Spring Speakers Series: Clinical Psychologists in Memory Services

Reinhard Guss is a Consultant Clinical Psychologist, Clinical Neuropsychologist; Dementia Workstream Lead, Member of the Faculty of the Psychology of Older People, BPS and Deputy Chair, Memory Services National Accreditation Programme. He will be speaking at the upcoming BGS Spring Meeting in Nottingham.

Clinical Psychologists have been part of Memory Clinics as long as they have been in existence as a part of service provision in the UK, using neuropsychology skills in the diagnostic process and in the development of coping strategies and employing clinical and psychotherapeutic skills in assisting with adjustment to a dementia diagnosis and in the support of families and carers.  An overview of the Psychology position on dementia can be found in the recent paper to the British Psychological Society’s Dementia Advisory Group.

Historically, the diagnosis of dementia was often the domain of Neurologists and Psychiatrist, particularly when this affected younger people, while Geriatricians would have encountered dementia in older people, and may or may not have seen a need to diagnose it in socio-historic context where dementia was seen as untreatable and often a part of ageing that was to be expected. Continue reading

New guidelines for recognising and assessing pain in older adults

New recommendations to help healthcare professionals recognise and assess levels of pain in older people were published today in the scientific journal Age and Ageing. The guidelines were developed by the British Geriatrics Society, the British Pain Society, the Royal College of Nursing, in collaboration with researchers at Teesside University, Anglia Ruskin University, University of Bournemouth, Centre for Ageing Better, and the Centre for Positive Ageing.

There is growing evidence to demonstrate that chronic pain is more prevalent among the older population and pain that interferes with everyday activities increases with age. Alleviating pain in the older population is therefore a priority but presents a number of challenges, especially in relation to communication with patients. These guidelines seek to address specific areas in which improvements can be made. To support this aim all existing publications on acute and chronic pain screening and assessment in adults over 60 years of age were identified, and two reviewers independently read and graded the papers according to the National Health and Medical Research Council criteria (1999b). Continue reading

How (I try!) to avoid a hospital admission for someone with frailty

Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care.  The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting.  The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com

The bag I take on every home visit has numerous pockets with endless equipment and forms required at my fingertips. I clip the same badges and emergency kit to myself at the start of every shift and I take this order and strict routine with me into environments over which I have little control.  It is within this mix of structure and chaos that the creativity to manage conditions and sometimes crises within a community setting arises.

Publications and conferences have explained the importance of avoiding unnecessary hospital admissions (especially for those with frailty) and commissioners require data on the number we have achieved. Continue reading

Spring Speakers Series: An overview of post stroke visual impairment

Claire Howard is a Stroke Specialist Research Orthoptist based at Salford Royal Hospital and is part of the VISION research unit at University of Liverpool. She holds an NIHR clinical fellowship and is currently researching the area of adaptation to post stroke visual field loss. Her main field of interest is rehabilitation of visual impairment following stroke. She will be speaking at the upcoming BGS Spring Meeting in Nottingham.

The size of the problem: the point prevalence of visual impairment in stroke survivors has been reported as 72% (Rowe, Hepworth, Hanna, & Howard, 2016). This visual impairment can be the result of a range of different problems either individually or in combination; these problems include visual field loss, eye movement disorders, reduced / blurred vision and visual perception defects.  In the post stroke period, a person may be experiencing a visual impairment that is of new onset, or their visual problems may pre-exist the stroke.  Continue reading

Creating a ‘Frail Friendly’ Acute Medical Unit… ‘not rocket science’

Teresa Dowsing trained as a physician associate at the University of Birmingham Medical School. She has worked in geriatric medicine for around 7 years and is the Frailty Lead for the George Eliot Hospital NHS Trust. To read more about physician associates and the British Geriatrics Society click here.

