Advanced Professionals supporting our frail patients, but how?

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

Nationally there is increasing recognition of the needs of frail older people in health systems, and  the UK’s rapidly ageing population will only increase in the years to come.

Dr Ram Byravan (Consultant and Clinical Director Heart of England Elderly Care) states that the prevalence of multimorbidity is on the rise, with 44% of people over 75 now living with more than one long-term condition –  geriatricians and GPs are uniquely suited to lead the response to the challenges of caring for this group. Continue reading

The GERIATRIC 5Ms – the 5 simple words every geriatrician needs to know (the new mantra)

Frank Molnar is a Canadian Royal College specialist in Geriatric Medicine who serves as the President of the Canadian Geriatrics Society and as the editor of that society’s Continuing Medical Education Journal. He tweets @FrankMolnarCGS

Those outside Specialized Geriatric Services have long had great difficulty understanding what specialists in Geriatrics do. We have contributed to this lack of clarity. As experts in complexity we often have difficulty communicating simply. In well-intentioned efforts to be inclusive and comprehensive we have employed long complex definitions that few outside our field can understand much less recall.

How often have you heard “what do you geriatricians really do?” Are you tired of explaining and re-explaining yourself? Are you looking for a better way to explain and sell our specialty? Continue reading

How older people move in bed when they are ill

Kenneth Rockwood MD, FRCPC, FRCP is Professor of Medicine (Geriatric Medicine & Neurology) at Dalhousie University, and a staff physician at the Halifax Infirmary of the Nova Scotia Health Authority. He tweet @Krockdoc  

The dangers of going to bed”, elaborated by Richard Asher in 1947 illustrates for just how long the hospital bed has been recognized as a hazard for older adults.  It can also be source of rich clinical information.  Understanding this through quantification and plain language descriptors offers one means to “geriatrize” routine care. Like many of such workaday skills, assessing how someone moves in bed is not that tricky, but it requires both the cognitive task of paying attention and the affective one of wanting to do so. Continue reading

Old problems, new solutions

Alistair Burns is Professor of Old Age Psychiatry and Vice Dean for the Faculty of Medical and Human Sciences at The University of Manchester. He is the National Clinical Director for Dementia and Older Peoples’ Mental Health, NHS England. This blog was originally published on the NHS England website. He will be speaking at the upcoming BGS Autumn Meeting in London.

As now seems to be tradition, let’s start with some statistics.

Up to four out of ten people over the age of 65 experience mental health problems. Depression is both the most common and most treatable mental illness in old age, affecting one in five older people in the community. This figure doubles in the presence of physical illness and trebles in hospitals and care homes. Nor should we forget that older people also experience severe mental illnesses.

About one fifth of all suicides happen in older people. Risk factors include: being male, being widowed, increasing age, social isolation, physical illness – present in up to 80 per cent of cases – pain, alcohol misuse and depressive illness past or present. Continue reading

Comprehensive Geriatric Assessment and the role it plays in improving care delivered to the older person

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital Dublin, and Clinical Lead for the National Clinical Programme of Older People in Ireland.  

Ms. Carmel Hoey is a Nursing & Midwifery Planning and Development Officer at the NMPD Unit, Galway, and HSE Service Planner for the National Clinical Programme of Older People in Ireland. 

Countries around the world are seeing significant growth in the numbers of people living longer and healthier lives. We all need to reflect proactively on how we can best maximise the intergenerational benefits this will undoubtedly bring and we must also address the challenges it will generate.

Ireland is no different, with a substantial growth evident in our older population. The number of people aged over 65 years increased by 14% between 2006 and 2011. An increase of 17% is predicted between 2011 and 2016, and a further 17% is expected by 2021 (Central Statistics Office, 2013). Continue reading

New Horizons in multimorbidity

Dr John V. Hindle was appointed Senior Clinical Lecturer in Care of the Elderly, to the School of Medical Sciences, in 2009. He has also held an honorary appointment as Senior Lecturer in Bangor University’s School of Psychology, since 1998. Here he discusses his Age and Ageing paper New horizons in multimorbidity in older adults.

