The struggle for age-proof medical care in the Netherlands

Wilco Achterberg (1963) is an elderly care physician and a Professor of institutional care and elderly care medicine in Leiden, the Netherlands. His research focus is on the most vulnerable elderly, most of whom live in nursing homes, and is centered around two themes: pain in dementia and geriatric rehabilitation. He tweets @wilcoachterberg

The Netherlands have been very fortunate to have had a very good insurance system for long term care, which provided good funding for nursing home care. That is why in a typical Dutch Nursing home you can find, next to nurses, therapists like physiotherapists, occupational therapists, psychologists, dieticians and even physicians. In 1989, a 2 year post graduate medical training program started, and ‘nursing home physician’ became an officially recognised medical specialism.  The biggest challenge for Ageing Holland is not how to provide good care for older persons, but how to pay for that care. Therefore, for several years now government is trying to find other ways of caring for vulnerable and care dependent persons. 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

The Challenges of Research in the Care Home Setting

Annabelle Long is a Chartered Physiotherapist working as a Research Assistant at the University of Nottingham on a Dunhill Medical Trust funded PEACH study, which considers the role of Comprehensive Geriatric Assessment in UK care homes. She has a developing research interest in wellbeing for people with dementia in community environments. In this blog she outlines the potential challenges and solutions in doing research at the health and social care interface.

As practitioners and researchers in care of older people, it is important for us to be continually working to include more dependent groups in research. The reason for doing so is to ensure that the evidence base can reliably be applied to the patients we see in everyday practice. However involving older people with dependency in research can be challenging because cognitive and physical impairments can make standard procedures for recruitment and data collection difficult. Continue reading

Patients with vertebral fragility fractures treated in hospital – could we do better?

Terence Ong is a Research Fellow funded by the Dunhill Medical Trust at the Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust. He discusses his Age and Ageing Paper Characteristics and outcomes of hospitalised patients with vertebral fragility fractures: a systematic review. He tweets @terenceongkk

Vertebral fragility fractures have received much attention lately due to growing research interest and increased awareness driven by high-profile osteoporosis groups such as the International Osteoporosis Foundation (through its vertebral fracture initiative) and the National Osteoporosis Society.

There is growing literature to support how well vertebral fragility fractures predicts future fractures, morbidity and risk of mortality. However, what has been lacking is research exploring the specific cohort of people with vertebral fractures who are admitted to hospital. Continue reading

MAPLE-V: Taking a collateral history for cognition

Rebecca Winter is an Elderly Medicine registrar; she is currently taking a year out of programme as a Clinical Education Fellow at Brighton and Sussex Medical School (BSMS). Twitter: @rebeccawinter27

Muna Al-Jawad is an Elderly medicine consultant at the Royal Sussex County Hospital, Brighton. She works on a mixed acute medical and mental health ward.

mapleIt’s a familiar scenario, you are on your Elderly Medicine placement and you are asked: “Can you get collateral history about Mrs Smith´s cognition?” You don´t want to miss anything, but what exactly do they want to know?

Dementia is an increasingly common and important condition. In the UK, at least one quarter of acute hospital beds are occupied by patient with dementia, with admissions spread across a broad range of specialties. (1) Despite this, the UK National Dementia Strategy (2) has highlighted deficiencies in behaviour and skills of healthcare professionals caring for people with dementia. Continue reading

Desperately Seeking Ethics: Reflections on attending a research ethics committee meeting

Liz Charalambous is a nurse and PhD student. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

me-fbI am in the second year of a PhD researching volunteers in dementia and acute hospitals. The project came about as part of my clinical work as a staff nurse in older person acute care. It was while working on a prevention of delirium research study, I realised that volunteers could play an important role.

The first year of my PhD has been spent mainly completing modules and designing the project from scratch. I have lost track of how many drafts of countless documents have been sent to my long suffering supervisors as they guide me towards refining my ideas, sifting through my thousands of words to put together a robust study which will stand up to scrutiny. Continue reading

Developing new guidance on how to measure lying and standing blood pressure- harder than you think!

Shelagh O’Riordan is a consultant geriatrician and the clinical lead for the National Audit of Inpatient  Falls. She was an acute hospital geriatrician in Canterbury in Kent for 14 years but moved in September 2016 to work Kent Community Foundation Trust as a community geriatrician. She developed and runs East Kent Falls and Osteoporosis service. She tweets at @jupiterhouse1  

bpAs the clinical lead for the National Audit of Inpatient Falls (NAIF) I have been involved in the development of some new tools to standardise fall prevention in hospitals and they are being launched this month. The first of these was launched on 13/01/17 and is on the measurement of lying and standing blood pressure.

One of the results we found in the last audit round (data collected May 2015) was that on average only 16% of patients over 65y in an acute hospital after 48 hours had had a lying and standing BP recorded! I found this to be a fairly shockingly low number. I’m known, like many geriatricians, to be a bit obsessed with measuring lying and standing BP. 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

Nutrition in geriatric medicine in context

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

tnt-geriatric-marketing-brochure-a4-v14-page-001Do you reach for protein to nibble within minutes of finishing a session at the Gym?  Many do. Protein bars, pots of creatine and drugs you can get at the Gym are all very well but they’re wasted on fit young things. What we really need to do is keep the best stuff for older people, especially our patients. So, OK, we have to justify the cost – there needs to be some evidence. On the plus side however our patients are not pulled aside by WADA or the other anti-doping bodies so they could get away with anabolics or even the odd transfusion. On the minus side maybe the anabolics don’t work! But good nutrition does!

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Nursing documentation: Mind the gap?

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She is currently a PhD student at The University of Nottingham. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Her blogs are her own opinion and do not represent the opinion of her employer or any other organisation. Co-author and supervisor, Dr. Sarah Goldberg, is an associate professor at The University of Nottingham. She tweets as @se_goldberg

Introduction

docsNew research out this week highlights the importance of nursing documentation for older patients in an acute hospital setting. The research ‘Gaps, Mishaps and Overlaps: Nursing Documentation, how Does it Affect Care?’ published in The Journal of Research in Nursing found that paperwork is time consuming to complete, takes nurses away from caring for patients, and can be counterproductive to delivering good quality nursing care to older people in hospital.

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