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

Autumn Speaker Series: Exercise during periods of decompensation. What is the current evidence?

Stephen Lim is a Clinical Research Fellow and a Specialist Registrar in Geriatric Medicine in Academic Geriatric Medicine at the University of Southampton. His research interest is in physical activity and deconditioning in hospital. He will be speaking at the upcoming BGS Autumn Meeting in London. He tweets at @StephenERLim

Hospital-associated deconditioning is high on the agenda across hospitals in the UK and many hospital trusts have jumped on the ‘endPJparalysis’ bandwagon to encourage patients to get up and get moving, – and rightly so! It is encouraging to see that healthcare professionals and non-clinical staff members are increasingly aware that prolonged bedrest and immobility is bad medicine.

During an acute illness, older people are at risk of worsening sarcopenia and consequently a decline in physical function. The hospital environment, altered mental state, physiological stresses and poor nutrition (as a sequelae of the acute illness), are some of the important risk factors contributing to a loss of function. 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

Why I’m Fine with “Frailty”

Professor David Oliver is a Past President of the BGS, clinical vice-president of the Royal College of Physicians, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon? He tweets @mancunianmedic

Dr Steve Parry’s recent blog here, “The Frailty Industry. Too much too soon” certainly generated a great deal of hits and online responses. He is a well-respected geriatrician, has done sterling work for our speciality and we are friends in a speciality where solidarity and mutual respect are wonderfully the norm.

The more I reflect, the more I realise that none involved in the debate are a million miles apart in any case. We have all devoted our professional lives to the skilled multidisciplinary care of older people, especially those with the most complex needs; to the speciality of geriatric medicine; to the leadership of local services; to the education of the next generation of geriatricians and to developing the evidence base for practice.  Continue reading

Person-centred care in a sustainable system

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. She tweets @EileenBurns13 This blog originally appeared as part of Independent Age’s Doing Care Differently series. You can join the debate here.

We warmly welcome Independent Age’s new project, Doing care differently. Our members are passionate advocates for person-centred care. The role of geriatricians and specialist health care professionals starts with identifying the care and treatment that best suits an older person’s individual needs and wishes, and those of their families and carers.  Delays in access to social care, and also in intermediate care, for example, occupational and physio therapy, create unnecessary barriers to person centred care, leading to poorer health outcomes, an increased likelihood of presenting at A&E, and people having to stay on acute hospital wards for longer than necessary.  For older people with frailty the negative impact when this occurs is significant, and their health deteriorates with every additional day spent on an acute hospital ward. Continue reading

Rapid assessment and frailty

Beverley Marriott is a Advanced nurse practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow

There continues to be a growing emphasis on older people and emergency hospital admissions, with Frailty often used as a ‘wrap’ around term for ‘older people’. Older people with multiple complex comorbidities are a growing number of emergency attendances, hospital stays and admissions.

Frailty defined as a loss of physical and psychological reserves, which means an increased vulnerability to minor stressor events. People living with frailty can often go unnoticed until they reach crisis point as many people with frailty are not necessarily known to their community services, acute care, voluntary sectors or GPs. Is A&E the only place for frail patients to go when they hit crisis?   Continue reading

Autumn Speakers Series: A glimpse into the future of acute care for older people; innovation, connectivity, transformation

Professor Roger Wong is Executive Associate Dean, Education in the Faculty of Medicine, University of British Columbia (UBC). He is a consultant geriatrician at Vancouver General Hospital, where he founded the Acute Care for Elders (ACE) unit that is replicated across Canada and internationally. He tweets at @RogerWong10 and is a key opinion leader in geriatrics and ageing. In this blog article he discusses the determinants that can transform the future of acute care for older people. He will be speaking at the upcoming BGS Autumn Meeting in London.

For all of us who work with seniors in the hospital setting, we often wonder what the future holds for acute care for older people. While our crystal ball may appear blurry on some of the exact details, we can certainly take a sneak preview now on three determinants that can change and shape the future of acute care geriatrics.

First, disruptive innovation in the medical sciences has already begun to transform the delivery of healthcare in seniors. Take cancer for example, which affects a significant number of older people every year. Continue reading

How to be a Delirium Superhero this World Delirium Day

Hazel Miller, Consultant Geriatrician, Glasgow Royal Infirmary.  Delirium enthusiast (or should that be delirium hater?) hoping she has earned the right to don a cape from time to time…  Follow me on twitter @hazelmiller99

It’s fair to say that our understanding and management of delirium has increased hugely over the past ten years.  It has gone from being the ultimate in Cinderella syndromes (unanticipated, undiagnosed, untreated, unexplained, unnoticed) to having high profile and energetic researchers and advocates (its own Delirium Superheroes).  Everyone is being asked to Think Delirium these days. 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

Patients don’t just have dementia

Beverley Marriott is Birmingham Community Healthcare Foundation Trust Nurse Practitioner – Community Matron based at Heart of England Good Hope Hospital. She is currently undertaking a Fellowship in Older People at Kings College London. Here she reminds us that we need to see the whole person when looking at someone with dementia.

medical-pillsMany of us work within dementia care on a daily basis. As a community matron on an AMU department supporting safe and timely discharges for patients with dementia, I understand the importance of getting it right and what happens when we get it wrong.

Dementia has reached a critical point – over recent years the government has seen improvements in diagnosis, raising public awareness and promoting dementia friendly settings. However to deliver this level of improvement requires, time, resources and focus.  Continue reading