Creating a ‘Frail Friendly’ Acute Medical Unit (AMU) at George Eliot Hospital NHS Trust ….or what some specialities in my Trust used to call ‘not rocket science’…

Thinking about the latter part of this title, most of us that try to ‘practice’ geriatrics understand that it does sometimes feel like some form of mysterious dark art. A pinch of medicine, followed by a smidgeon of rehabilitation, mixed together with a drop of social care, a big dollop of communication and a dash of common sense. Simple? Not always….. Continue reading

Spring Speakers Series: Developing an Intervention for Falls in Dementia

Louise Allan is a Geriatrician with a specialist interest in the Neurology and Psychiatry of Old Age. Her research interests include the non-Alzheimer’s dementias and the physical health of people with dementia. She will be speaking at the upcoming BGS Spring Meeting in Nottingham.

Between 47-90% of people with dementia (PWD) fall at least once a year (almost ten times more often than controls). After a fall, PWD are less likely to recover well, more likely to be hospitalised, are hospitalised for longer and are more likely to require increased care. We currently know little about the care received by these patients. There is evidence to suggest that staff may perceive PWD as less capable of rehabilitation and staff in community services providing follow-up care may not have specific training in the care of PWD. Continue reading

“The Emperor’s New Clothes”

Professor Martin Green OBE has had an extensive career in NGO development, both in the UK and internationally, and is Chief Executive of Care England, the largest representative body for independent social care services in the UK. He will be speaking at Living and Dying Well with Frailty event on 6 March. Follow the conference on the day via #bgsconf

We have now got a Department of Health and Social Care, what a difference that is going to make (I said sarcastically). With increasing regularity, the Government seems to think that messing about with the headed paper is a route to change. How much evidence do they need that changing titles and rejigging the logos is not going to deliver the transformational change that is required in order to deliver the route map to integrated services. If we had spent one tenth of the money we have spent on new titles, new structures and new logos on culture change, we would be in a far better position than we find ourselves today and the integrated services that citizens are crying out for might be a more attainable goal. Continue reading

The Other “F” Word: Is upstream prevention the way forward for falls?

Steve Parry works in acute medicine and older people’s medicine. He has a special interest in investigation and treatment of falls and blackouts in adult patients of all ages. He is BGS Vice President – Academic and Research.

Since those heady days in the late 90s when our local falls service was started by Rose Anne Kenny, falls services have moved from novelty to mainstream in the UK’s care of older people landscape. But has this service ubiquity made a difference?

Probably. Possibly. Or perhaps not. It’s almost impossible to say. Falls are notoriously poorly recorded and coded, though falls surrogates like hip fracture, the tip of the falls iceberg, provide at least a hard outcome measure universally recorded. Here, however, despite a decade and a half of falls and bone health services, the news is not good. Continue reading

Fostering attachment in dementia care

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. He tweets @berrisfjord

One of the most useful pieces of advice I can share with a colleague working in dementia care is this: whenever confronted with what you perceive to be attention­-seeking behaviour, reframe it to yourself as attachment-seeking behaviour.

Attachment is a hard-wired evolutionary mechanism in all mammals. Simply put, in order to survive, infants must imprint upon a main carer (typically one or both parents) to ensure that their essential needs are met.

These needs are not purely physical (food, drink, protection); the relationship itself is essential. This fact is aptly demonstrated by animal experiments (Harlow’s monkeys and Skinner’s rats, for example) which consistently show that infant mammals raised in isolation – with no access to a main carer to imprint upon – age quickly and die younger. Continue reading

Spring Speakers Series: Are rules of thumb the answer?

Nathan Davies is a Senior Research Fellow at University College London focusing on care for people with dementia towards the end of life and supporting family carers. In this post he talks about his upcoming talk at the BGS Spring Meeting in Nottingham on his work developing rules of thumb for providing care towards the end of life for someone with dementia.

Can rules of thumb help manage uncertainty and the challenges facing practitioners caring for someone with dementia at the end of life?

We know that caring for someone towards the end of life can be a rewarding and intimate experience with that individual and those close to them. However, unfortunately for practitioners it can also be emotionally tough and challenging. This is particularly the case when caring for someone with dementia towards the end of life. Continue reading