Older HIV-Infected Adults are Geriatricians’ Business

Fátima Brañas is a consultant geriatrician and the clinical lead for orthogeriatrics at the Infanta Leonor University Hospital in Madrid (Spain). She holds a PhD, specializing in HIV infection in older adults, and is working hard in this field—from both a clinical and a research point of view—to provide all the benefits of a geriatric assessment for older HIV-infected adults. She recently co-authored ‘Frailty and physical function in older HIV-infected adults @FatimaBranas

hivThe HIV-infected population is aging due to the success of combination antiretroviral therapy, which prolongs survival, and also because of the growing number of newly diagnosed cases in older adults. Nowadays, over half of people infected with HIV are older than fifty years, which is the age cutoff accepted by the scientific community to consider someone an HIV-infected older adult. Fifty is only their chronological age, but biologically they are older, as accelerated aging in this population has been demonstrated. So, it seems that in the coming years, HIV care is going to be focused on a growing group of older adults and their specific problems. This means more than only survival, infection control, or avoiding the adverse events caused by antiretroviral drugs; it also includes consideration of comorbidities, polypharmacy, functional decline, and geriatric syndromes. Continue reading

Frequent sauna bathing protects men against dementia

Jari Laukkanen is a professor at the University of Eastern Finland. He and his co-authors have recently published a research paper in Age and Ageing journal on the link between sauna bathing and memory diseases. You can follow him on twitter @LaukkanenJari

saunaFrequent sauna bathing can reduce the risk of dementia, according to a 20-year follow-up study.  Men taking a sauna 4–7 times a week were 66% less likely to be diagnosed with dementia than those taking a sauna once a week. The association between sauna bathing and dementia risk has not been previously investigated.

The effects of sauna bathing on the risk of Alzheimer’s disease and other forms of dementia were studied in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), involving more than 2,000 middle-aged men living in the eastern part of Finland. Continue reading

How do geriatricians improve outcomes after hip fracture?

Jenny Neuburger is a Senior Research Analyst at the Nuffield Trust  (@NuffieldTrust) and a Visiting Research Fellow at the London School of Hygiene & Tropical Medicine. She and her co-authors have recently published research in Age and Ageing journal.

hipWe have just published a paper showing that geriatrician involvement in hip fracture care can improve patient outcomes.  Patients treated on wards with higher numbers of geriatrician hours tended to have lower mortality within the 30 days after presentation.

We measured geriatrician hours worked in orthopaedic departments using data collected via the National Hip Fracture Database annual survey each year from 2010 to 2013 for English hospitals.  Over this period, geriatrician hours increased from 1.5 to 4.0 hours per patient, reflecting investments made in response the financial incentives introduced under the Best Practice Tariff scheme. Continue reading

A New Holistic Approach to Pain Management in Older People

Nan Ma is specialist registrar in clinical Gerontology and Aza Abdulla is a consultant geriatrician and general physician at the Princess Royal University Hospital, Kings College NHS Foundation Trust. He is co-founder of the Special Interest Group on Pain in Older People in the British Geriatrics Society (BGS) and participated in producing the first National Guidelines on Management of Pain in Older People. He is also the immediate past president of the Geriatrics & Gerontology Section at the Royal Society of Medicine.

painPain in older people is under-reported and often poorly appreciated. For many, it is seen as part of normal ageing and has to be accepted. It is also a subjective feeling (different people have different pain thresholds) making it difficult for the clinician to quantify its impact in an individual patient. Consequently, it may be overlooked as an important factor that can affect older people’s wellbeing. In fact, chronic pain has a huge influence on quality of life (QoL) through its effects on the physical and mental state, which in turn adversely impacts on the older individual’s economic and social status (effects on carers, friends and family). Inadequately controlled pain perpetuates disability, anxiety, and depression all interfering with the overall QoL. It follows that effective management of pain is crucial in optimising welfare in the older person. Continue reading

How can hospitals empower older people with advanced disease?

