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!

Continue reading

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.

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

Global Summit on Aging and Health- personal reflections on a conference and a cultural exchange

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President of the BGS. She is currently Clinical Lead for integration in Leeds and Chairman of the BGS Community Geriatrics Special Interest Group. She tweets @EileenBurns13

chinaI was fortunate enough to attend and speak at a Global Summit on Aging held in Shanghai recently. It was a fascinating event, with speakers from an enormous variety of backgrounds- from the US Embassy in Beijing, the World Health Organisation, and the United Nations Population Fund, as well as numerous Chinese Government office holders.

The summit was jointly organised by Columbia University, USA (under the auspices of the wonderful Professor Linda Fried) and Fudan University in China. Continue reading

Can We Choose Wisely?

Dr Ramai Santhirapala is an Honorary Consultant in Anaesthesia and Perioperative Medicine at Royal Surrey County Hospital and a Clinical Advisor at the Academy of Medical Royal Colleges. In the latter role she advises on the international programme ‘Choosing Wisely’, which aims to improve conversations between healthcare providers and patients. Dr Santhirapala’s specialist interests are shared decision making and end of life care, believing patients should lie at the heart of healthcare decisions. She has published in the British Journal of Anaesthesia and Perioperative Medicine and is undertaking research into educational needs for physicians to practice shared decision making. She tweets at @ramai23

choosing-wisely_2Shared decision making (SDM) is increasingly synonymous with healthcare, moving away from paternalism towards a balanced approach to decision making involving both patients and clinicians. What exactly is SDM? That is the ubiquitous question to which there is currently no universally agreed answer. The King’s Fund intimates a definition pointing out SDM is a process during which patients and physicians use evidence based information to support the deliberation process based on patients’ values, beliefs and preferences. This highlights that a physician is still expected to bring clinical expertise, whilst a patient brings expertise on what matters to them. Continue reading