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 →
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 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 →
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 →
“‘I don’t know where to start” a colleague confessed. “I’ve only been a consultant for 6 months, and now they want me to set up a new service…”’
It turns out that being a consultant is as much about leadership and management as it about the clinical work: leading a service or setting up a new one, writing a business case, managing colleagues and much more besides. Yet for the majority of us, the closest we come to leadership training as a registrar is a few days spent on a course. Continue reading →
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 →
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 →
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 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 →
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 →