Dr Lucy Selman is Cicely Saunders International Faculty Scholar in the Department of Palliative Care, Policy, and Rehabilitation at King’s College London, and a Research Fellow at the University of Bristol. In this blog Lucy discusses her recent Age and Ageing paper on an international study of patient empowerment in hospitals in London, Dublin and San Francisco (part of BuildCARE, a project led by Prof. Irene J. Higginson at King’s College London).

superheroEmpowered patients adopt healthier behaviours, use health services more cost-effectively, and experience better quality of life than patients who feel they are passive recipients of healthcare. Across the developed world, policy-makers are waking up to the benefits for patients and health services when people are encouraged to engage with clinicians, make decisions and manage their illness in a way that reflects their own values. Continue reading

Only half of people with dementia get annual medical review

Claudia Cooper is an honorary consultant old age psychiatrist with Camden and Islington NHS Foundation Trust. She focuses on research related to dementia and mental health in older age. Here she discusses her recent Age & Ageing paper Inequalities in receipt of mental and physical healthcare in people with dementia in the UK.

Age&Aging front cover design chosen chosenPeople with dementia experience more mental and physical health problems than people without dementia, and more frequently take medication for mental health problems, so ensuring the get fair access to mental and physical healthcare is important.

Our study looked at primary care records of 68, 061 people with dementia and 259,337 people without dementia between 2002 and 2013. We looked at how rates of mental health medication prescribing (antipsychotic, antidepressant and sedative drugs);  contact with General Practice surgeries and physical health checks  (blood pressure, weight monitoring and an annual review) varied between people living in more and less deprived areas, and between men and women. Continue reading

Shane O’Hanlon’s Age & Ageing Christmas Review- Part 2

Shane O’Hanlon is the Digital Media Editor for the BGS. He tweets @drohanlon

shaneThe second part of our look back at the most downloaded Age & Ageing articles of 2016…

  1. Jeanet Blom and team conducted a cluster randomised controlled trial of effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people in the Netherlands. No beneficial effects were found on QoL, patients’ functioning or healthcare use/costs, but GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care.

Continue reading

Shane O’Hanlon’s Age & Ageing Christmas Review- Part 1

Shane O’Hanlon is the Digital Media Editor for the BGS. He tweets @drohanlon

shaneAge and Ageing begins 2017 with a swish new look, but first let’s look back at the most downloaded journal articles of 2016…

  1. Helen Jones and colleagues looked at the theory that selective serotonin reuptake inhibitors (SSRIs) may affect the neurodegenerative process of dementia, enhancing cognition. To investigate this, they performed a systematic review of placebo-controlled RCTs. A small number of relatively low-powered studies showed no benefit or harm from SSRIs in terms of cognition, mood, agitation or ADLs in dementia. There was insufficient data to say whether SSRIs are beneficial for cognition, and there was some suggestion of increased side effects.

Continue reading

Getting to grips with multimorbidity and polypharmacy for older people

Dr Kevin Mc Namara is a Senior Research Fellow at Deakin University’s School of Medicine and Centre for Population Health Research. He has a particularly interest in the implementation of models for chronic disease prevention and management, including the management of multimorbidity. His paper, Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia, has been published in Age and Ageing.

Age&Aging front cover design chosen chosenResearchers from Australia offer some valuable insights about effective multidisciplinary care for older people who often have multiple health conditions (multimorbidity) and take multiple medications (polypharmacy). In ageing populations across the developed world, multimorbidity and polypharmacy pose unique and growing challenges for health professionals and systems. Treatments and goals for different health conditions are often not compatible, guideline recommendations may not be feasible, the evidence often lacking for older adults, and health systems are not designed to coordinate the activities of multiple health professionals often involved with care. Continue reading

Hypertension and dementia: exploring the evidence

Jenni Harrison is a Clinical Research Fellow at The University of Edinburgh. Her previous role was as an Academic Clinical Fellow in Geriatric Medicine in Leicester. She was part of the Hypertension in Dementia (HIND) Research Group at the Universities of Nottingham and Leicester. The group recently produced a New Horizons article on the management of hypertension in people with dementia. She tweets @JenniKHarrison.

deerIn the face of uncertainty around the optimal management of hypertension in people with dementia we sought to review and summarise the available evidence. After first considering the rationale for the treatment of hypertension and possible reasons why the approach could be different for those with dementia, we structured our review around three key questions:

(1) Do people with dementia experience greater adverse effects from antihypertensive medications?

(2) Is cognitive function protected or worsened by controlling blood pressure?

(3) Are there subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful? Continue reading