Loneliness; A public health epidemic

Helen Stokes-Lampard is Chair of the Royal College of General Practitioners (RCGP), the UK’s largest Medical Royal College, representing over 52,000 family doctors across the UK. She is a part-time GP partner at The Westgate Practice in Lichfield, Staffordshire, and was the Head of Primary Care Teaching (undergraduate) in the Medical School of the University of Birmingham until becoming RCGP Chair. She will be speaking at the Loneliness in Older People and its Impact on Health event on 13 June at Wellcome Collection in London.

As a GP in the Midlands, I see patients in my surgery day after day with a variety of different health needs. We GPs are privileged to be the cornerstone of our communities, and the vast majority – over 85% of people – come to see their GP at least once a year.

Last year, at my speech to RCGP Annual Conference, I introduced the world to my patient, Enid, a character who every GP will recognise from their own surgery and their own community. My inspiration for this character stems from the type of patient which every GP will be aware of: she’s 84, she has hypertension and type 2 diabetes, and has intermittent flares of osteoarthritis pain in both her hips. Most significantly, she recently lost Brian, her husband of 62 years.

From uncertainty to understanding: Can psychodynamic theories improve our care of older adults?

Dr Juliette Brown is a locum consultant psychiatrist in CMHT for Older Adults in Newham and in liaison psychiatry at Newham University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS. 

Dr Cate Bailey is a Specialist Registrar in Psychiatry working in Liaison Psychiatry at Homerton University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS.

‘Psycho-analysis is not a child of speculation, but the outcome of experience; and for that reason, like every new product of science, is unfinished. It is open to anyone to convince himself by his own investigations of the correctness of the theses embodied in it, and to help in the further development of the study’ Sigmund Freud, On Psycho-analysis (1)

Can psychodynamic theory improve our care of older adults? A century of psychoanalytic thought and a half century of work by old age psychiatrists and psychotherapists suggest that it can (2-3). Psychodynamic approaches help in making sense of complex, bewildering and frustrating clinical encounters through the recognition and observation of unconscious communication (4). By becoming aware of the inner and outer worlds of ourselves and our patients we can provide more thoughtful and effective care.

Beyond text and images: Tackling loneliness with technology

Dr Eiman Kanjo is a Senior Lecturer at Nottingham Trent University. Eiman has written some of the earliest papers in the research area of mobile sensing and she currently carries out work in the areas of technologies and data science for health & Wellbeing, Smart cities, Environmental Monitoring and its impact of health, and wellbeing monitoring. She tweets @eimankanjo She will be speaking at the Loneliness in Older People and its Impact on Health event on 13 June at Wellcome Collection in London.

Loneliness is a sad and frustrating event in anyone’s life, however its impact is more damaging for older people. Many older adults have lost so much of their independence they are left with memories of the life they once knew. Things that were once so important to them are taken away, such as the ability to drive, go to church, read a book, or even connecting with their loved ones.

Among the ways to combat loneliness, technology is starting to play a major role in helping to bridge the gap of interactions that older adults need.

In general, older adults do not necessarily dislike one form of technology or another, however, they are sometimes distrustful about the need for technology or about their ability to utilise it.

The Lonely brain

Dr Samuel Barnes Ph.D is a Lecturer at Imperial College London in the Division of Brain Sciences and was recently awarded a UK Dementia Research Institute Fellowship. The goal of his research is to understand the role of neural circuit plasticity in aging and neurodegeneration. His group uses a combination of in vivo voltage and calcium imaging, bioelectronics and electrophysiology to investigate the neural plasticity factors that make the aged brain susceptible to neurodegeneration and ultimately dementia. You can read more about his work here.  He will be speaking at the Loneliness in Older People and its Impact on Health event on 13 June at Wellcome Collection in London.

Daydreaming can be one of life’s great pleasures. Losing yourself in a thought or spending time quietly reflecting on the day’s events is an important part of modern life. But what if solitary thought was the only option? For many older people periods of loneliness are all too frequent. Such periods of social isolation can involve little to no contact with people for prolonged periods of time. What do these prolonged stretches of loneliness do to the brain?

To answer this question, we must consider how the brain processes the sensory and social world. The substrate of thought is the electrical activity that flows between neurons in the brain. These tiny nerve cells are connected to each other forming complex circuits that store and process sensory experience.

