Attitudes and opportunities: Medical students’ and doctors’ attitudes towards older patients

Dr Rajvinder Samra is a Chartered Psychologist working as a Lecturer in Health and Social Care at The Open University. She enjoys researching the influence of attitudes and personality in medical settings and tweets at @RajvinderSamra Read her Age and Ageing Paper.

Social psychologists have been interested in attitudes for about 90 years now. Debate rages on about how much of what we do can be predicted from our attitudes. No doubt, over the past year, you will have read newspaper articles about how much someone’s attitude to a prominent issue covered in the media predicted their likelihood to vote for Brexit or Trump. This is an example of the attitude-behaviour link and the media trying to establish patterns so we can understand society better. The influence of attitudes on healthcare are frequently overlooked, but doctors’ or patients’ cognitive reasoning, preferences, values and emotions (i.e. all the things that come together to make up attitudes) can have a significant and meaningful impact on how services can, or should be, delivered. Continue reading

Heatwave! Acting on the weather forecast to reduce morbidity and mortality in frail older people

Duncan Forsyth has been a consultant in geriatric medicine, at Addenbrooke’s Hospital, for 27 years. A believer in global warming, he noticed that staffing levels in hospital were often inadequate to ensure adequate hydration of his patients during any heat-wave and that admissions due to acute kidney injury were especially prevalent in care home residents and frail older people receiving substantial packages of home care. He advocates incorporating the weather forecast in to the risk stratification for hospitalised patients, care home residents and those receiving three or more home care calls per day; in order to promote a review of potentially nephrotoxic medication

As you look forward to enjoying the (hopefully) warm summer weather, spare a thought for those less fortunate than yourself, who are frail; less able to increase their fluid intake; who are dependent upon others for provision of drinks; and at risk of acute kidney injury due to the potentially nephrotoxic drugs that they are prescribed. A leader article in the BMJ 2009 (Olde Rikkert, et. al) highlighted the dangers of heat waves and dehydration in frail older people and the resultant excess mortality in this population. Continue reading

Depression among older people living in care homes – a call for good practice examples

Caroline Cooke is Policy Manager at British Geriatrics Society. Caroline is currently supporting a joint project being carried out by BGS and the Old Age Faculty at the Royal College of Psychiatry. Here she explains the aim of the project and how you can help to make it a success. 

In the UK 405,000 older people (65+) currently live in care homes. Older people living in care homes have complex health needs and most residents have multiple long-term conditions, significant disability and frailty which affect both their physical and mental health. Dementia affects the majority of residents in care homes to some degree and depression is common. Integrated provision is required to meet the needs of care home residents who require co-ordinated input from generalists and specialists in multiple disciplines, and partnerships are essential to integration.  Continue reading

Autumn Speakers Series: Benchmarking Practice in UK Long-term care, can we make it work?

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham and a Consultant Geriatrician at Derby Teaching Hospitals NHS Foundation Trust. He is a specialist advisor to the East Midlands Academic Health Sciences Network Patient Safety Collaborative on Care Homes and will be speaking at the upcoming BGS Autumn Meeting in London. He tweets at @adamgordon1978

Contrary to what might be gleaned from the lay media, the quality of care received by residents in care homes – whether from care home or National Health Service staff – is frequently exceptional.  Care home residents are amongst the most complex recipients of care within the health and social care system and so they can stretch even the most capable and dedicated of staff. It is therefore, perhaps, unsurprising that things do not always go to plan – even in the best of homes. There are also, undoubtedly, examples of care homes where things go wrong more frequently – where shortcomings in care are not so much sporadic, as systematic. This is unacceptable. Continue reading

Sit up, Get Dressed, Keep Moving: Deconditioning Syndrome Awareness and Prevention Campaign: why is everyone talking about it?

Dr Amit Arora is a consultant geriatrician at the University Hospital of North Midlands and has served as Chairman of England Council of the British Geriatrics Society. He and his team have developed the campaign “Sit up, Get Dressed, Keep Moving” which is being adopted in many NHS hospitals and abroad.

In David Mitchell’s recent article “‘Get Out of Bed!’ scheme is more symptom than solution for the NHSwhich was published on the Guardian website he appreciates the simplicity and value of the campaign but questions whether the campaign is financially motivated.

I congratulate and thank Mitchell for raising awareness about benefits of early functional normalisation: “The Principle that people who have been hospitalized should re-start normal life as soon as they can is already well established”. He further writes that “it’s suspicious that a campaign exclusively pushing the idea of getting up and going home should coincide so precisely with the NHS’s dire shortage of money.”  I would like to detail how the campaign started and how it is free from any ‘spin’. 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

Better Transfers of Care for Older People – how to improve transitions of care

Dr Olivier Gaillemin trained in Geriatric Medicine and now works as a consultant physician in Acute Medicine at Salford Royal Foundation Trust. He has developed a Frailty Unit embedded within the Acute Medical Unit. He sat on the NICE guideline development group for NG27 – Transitions of care for adults with Health and Social Care needs – as well as on the committee for the associated NICE Quality Standard QS 136. He attended the King’s Fund conference as a speaker.

On the day of the launch of their report on STPs, the King’s Fund hosted an event on how to improve transitions of care for older people admitted and being discharged from hospital. In these times of very real stress to the systems in which we work, when too often we seem to fail those vulnerable people we are all invested and motivated in supporting, it is easy to become despondent. Continue reading

A New Holistic Approach to Pain Management in Older People

Nan Ma is specialist registrar in clinical Gerontology and Aza Abdulla is a consultant geriatrician and general physician at the Princess Royal University Hospital, Kings College NHS Foundation Trust. He is co-founder of the Special Interest Group on Pain in Older People in the British Geriatrics Society (BGS) and participated in producing the first National Guidelines on Management of Pain in Older People. He is also the immediate past president of the Geriatrics & Gerontology Section at the Royal Society of Medicine.

painPain in older people is under-reported and often poorly appreciated. For many, it is seen as part of normal ageing and has to be accepted. It is also a subjective feeling (different people have different pain thresholds) making it difficult for the clinician to quantify its impact in an individual patient. Consequently, it may be overlooked as an important factor that can affect older people’s wellbeing. In fact, chronic pain has a huge influence on quality of life (QoL) through its effects on the physical and mental state, which in turn adversely impacts on the older individual’s economic and social status (effects on carers, friends and family). Inadequately controlled pain perpetuates disability, anxiety, and depression all interfering with the overall QoL. It follows that effective management of pain is crucial in optimising welfare in the older person. Continue reading

Hospital discharge – everyone loses when its handled poorly

Dr Tom Nutt is Chief Executive of Healthwatch Essex and Dr Oonagh Corrigan led the hospital discharge research as Commissioning and Research Manager. Dr Alex Georgiadis is currently Acting Research and Commissioning Manager at Healthwatch Essex and co-authored the study. Healthwatch Essex tweets at @HWEssex

dischargeA major two-year research study undertaken by Healthwatch Essex into the experiences of patients discharged from three hospitals in the county has provided a comprehensive picture of this thorny issue. The report encourages local health and social care commissioners to overcome artificial boundaries and develop a unifying vision of care to provide high quality care.

The report, published at the end of last year, marks the organisation’s most ambitious project to date, involving almost 200 hours of observation and over 200 interviews with patients, staff, and family carers. 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