Is it time to redefine old age?

Vedamurthy Adhiyaman is a geriatrician working is North Wales. Here he discusses why we should redefine old age. He tweets @adhiyamanv 

Western literature arbitrarily defines old age as people above the age of 65 (Oxford textbook of geriatric medicine, Wikipedia etc). Few authors subdivide old age further as young old (65-74), old (75-84) and old-old (85+). This would make our reigning monarch ‘old-old’ and the next in line to the throne and our patron, old (not sure whether he would like to be called old…). And definitions of old age vary according to different parts of the world. For African countries, the United Nations set the age 60+ and the WHO defines 50+ as old. Dictionaries define old age as a later part of normal life without defining any numbers.

International Day of Older Persons 2016

David Oliver is the current 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. He tweets @mancunianmedic

I am delighted that October 1st sees the International Day of Older Persons and looking forward to all the activity that should go with it – in local communities, in public services and charities and in mainstream and social media. I also welcome the themes this year – highlighting and tackling ageism and celebrating older people.

Challenging the depiction of delirium in the media

The media’s portrayal of vulnerable elder people as ‘perpetrators of assaults’ shows us just how far we still have to go.

Dr James Woods is a registrar in Geriatric and General (Internal) Medicine in South East Scotland. He tweets at @jmwoods87

Earlier this week BBC Radio 5 Live ran a piece with corresponding BBC website article reporting on figures obtained from an NHS Protect report on physical assaults against NHS staff in England. The headline and corresponding analysis focused on patients over 75 years old as the most frequent ‘perpetrators of assaults’ against NHS staff. If you care about the healthcare needs of older people and want to see them treated with dignity and respect (which if you are reading this blog you probably do) then this makes for distressing reading.

Improving cancer care for older people

Dr Shane O’Hanlon is a consultant geriatrician with the Macmillan COCOC team (Comprehensive Care for Older People with Cancer) at the Royal Berkshire NHS Foundation Trust. He tweets @drohanlon

Today is World Cancer Day, and is a good opportunity to take stock of where we are with cancer care for older people.

Many people are surprised to hear that the majority of cancers are now diagnosed in people over the age of 65 years – this group is 11 times more likely to develop cancer than young adults. The incidence of cancer generally has been increasing since the 1970s, but the largest increase has been among people aged 75 years and older.

So we really should be offering excellent care to this group, and outcomes should be constantly improving. Is that what is happening?

Dementia is not contagious

Daniel Sommer is a Core Medical Trainee in South East Thames. He is an aspiring Geriatrician. He tweets at @danielf90

I am committed to a career in geriatrics partly because I want to help people with dementia live safe, happy and productive lives. Working on an acute geriatrics ward is an amazing privilege. I’m constantly overwhelmed by the humanity of the staff that I work with. They seem to have endless patience and a genuine enthusiasm for what they do. In the face of huge challenges, staff shortages and under funding, our staff members provide an astonishing level of care for all patients, especially those with dementia. We have dementia boards, dementia boxes, dementia specialist nurses, dementia pins, dementia stickers and dementia clocks.

It feels silly telling an interested and educated audience [yes, that’s you!] about cognitive impairment, but I feel it’s important to be mindful of the scale of dementia and delirium in society and in the acute hospital. According to the Alzheimer’s Society, 7% of over 65s have dementia. A recent BMJ paper indicated that 34.8% of acute hospital in-patients over the age of 80 suffer from delirium, and 50.9% of those had an underlying dementia. This is not something than any healthcare professional can ignore.

With the above in mind, you’ll have to excuse me if I get more than a little bit irritated and hurt that some patients and their relatives are offended by the word “dementia” or that they demand to be moved off the “ward full of lunatics” because it’s “bad for their health”.

Old and still driving

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

One of the most negative images of older people concerns older drivers. Yet by any yardstick they are the safest group on the roads, as Prof Des O’Neill, consultant physician in geriatric and stroke medicine at Adelaide and Meath Hospital in Dublin, pointed out. There were issues though with increasing age and it was worth geriatricians getting involved with assessing someone’s fitness to drive.

The problems of housing elderly prisoners

Adrian Hayes is a researcher with the Offender Health Research Network at Manchester Univeristy. @Offender_Health  

Image by mrrobertwade (wadey)

Whether old Victorian gaols or newly-built units, prisons are designed for young adults – both in terms of the regime and the physical environment itself. However, the over-60s are now the fastest-growing group amongst prisoners in England and Wales. We know from previous research that this group has a complex set of physical and mental health needs, and that these are often unmet. Our research looked at the social and custodial issues faced by older adults in prison.

We interviewed 262 prisoners aged 50 and above across North West England. Compared with the general prison population the older group appeared to represent less of a discipline problem, with fewer adjudications, a lower security rating, and less time spent in segregation.

The social and economic contribution of our elders

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

Another look at the future came from Claire Keating, commissioner for older people in Northern Ireland. “Shed loads of people are having increased longevity and that is a challenge but no-one becomes 80 overnight so it’s a case of planning. And current projections are not set in stone. For instance, we need to treat older people who have bowel cancer now but we also need to get their grandchildren to eat more vegetables so that there aren’t unacceptable levels when they get to that age.

“We get obsessed with money and the pessimistic outlook gets more attention. Yet the latest research shows that when you add up all economic and social contributions and all the taxes and voluntary work, older people make a net contribution to society of £40bn.

Chance favours the prepared: surgery in older patients

David Cohen is a consultant geriatrician at Northwick Park Hospital and a spokesperson of the British Geriatrics Society.

The Duke of Edinburgh’s recent admission to hospital raised the question of surgery in older people.  Surgery and an anaesthetic are a major stress on anybody and older people are particularly susceptible.  This not only applies to people who are frail and have other illnesses but also to people who appear very fit.  Obviously, in an emergency, there may be no choice other than to go ahead with surgery but in non-urgent situations it is important to take particular precautions in later life.  Anyone contemplating surgery should make sure that they have a good general medical history and examination well before the operation.  Problems that may affect recovery should be carefully sought and investigated so that there are no surprises. 

European Courts and Old People

Graham Mulley is emeritus professor of elderly care, University of Leeds.

image Gwenaël Piaser

The current issue of Age and Ageing features an original paper on Older Europeans and the European Court of Justice by Israel Doron.  Why should busy geriatricians be interested in legal activities in Europe?

The short answer is that these courts have the potential for championing old people’s human and legal rights.  These courts often judge in favour of elders, yet the number of cases referred is small and is not increasing – despite the greater numbers of elderly citizens.