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

Only half of people with dementia get annual medical review

Claudia Cooper is an honorary consultant old age psychiatrist with Camden and Islington NHS Foundation Trust. She focuses on research related to dementia and mental health in older age. Here she discusses her recent Age & Ageing paper Inequalities in receipt of mental and physical healthcare in people with dementia in the UK.

Age&Aging front cover design chosen chosenPeople with dementia experience more mental and physical health problems than people without dementia, and more frequently take medication for mental health problems, so ensuring the get fair access to mental and physical healthcare is important.

Our study looked at primary care records of 68, 061 people with dementia and 259,337 people without dementia between 2002 and 2013. We looked at how rates of mental health medication prescribing (antipsychotic, antidepressant and sedative drugs);  contact with General Practice surgeries and physical health checks  (blood pressure, weight monitoring and an annual review) varied between people living in more and less deprived areas, and between men and women. Continue reading

Delivering high quality care for older people – are you sure you do?

Dr Christine McAlpine is a geriatrician and stroke physician in Glasgow, Chair of the British Geriatrics Society Scotland Council and the geriatric medicine speciality adviser to the Chief Medical Officer for Scotland. She chaired the multiprofessional group which produced the Healthcare Improvement Scotland Standards for the care of older people in hospital, published in 2015. She tweets at @CHRISTINE030214

bgs-principles-and-standards-page-001Health care for older people is core business for the NHS. Getting health care right for older people helps ensure we get it right for everyone.  Today the BGS publishes ‘Effective healthcare for older people; Principles and Standards‘, with a particular focus on those living with frailty.

The Principles and Standards are for the health care of older people in any setting –  not only for geriatric medicine wards, but for all of the health care departments older people may encounter – Emergency Medicine, ophthalmology, gynaecology etc – across the spectrum of care.

The concise 4-page paper includes core standards for care delivery and reminds us of the principles enshrined in human rights and equalities legislation. It outlines principles of health care for older people including effective, accessible and timely care; autonomy, choice and person centred care; and ensuring safety and dignity. Continue reading

Every older person in a care home needs access to high quality healthcare

chg-v2The British Geriatrics Society (BGS) calls for everyone who commissions or provides healthcare in care homes to follow the principles of good practice set out in the guidance we are publishing today, so that every older person who lives in a care home in the UK has access to high quality healthcare which fully meets their needs. Based on the clinical expertise of our members our updated guidance sets out clinical and service priorities for how best practice can be achieved, and provides clear indicators of what successful delivery looks like for older people, their families and carers.

In the UK 405,000 people over the age of 65 years old currently live in care homes. This represents 16% of older people over the age of 85. Their healthcare needs are complex and the average care home resident has multiple long-term conditions, and frailty. They are likely to have better health outcomes if health services reflect these needs, and they have access to comprehensive, multidisciplinary assessment, with input from healthcare specialists trained in the care of complex medical problems in later life. Continue reading

An overview of the Policy Forum for Wales event

Hospital in Bridgend, Wales. He is a care of the elderly physician with an interest in Parkinson’s Disease and movement disorders.
flag_of_wales_2-svgOrganised by the Policy Forum for Wales, this event which was held on 19 October, provided the Welsh Government, and other agencies, the opportunity to engage with key stakeholders and discuss public health policy issues that particularly affect Wales. This seminar was about involving health and social care senior policy makers in developing a vision for Wales and bringing together multiple organisations (public sector, voluntary and third sector) to have a dialogue about how best to influence the Welsh Government’s health and social care policies.

The day was kicked off by chair Mr Huw Irranca – Davies AM, with a cross party group on cancer introducing the theme of the day. This was followed by brief from Professor Siobhan McClelland on current trends in health care in Wales including a £700 million gap in the budget for health and social care (10% of the total health budget). She emphasised that service configurations should be decided according to local need rather than by committee or Government mandate. Continue reading

Joining up care for older people with frailty

Across the UK, innovative collaborations between GPs and specialist geriatricians are paving the way to better care for older people with frailty

rcgp-bgd-coverA new joint report from the Royal College of GPs and the British Geriatrics Society has been published today, showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Advancements in medicine are a great success story, and as a result our patients are living longer, but they are also increasingly living with multiple, long term conditions and that brings a number of challenges for general practice and the wider NHS.

Older patients make up the majority of those attending GP surgeries and acute hospitals so getting the right combinations of care in the right place and at the right time is crucial to avert avoidable admissions and delayed discharge from hospital. Continue reading

Time to Up our Game (TUG) in the management of falls!

Debra Eagles is a Resident in Emergency Medicine at The Ottawa Hospital in Canada. Here she discusses her recent Age & Ageing paper.

970Your medical student reviews a case with you.  It is a 78 year old woman who presents with right knee pain subsequent to a recent fall.  The student has taken a comprehensive falls history and physical examination.  After reviewing the knee x-ray, the student summarizes the case by stating the patient suffered a mechanical fall, luckily without evidence of fracture and can be discharged home.  But wait, you say, can she safely mobilize?  The medical student smiles triumphantly, yes, she was able to use her walker to ambulate a short distance.  Excellent, you say, she can be discharged home.  But you wonder, is there anything further you can do to determine what her risk of negative outcomes associated with falling is. Continue reading

Sometimes good things really do come for free!

Mary Ni Lochlainn is an Academic Clinical Fellow in Geriatric Medicine. BGS Junior Members’ Representative and on the BGS Trainee’s Council. She works at Queen Elizabeth Hospital, Woolwich @younggeris. Her email is marynilochlainn@gmail.com

picture-for-bgs-website-mary-ni-lochlainnMembership of the British Geriatrics Society (BGS) is open to all medical students and Foundation Year doctors and is completely FREE!

I joined the BGS as a first year medical student and thus have benefited from free membership for quite a few years now, and would highly recommend it to all those who are interested in the healthcare of older adults.

You do not have to have your mind set on specialising in geriatric medicine; as we all know the proportion of people older than 65 is growing faster than any other age group (WHO, 2002). In the United Kingdom the population aged 65 years and older is set to increase by two-thirds to reach 15.8 million in 2031 (Wise, 2010). Geriatric medicine is set to become the largest and most exciting specialty in medicine! Beyond that, healthcare professionals in all other specialties (medical, surgical and the rest) will be dealing with more and more older adults in their services. Continue reading