Professor Fiona Matthews is Professor of Epidemiology at Newcastle University, Newcastle-upon-Tyne, UK. In this blog, she shares a recent Age and Ageing publication looking at data collected since the 1990s on how much frailty exists in the population and whether it is more or less related to dying now than 30 years ago.
Most doctors involved in the care of older people would claim to know a frail patient when they see one. Being able to detect this frailty is crucial to ensure that treatment is appropriate, proportionate and likely to produce positive outcomes wherever possible. The measurement of frailty has become important recently with the inclusion of frailty within the requirements of an assessment in general practice, and tools to assist doctors in emergency departments evaluate frailty quickly. The most popular method for these investigations has been the frailty index, where diseases and impairments are added all together to give a score. The relationship between this frailty index and mortality has been seen across the world, giving rise to suggestions that it is one measure that is consistent across time and place. Continue reading →
Fall related injuries in older people constitute a significant public health issue in Australia and internationally. Falling represents the leading cause of unintentional injury in this population with approximately one third of older adults falling each year. Effective management of falls in older populations has proven to be challenging. Despite the substantial focus on falls prevention by the Australian government over the last decade the age standardised hospital admission rates attributed to falls continue to increase. The complexity of managing falls risk in the diverse populations found within Australia, coupled with an ageing population and finite resources, drives the need to better understand factors that can influence falling from the perspective of the older person. Continue reading →
With increasing age, blood pressure rises as a consequence of arterial stiffness. It has been debated whether or not to it is beneficial to treat hypertension in old age, especially in >75-year-olds when they have multimorbidity, polypharmacy or frailty. Large hypertension trials showed that lowering blood pressure in over 60-year-olds is beneficial and lowers the risk for myocardial infarction, stroke and all-cause mortality, even in >80-year-olds. However, these trials lack generalizability and typically excluded patients with multimorbidity and frailty. At the same time, observational studies raise concerns about lowering blood pressure too much, since there are several cohort studies showing a reverse association between low blood pressure and increased mortality and accelerated cognitive decline starting from age >75-year-olds. Continue reading →
Within the United Kingdom, older people experience more alcohol-related hospitalisations and deaths than any other age group. Risky drinking amongst older people is not just confined to the United Kingdom. Potentially harmful patterns of drinking are common amongst older age groups across the globe. Older people are not only at risk because they drink more often, but also because quantities of alcohol that may have been safer earlier in life have the potential to damage an older person’s health if, like most, they have medical conditions or take medications. However, moderate drinking in older age has been linked with some health benefits, and drinking may also have a positive impact on their social lives. The impact of alcohol on older people is complex, and many different factors can influence their choices. To modify riskier drinking in later life and support people to live longer, healthier lives, it’s vital that we understand these complexities. Continue reading →
The vast majority of older adults are admitted to hospital in their last year of life. For many of these people, hospitalizations are frequent and prolonged.
We reviewed the medical records of 410 older adults who were admitted to our hospital in the year prior to death. The median number of days spent in hospital was 32. While in hospital, patients consumed an average of 24 different medications. One-in-six patients consumed 35 or more individual medications. When discharged home from hospital, patients were prescribed an average of 2 unnecessary or inappropriate medications. Continue reading →
The scientific journal of the British Geriatrics Society, Age and Ageing, and the Journal of the American Geriatrics Society have launched a joint initiative, publishing two articles debating the relative benefits and risks of treating hypertension in older people.
It is widely recognised that raised blood pressure is probably the single most important treatable risk factor for cardiovascular disease in later life. The evidence that older people can benefit from antihypertensive drugs has accumulated with a succession of randomised controlled trials over the past 35 years. These trials have shown reduced risk of stroke and myocardial infarction, as well as decreased total mortality. However, despite the extensive evidence that is now available, questions remain about who to treat and on optimal blood pressure targets. Consequently practice varies widely and many clinicians are uncertain about what best to recommend for their older patients. Continue reading →
The paper reveals the complexity of the discharge process for older people and that more support is required than is currently widely recognised. Her team found that falls prevention strategies, known to reduce falls for older people in general, were not as effective for older people following hospital discharge.
Evidence has shown 30% of the population of older people who live in the community fall at least once per year, 10% of these falls result in a serious injury. Whereas 40% of the population of older people who have recently been discharged home from hospital fall within 6 months of discharge, most of these falls occur in the first month and 54% result in a serious injury, particularly hip fractures. Continue reading →
Professor Sarah Hilmer works as a geriatrician and clinical pharmacologist at Royal North Shore Hospital in Sydney, and conjoint professor of geriatric pharmacology at Sydney University, Australia. Dr Danijela Gnjidic is a pharmacologist who is a NHMRC Dementia Leadership Fellow and Senior Lecturer in Pharmacy Practice at Sydney University, Australia.
One of the most reversible causes of a geriatric syndrome in our older patients is an adverse drug event. Approximately 1 in 5 hospital admissions amongst older people are due to adverse drug reactions and during their time in hospital 1 in 6 older people experience an adverse drug reaction. Consequently, comprehensive medication review is an integral part of the practice of geriatric medicine.
The process of a health professional withdrawing medicines for which the current risk may outweigh the benefit in their patient has been given a variety of names including the ‘geriatrician’s salute’ and increasingly ‘deprescribing’. Continue reading →
The May 2018 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:
New pain assessment guideline
Future population burden of
Systemic anti-cancer treatment for
Treating malnutrition in care homes
Effects of different types of
exercise in older people
Research methods – diagnostic test
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 →
Mr. Tai-Wa LIU is a Senior Lecturer at the Open University of Hong Kong. In this blog, he shares a recent Age and Ageing publication looking at the effectiveness of cognitive behavioral therapy in reducing fear of falling and improving balance among older people.
Whenever you are afraid of losing balance in doing something, it means you might have fear of falling. For example, a baby first tries to stand on its own, or a kid learns cycling. We all have had this fear of falling, especially in situations where we might get hurt or be embarrassed in public. This fear is normal and self-protective in nature, but the reality is that older people with excessive levels of this fear could lead to restricted activity of daily living, limited social participation and physical deconditioning. Eventually, it could lead to increased fall risks and form the vicious cycle of “fear of falling and actual falls”.
For some reasons, such as deteriorated physical ability or previous fall experiences, fear of falling is common among older people. The origin of this excessive level of fear is believed to be psychological and stems from the impaired balance confidence and over-pessimistic view regarding the consequences of falls. Continue reading →