There is increasing political and clinical interests in the concepts of multimorbidity and frailty. For those of us working with older people in primary and secondary care we feel that intuitively we understand these concepts. After all, we have been working towards improvement in care people with multimorbidity and frailty for many decades, and in some ways this was the origin of the specialty of Geriatric Medicine. However, although I have been working as a geriatrician for over 30 years, armed with my intuition, it is only in recent times that I have begun to truly understand the complexities of these issues. In recent years the concept of multimorbidity and particularly frailty have been injected with scientific understanding and explanation. We have come to understand the great impact that these issues have on health and social care, and the pressures that they bring to bear. The complexity of multimorbidity in the context of frailty, dementia and polypharmacy particularly bears a substantial healthcare burden. If like me you struggle to understand the full picture of the relationship between frailty and multi-morbidity, it is worth reading the article on New Horizons on Multimorbidity in Older Adults [1]. This overview helps explain the link between the concepts of multi-mobility and frailty and their relevance to the healthcare of older people. Although many people live with multimorbidity in midlife, particularly contributed to by social deprivation, it is important to understand that complex multimorbidity increases with increasing age.  The majority of older people have two or more long term conditions with care home residents having significant levels of multimorbidity.    Continue reading

Promoting Activity, Independence and Stability in Early Dementia (PrAISED)

Professor Rowan H Harwood is a geriatrician at Nottingham University Hospitals NHS Trust, and the University of Nottingham, with particular interests in delirium, dementia and end of life care, who maintains an active portfolio of research. He tweets @RowanHarwood 

Can exercise-based therapy prevent or delay disability and dependency in those in the early stages of dementia?

We have heard the drum beat of gloomy messages. We cannot continue to cope with ever greater demands for health and social care. Prevention is better than cure, but the NHS is ‘on the hook’ for failing to take prevention seriously.

There is a semblance of a response. Sustainability and Transformation Plans emphasise prevention. We know that some groups, such as people with frailty or dementia, are at risk of crises and functional decline, and on the cusp of dependency and need for services. It makes sense to identify people at risk earlier, and intervene. Continue reading

Quality Dementia Care in Hospital Settings – It can be done!

Lynn Flannigan is an Allied Health Professional who is working as an Improvement Advisor for Focus on Dementia. She tweets @lynnflannigan1 Dr Graeme Hoyle is a Consultant Physician in the Department of Medicine for the Elderly in NHS Grampian. He tweets @AbdnGeriatrics.

Focus on Dementia, in partnership with Aberdeen Royal Infirmary, have produced a publication which explores the critical success factors which lead to improved outcomes for people with dementia, their carers and staff in acute care, which we would like to share with BGS members.

Focus on Dementia is a national improvement portfolio based within the ihub of Healthcare Improvement Scotland. We work in partnership with national organisations, health and social care practitioners, people with dementia and carers to reduce variation and improve quality of care. Continue reading

Geriatric co-management: where is the evidence?

Bastiaan Van Grootven is a PhD researcher at the KU Leuven – University of Leuven in Belgium. His paper Effectiveness of in-hospital geriatric co-management: a systematic review and meta-analysis has recently been published in Age and Ageing. He tweets at @accentvv

Hospitals have long been recognized as a hazardous environment for frail patients. To date, care is still sub-optimal: cognitive and functional problems are not recognised or treated properly and patients are at high risk for delirium and functional decline. In our study, we reviewed 12 experimental studies to evaluate if geriatric co-management can improve outcomes for older in-patients. Co-management was defined as a shared responsibility and decision making between a medical doctor (e.g. surgeon) and geriatrician (or geriatric team) aiming to prevent and treat geriatric complications. Continue reading

The frailty journey so far: where are we heading?

Professor Martin Vernon qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England. Here he discusses the 3rd National Frailty Conference which will be held on 28 September 2017 in Leeds. He tweets @runnermandoc 

The 19th Century term ‘watershed’ refers to a ridge of high ground separating bodies of water flowing in different directions. With this in mind I believe the 3rd National Frailty Conference in Leeds this year truly does mark a watershed moment. It will provide a valuable and timely opportunity both to reflect and add clarity to the new direction of travel we are taking with routine frailty identification and intervention for older people on a national scale. Make no mistake: bringing frailty into the mainstream is game changing.

Over the last year I have been continually impressed by the enthusiasm, ingenuity and commitment around the country focused on improving care and outcomes for our expanding and ageing population.  As a health and care system collectively we have much to celebrate from the hard work already done. Continue reading