Is this your first time?

Dawne Garrett is Professional Lead for Older People and Dementia at the Royal College of Nursing (RCN) Eleanor Sherwen is Professional Lead for Palliative and End of Life Care, and also works at the RCN. They will be delivering a workshop at Living and Dying Well with Frailty Meeting on 6 March in London. Please note this meeting has now sold out and there will be no on site registration. To join the waiting list please email registrations@bgs.org.uk

Approaching end of life care discussions with the patient for the first time…

Dawne and I have been asked to deliver a 60 minute workshop on this key and sometimes challenging area of practice. The importance of choice and the delivery of holistic person centred care is repeatedly highlighted in the literature, both from researchers and policy makers.  Yet how can we even begin to deliver person centred care when there is at times a reluctance to open up and initiate these essential conversations? Let alone when communicating with someone who has limited sight, poor hearing and cognitive impairment. The evidence says that professionals can feel more comfortable approaching conversations in relation to sex, rather than having conversions with patients and those that are important to them focused on death and dying. 

A life-course perspective necessary to improve the health of older adults

Dorota Chapko is a PhD candidate in Public Health at the University of Aberdeen in Scotland, and a graduate from the Massachusetts Institute of Technology (MIT) with a double-major in Brain & Cognitive Sciences and in Anthropology. In this blog she discusses her recent Age & Ageing paper on the triad of impairment; she tweets at @dorotachapko

Although frailty is a central concept in clinical assessment of older people, there is no consensus definition. The concept is certainly multifactorial but physical components dominate. However, it is known that age-associated physical decline is likely to be accompanied by cognitive and emotional deficits. The ‘triad of impairment’ (triad) recognises the co-occurrence of cognitive, emotional and physical deficits in late-life and might be a useful alternative to ‘frailty’.

Identification of pathways to prolong healthy living and decrease the degree of frailty in old age will have benefits for individuals and society.

Collaborative Care and Support Planning: is it relevant to care for older people?

David Paynton is RCGP National Clinical Commissioning Lead and can be contacted on david.paynton@nhs.net

A revolution is starting to sweep through clinical practice. Clinicians, exhausted as they are in dealing with a seemingly endless tide of demand, are testing out new ways of working: trying to move upstream, developing proactive care plans with the person with long term conditions and their carer and changing the conversation from “how can I help” to “what is important to you”.

Older people want more opportunities to plan their care

Patients are increasingly planning for end-of-life care, but services aren’t always available, reveals new study.

Older people who want to talk to health professionals about advance care planning (ACP) are not always able to do so, a new study published in Age & Ageing has revealed.

More than a third of respondents in the East Midlands study said that they would be interested in discussing advance care plans with a health professional. However, only 17% of respondents had prepared an advance care plan, and only 5% had been actively offered the opportunity to talk about it with a health professional.

Advance care planning is a process of assessment and dialogue to document an individual’s preferences for future care and treatment. It can result in ‘advance’ directives (often referred to as ‘Living Wills’) which record views on specific treatments; the nomination of a proxy to represent the individual if they lose mental capacity; and statements of values and views about care and treatment.

This study received responses from 1,823 people aged 65 and over, living in community settings, and indicated an increase in the number of patients putting advance care plans in place (up from 8% in a 2005 poll). The study concludes that these results should encourage healthcare professionals to explore what people understand by ACP, and the role of professionals in providing it.

Corresponding author Irfana Musa of Leicester Royal Infirmary said:

“With the population growing older and living longer, we are treating many more conditions such as dementia, in which an individual’s decision making ability becomes impaired. Advance Care Planning can help people think ahead and also inform others of their wishes in anticipation of a time when they cannot communicate themselves.

This study gives us a flavour of what the population understand by Advance Care Planning, whether they would engage in the process, and what the barriers might be.”

Speaking on behalf of the British Geriatrics Society, Prof. Adam Gordon said:

“Doctors and health care professionals often feel nervous about exploring issues around advance care planning in case they offend or unduly distress patients. This sometimes stops them preparing these plans in discussion with patients, even when they think it might be in a patient’s best interests.

