New guidelines for recognising and assessing pain in older adults

New recommendations to help healthcare professionals recognise and assess levels of pain in older people were published today in the scientific journal Age and Ageing. The guidelines were developed by the British Geriatrics Society, the British Pain Society, the Royal College of Nursing, in collaboration with researchers at Teesside University, Anglia Ruskin University, University of Bournemouth, Centre for Ageing Better, and the Centre for Positive Ageing.

There is growing evidence to demonstrate that chronic pain is more prevalent among the older population and pain that interferes with everyday activities increases with age. Alleviating pain in the older population is therefore a priority but presents a number of challenges, especially in relation to communication with patients. These guidelines seek to address specific areas in which improvements can be made. To support this aim all existing publications on acute and chronic pain screening and assessment in adults over 60 years of age were identified, and two reviewers independently read and graded the papers according to the National Health and Medical Research Council criteria (1999b). Continue reading

200 years of Parkinson’s disease

Gavin Gordon is a medical student from Newcastle University currently intercalating in the History of Medicine MA programme. He is the co-author of “200 Years of Parkinson’s disease: what have we learnt from James Parkinson?” recently published in Age and Ageing.

The 200th anniversary of James Parkinson’s seminal Essay on the Shaking Palsy gives cause for commemoration and reflection. Parkinson’s astute observation and careful description of only six patients led to one of the earliest and most complete clinical descriptions of Parkinson’s disease. With the concept of a syndrome still not fully realised, Parkinson was among the first writers to unify a set of seemingly unrelated symptoms into one diagnosis. Continue reading

Number of older people with four or more diseases will double by 2035, say researchers

A study published recently in Age and Ageing, the scientific journal of the British Geriatrics Society, reports that the number of older people diagnosed with four or more diseases will double between 2015 and 2035. A third of these people will be diagnosed with dementia, depression or a cognitive impairment.

The study, conducted by researchers at Newcastle University’s Institute for Ageing, found that over the next 20 years there will be a massive expansion in the number of people suffering from multiple diseases, known as multi-morbidity. As a result two-thirds of the life expectancy gains, predicted as 3.6 years for men, 2.9 years for women, will be spent with four or more diseases. Continue reading

Qualitative Research in Age and Ageing

This themed collection of Age and Ageing articles includes a selection of papers published over the last 10 years which highlights the value of qualitative methodologies in health services research, particularly in understanding patient experience of health and illness and decision making about treatment and preventive care. We hope this issue will raise awareness of the scope for further contributions and encourage authors to submit papers reporting qualitative studies to the journal.

Summary of topics and themes:

In an editorial in Age and Ageing (5), we drew attention to the way in which the application of qualitative research methods within the social science disciplines of sociology, anthropology and social psychology can enrich understanding of ageing and illness: for example, through eliciting the meaning and process of ageing, health and illness from the perspective of older people; the practice of service delivery and what shapes it; and the beliefs, values and ‘taken for granted ‘knowledge that professionals may apply in their work with older people. Continue reading

BGS MDS trainee reps – what’s involved & is this for me??

Jo Russell is a ST7 registrar in geriatric medicine in South Yorkshire, BGS MDS trainee rep since 2015, will be starting her consultant post in March 2018 (with interest in movement disorders). She tweets at @russ_jo 

The BGS Movement Disorders Section are actively seeking to appoint new trainee representatives, ideally at ST4 level or above.

During the BGSMDS meeting in 2015 I was advised of trainee rep vacancies on the committee. My first thought was “I’m not sure that sounds like me”, but after a chat with the committee Chair, I was soon persuaded that it would be a fantastic opportunity. So much so, that I submitted an an expression of interest the following week. Continue reading

‘Geriatrics for Juniors’ is 5! Where, when and what next for AEME?

Dr Nick Saxton is an ST5 in Geriatric Medicine living and working in the North East of England. He attended the first ‘Geriatrics for Juniors’ conference as a core medical trainee in 2013. He began specialty training in 2015 and joined the Association for Elderly Medicine Education as treasurer in 2016. He tweets @saxton1986

Who are the AEME and what is G4J?

The Association for Elderly Medicine Education (AEME) is an organisation set up by trainee geriatricians in 2012, to provide educational tools and experiences in elderly medicine. The aim was also to attract more trainees into the specialty. You can follow us on Twitter and on Instagram @elderlymeded. AEME’s flagship event is our annual conference, ‘Geriatrics for Juniors’ (G4J), which is now in its fifth year. It’s a one-day conference aimed at foundation doctors, core medical and GP trainees and also specialist nurse practitioners who work with older patients. This year it is being held on 4th November 2017 at the Hilton Hotel Gateshead, Newcastle upon Tyne. Continue reading

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

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

MDTea Club and Podcast – Join the conversation

MDTea is by Dr Joanna Preston @GerisJo and Dr Iain Wilkinson @geriatricsdoc, consultant Geriatricians at St. George’s Hospital, London and Surrey and Sussex Healthcare Trust respectively.

MDTea offers free education on ageing for the whole MDT. We produce fortnightly podcasts on common topics encountered in clinical practice, critically looking at what evidence bases exist and which do not and applying practical solutions. The aim is to upskill a diverse workforce by discussing each topic from multi-disciplinary view points, not just one profession. We work and learn in teams in real life to solve problems so we aim to translate this to a shared format.

We have released 30 episodes over the last 18 months with funding for 20 more at the moment. Our 4th series started recently with an episode on Theories of Ageing. Others include mouth care, pain, delirium, falls prevention and management, interventions in early dementia, identity and nutrition, to name a few. Our most recent episode was on Sex and older adults – a largely neglected topic. Continue reading

Dying with dementia – we need to measure more than the place of death

Katherine Sleeman is an NIHR Clinician Scientist and Honorary Consultant in Palliative Medicine at the Cicely Saunders Institute, King’s College London. In this blog she discusses her paper Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data. She tweets @kesleeman

Over the past decade there has been a strong policy focus in the UK and elsewhere on dying out of hospital as a marker of good quality of end of life care. We have previously shown that, for people with dementia, hospital deaths have fallen over this time period, possibly as a result of these policies.

However, it is increasingly recognised that the place of death is an imperfect proxy for the quality of end of life care, providing little more than a snap shot of where a person was in their last moments. Continue reading