Retirees leaving sociable workplaces may experience accelerated cognitive decline

A study published recently in Age and Ageing, the scientific journal of the British Geriatrics Society, provides new evidence that workers retiring from occupations which involve high levels of social stimulation may be at greater risk of accelerated cognitive decline in later life.

The study, which was conducted by researchers at University of Liège, in collaboration with the Universities of Bordeaux and South Florida, surveyed 1,048 individuals over the age of 65 from Bordeaux. Participants were evaluated at 2 year intervals for a period of 12 years. Psychologists’ evaluations included detailed assessments of subjects’ mental cognition, general health and information about their former occupation. Three independents raters were asked to evaluate the level of social and intellectual stimulation for each occupation.

PSP – more than just difficult PD, and how geriatricians have a key role to play…

Carol Amirghiasvand is the Helpline and Information Services Manager for the PSP Association (PSPA). She has worked in the voluntary sector for nearly 20 years providing information and support to people with neurological conditions. Her current role is managing the Information and Support services provided by PSPA to ensure knowledge and understanding of PSP and CBD is increased and that people affected by these conditions have access to a more acceptable quality of care and support. Follow the PSP Association @PSPASSOCIATION

Progressive Supranuclear Palsy (PSP) is a commonly misdiagnosed neurological condition with an average age of onset of 63. Almost 40% of respondents to a recent survey by the PSP Association saw a geriatrician before being referred to a neurologist, meaning that geriatricians can play a vital role in identifying the disease and ensuring rapid access to the most appropriate care.

Changes to Deprivation of Liberty Safeguards and what they mean for clinical practice

Sarah Goldberg is Associate Professor in older persons care at the University of Nottingham; Rowan Harwood is Professor of geriatric medicine at Nottingham University Hospital; Adam Gordon is Honorary Secretary of the British Geriatrics Society and a consultant geriatrician

Health care professionals in England and Wales, have been slightly Janus-faced about Deprivation of Liberty Safeguards (DoLS) since the roll-out in response to the Bournewood judgement in 2008.

On one hand they have been seen as an important adjunct to the 2005 Mental Capacity Act, protecting vulnerable patients from the worst vagaries of best interest assessments. On the other hand, they are considered logistically burdensome, generating both additional paperwork and workload for hard-pressed health and social care professionals.

Deprivation of liberty safeguards

In March this year, the Supreme Court handed down its judgement on two cases which will have significant impact in determining whether arrangements made for the care and/or treatment of an individual lacking capacity to consent to those arrangements amount to a deprivation of liberty.

Key points of the Supreme Court Judgement: The Court ruled that there is a deprivation of liberty in terms of Article 5 of the European Convention on Human Rights if the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements. Whether the person objects to the arrangement or not is irrelevant, as is the ‘relative normality of the placement in the context of the person’s needs.’

A new look at case reports in Age and Ageing journal

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. Here he introduces two case reports from the latest issue of the journal.

The inclusion of case reports in Age and Ageing emphasises the clinical focus of the journal. Typically they illustrate either classic presentations of uncommon diseases or unusual presentations or aspects of common diseases in older people. At their best case reports provide a blueprint for high-quality clinical decision making and health care in ‘tricky’ cases. They often carry general lessons that can be learned from specific challenging circumstances. Case reports are generally valued by our readers, providing clinical education and giving balance to the journal’s content.

In the current issue of the journal we report a case of an unusual infection causing acute neurological deterioration (a stroke mimic), and of a rare but treatable disease, Anti-N-Methyl-D-Aspartate (NMDA) receptor encephalopathy. In both these cases failure to make the diagnosis would likely have carried catastrophic consequences.

In this issue we have a new development, adding a short expert commentary by Tom Hughes (from Cardiff) to the case reports which places them in a wider context, helping to bring the implications of the cases to the fore.

Good mental health care is a part of good geriatrics

Tom Dening is Professor of Dementia Research at the Institute of Mental Health at the University of Nottingham. He tweets at @TomDening 

Sir Simon Wessely (yes, we are going through a phase where the RCPsych Presidents get gongs – I suppose it’s cheaper than investing in mental health services) has made some eloquent points about the current state of mental health provision.

He didn’t specifically mention older people, though of course they have common mental disorders like depression. Also he didn’t talk about the complex world where physical and mental ill health conspire against people and bring them into contact with geriatrics or old age psychiatry, or both.