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

A call for collaboration…

Cassandra Leese is a Nurse, Clinical Supervisor and a wannabe dog owner.  She occasionally remembers to tweet @contrarylass

In today’s economic climate, when health and social care are really feeling the crunch, I often find myself feeling morose about the future. Day after day we see the terrible pressures our overstretched services are under, read about the heartbreaking death of another promising doctor burnt out from battling it out in secondary care; or hear about another valuable service making drastic cuts. And selfishly, I’m rather cross that all this seems to have come at a time when I’m incredibly excited to have finally found my place in the nursing landscape, that of gerontology and geriatrics. Coming along to my first BGS West Midlands meeting this spring was a welcome reprieve from the madness spewed daily by the tabloids and renewed my faith that the good guys are still out there! Continue reading

Inspiring carers – all too often overlooked

Alex Greenwood is a recent graduate who’s been exposed to the realities of domiciliary care through her work with Konnektis, a hub digitizing social care and communication, facilitating better care for those in their own homes. She tweets @konnektis 

alexHaving lost my grandparents at an early age, I had very limited understanding of the realities of care. Through my work with Konnektis, and the inherently person-centred process of co-design, I am gaining privileged access to the outstanding work of carers. A commonly misunderstood and under-appreciated profession, carers have  been absorbing the the pressures of our overstretched care system for years and the sector is now at breaking point. Whilst recent public concern over sustainability of care in the context of an aging population is an important debate, it is these inspiring carers – all too often overlooked – whose stories I wish to share in this space. Continue reading

Multi-morbidity – the case for change

David Paynton is a GP in an inner city surgery. He is also the Clinical Lead for Commissioning for the RCGP.

Dr David Paynton

Generalists are the solution.

For too long policy makers have ignored what clinicians on the front line have been telling them, people with multiple conditions not only exist but are the mainstream.

It is our failure to recognise this fact that has put pressure in the system as the NHS struggles to keep its head above water especially when one adds social factors, depression and mental health into the mix of complexity.

The RCGP “responding to the needs of patient with multi-morbidity” has created a powerful case for change with the need to substitute ever-increasing investment into super specialism by a call for the generalist to support those with multi-morbidity in the community. Continue reading

Geriatric conditions, are they recognized as relevant problems by community dwelling older people?

Marjon van Rijn is a PhD candidate at the department of Geriatric Medicine in the Academic Medical Center in Amsterdam and lecturer at the School of Nursing, Faculty of Health, Amsterdam University of Applied Sciences the Netherlands. In this blog she comments on her recent paper in Age and Ageing.

aaComprehensive Geriatric Assessment (CGA) is increasingly implemented in community care settings and involves an assessment of physical, psychological, functional and social geriatric conditions, such as urinary incontinence, memory problems, fall risk and loneliness.

In this study, CGA is part of a complex intervention to prevent disability in community dwelling older people. Older people with an increased risk of functional decline, according to the Identification of Seniors at Risk questionnaire that was validated for primary care, were invited for a CGA at home. A community care registered nurse visited older persons to conduct the CGA, and if necessary, made an individual care plan with several follow up visits. Continue reading

Dementia friendly communities; compassionate and collaborative

Dr Fiona Marshall is a neuroscientist working on treatments for Alzheimer’s disease and other conditions. Dr Marshall also volunteers as an Alzheimer’s Research UK Trustee and is Founder and Chief Scientific Officer of Heptares Therapeutics.

dementiaIn recent years there have been major initiatives to change the way that society is able to respond to the growing number of people with dementia – we are aiming for “dementia friendly societies” where people with dementia and those who care for them are not alienated, or even merely tolerated, but enabled to sustain their local connections and lead meaningful lives. Living with dementia is often full of many challenges and can leave families isolated, lonely and exhausted; as a society we need to minimise these ongoing issues and promote valued connections within local communities. Continue reading

Paramedics; Frailty detection and admission avoidance

Dr Amy Heskett works as a Speciality Doctor within the West Kent Urgent Care Home Treatment Service. This team aims to prevent hospital admissions by working alongside GPs, nurses, carers and paramedics to provide a holistic management plan. She writes a blog about her experiences on her blog communitydoctoramy.wordpress.com and can be found on twitter @mrsapea

paramedics-photoThe West Kent Home Treatment Service provides home-based medical treatments to avoid hospital admissions when appropriate. Referrals come from GPs, Community Nurses and Paramedics; but more importantly our team widens as soon as we start to work with patients, their family and carers.

A day of referrals began with a call from a Paramedic who had attended V after she had fallen in her bedroom, but luckily sustained no injury. This was on a background of dementia and the need for daily support from her son to assist with meals, prompt medications and support trips made outside the home. V’s only other medical history was that of hypertension and one fall a year ago. V was normally able to get herself to the toilet and used a stick to mobilise slowly indoors; while carers attended once a day to provide personal care. Continue reading

Take the high road or the low road…but don’t miss the BGS in Glasgow this November!

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President-Elect of the BGS. She is currently Clinical Lead for integration in Leeds and Chairman of the BGS Community Geriatrics Special Interest Group. She tweets @EileenBurns13

eileenburnsThe Autumn Meeting of the BGS in Glasgow this November looks to be a great event with a broad range of topics and sessions.

But the day that excites me the most is Wednesday November 23rd.

Many of us have been approached by commissioners of services to “move into the community” in some way (in whichever part of the UK we are based). Others have seen the need to look at alternatives to acute hospital care for older patients with less severe illnesses, and it’s been clinicians rather than commissioners or managers who have been the spark for new developments. Continue reading

Esther Clift’s African Blog Series; Part 2 ‘The concept of Mzee and Heshima’

Esther Clift is a Consultant Practitioner Trainee in Frailty with Health Education Wessex. This is the second part of a four part BGS blog series about her time in Africa. She tweets @EstherClift

estherIt is well recognised that in much of East Africa the concept of ‘Heshima’ or respect for ‘Wazee’ is still widely practised. The term “Mzee” describes an older person, often with greying hair, but has a tone of respect and deference to it. I heard the term used widely, from young white men joshing their father, to students upholding a faithful teacher, but always with a tone of love and respect. There is no direct translation into English were our language for ageing is often loaded with a derogatory tone and disliked by one group or another. Phenomenology is a challenge we are all too familiar with in Medicine for Older People! We often refer to such expression as an example of how Western cultures need to learn from those of the global South. Continue reading

Making it happen! An Acute Clinical Team in action

Firdaus Adenwalla is a consultant geriatrician in ABM University Health Board.  He is part of the Neath Port Talbot Acute Clinical Team providing an intermediate care service for the community. 

The media reminds us daily of how our health service is not keeping pace with our changing world. The negativity around health care, hospitals overflowing, not enough doctors, not enough nurses, GP practices closing, and the list goes on. Increasing demand, improved technology and our increased life expectancy, all compound the notion that our health service cannot meet our needs. Continue reading