This study tells us they should be less nervous and more forward in introducing advance care planning concepts. Such discussions, though, can take time and this is one of many reasons we need to reflect upon the time available to general practitioners for routine consultations in older patients with frailty and work to increase resources in primary care to support patient-centred care planning.”

Year of Care Explained

By Eileen Burns and Amit Arora

Payment by results (PbR) never fully addressed the management of long term conditions, and the importance of timely and seamless transition to and from the community for patients who live with them.

Year of Care (YoC) was suggested as a possible solution in 2011 by Richard Murray, Chief Economist at the Department of Health in his document, “Payment reform in the NHS”. The long-term conditions YoC tariff is designed to allow health and social care to be provided based on a person’s overall needs as opposed to what specific diseases they have. It fits with the work being undertaken across the NHS to make care better integrated. If it works as intended, it will allow funding to be moved around as needed to provide the most effective ‘package’ of care for the person over a 12-month period. The underpinning philosophy is that money should be present in the parts of the healthcare system best-suited to provide patient care. The financial model is based upon an annual risk-adjusted ‘capitation’ budget, based on levels of health care need.

To Feed or Not to Feed? This is only half the question

Dr Eleni Tsiompanou is a specialist in nutritional medicine at the Health-Being Institute. She blogs at www.blog.healthbeing.co.uk and Tweets at @DrEleni   

For some time I have been intrigued by patients who, thought to be dying, were put on the Liverpool Care Pathway (LCP) but instead of dying improved. Such cases of unexpected recovery, reported in the Daily Mail, were of patients on the LCP who had had their treatment, feeding and hydration withdrawn. In two recent articles, in Clinical Medicine and BMJ online, I argue that there is more to these stories than meets the eye.

Third sector organisations – the forgotten dimension of integrated care?

By Robin Miller, Senior Fellow at the University of Birmingham and Co-Editor of the Journal of Integrated Care

The need for better integrated working between health and social care and acute and community services has been recognised for many years in policy and practice. However, despite this emphasis, many older people and their families continue to experience services that do not communicate effectively, are far from seamless, and require considerable persistence to successfully navigate. The increasing challenge of responding to our changing demography with limited resources means that it is more important than ever that we avoid wasteful duplication or gaps that result in older people being unnecessarily admitted to residential care or hospital.

Why does ‘integrated care’ matter?

The jargon of ‘integrated care’ is much-used in health policy and management circles. But why does ‘integrated care’ matter? And what will it mean for patients?

The Kings Fund have just developed a short animation designed to address these questions.  A large team were involved, including Prof David Oliver, President Elect of the British Geriatrics Society.  It aims to bring integrated care to life for anyone involved in improving patient care. If those working towards integrated care can share this vision with others in their local health and care system, then there is a real chance they can make integrated care happen.

Integrated care: making it happen

Too often, care is fragmented with services reflecting professional and institutional boundaries when it should be co-ordinated around the needs of patients. Delivering integrated, or joined-up, care for people with complex needs should be a priority for the NHS and core business for everyone working in health and social care.

We’d like to help make integrated care a reality across the country.

Our short animation aims to bring integrated care to life for anyone interested in improving care.

The full details can be found on the King’s Fund Website.

Read David Oliver’s recent article on the Making Health and Care Fit for an Ageing Population conference on 22nd October.

The Vulnerable Older People’s Plan – Important points from the coalface

Dr Adam Gordon is a Consultant Geriatrician and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust. He is Deputy Honorary Secretary of the British Geriatrics Society and also edits this blog.

The list of imperatives to improve care for older people is convincing. It’s now difficult to accept a future version of our National Health Service that doesn’t have a coordinated plan for frail older people at its middle. In this respect it’s good to see that the government is taking the issue seriously with a national consultation on it’s Vulnerable Older People’s plan (VOPP).  On September 11^th, I went to a meeting in London to present the British Geriatrics Society’s position.

Unco-ordinated care: we need named responsible clinicians in hospital too!

Ron Murphy is a software designer, he blogs at ronmurp.net 

I read the “Named clinicians …” post today, and the linked post by Prof David Oliver. It addresses continuity of care after discharge. This is a concern, as he quotes, “we need to know that there is a clinician accountable for vulnerable older people in the community, just as there is in hospital”.