv

    Hospitals have long been recognized as a hazardous environment for frail patients. To date, care is still sub-optimal: cognitive and functional problems are not recognised or treated properly and patients are at high risk for delirium and functional decline. In our study, we reviewed 12 experimental studies to evaluate if geriatric co-management can improve outcomes for older in-patients. Co-management was defined as a shared responsibility and decision making between a medical doctor (e.g. surgeon) and geriatrician (or geriatric team) aiming to prevent and treat geriatric complications. 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

    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

    Systematic reviews for studies of older people

    Susan Shenkin is Associate Editor for Systematic Reviews at Age and Ageing journal. She has recently published Systematic reviews: guidance relevant for studies of older people. She tweets at @SusanShenkin

    Systematic reviews and meta-analyses are increasingly common. Our recent article in Age and Ageing journal aims to provide guidance for people conducting systematic reviews relevant to the healthcare of older people. It’s essential that systematic reviews are performed by a team which includes the required technical and clinical expertise: if you’re planning to do a review, ask for advice and support early. We hope that highlighting these issues will also help people reading systematic reviews to determine whether the results will influence their clinical practice. Here is a summary of ‘good practice points’. Continue reading