Autumn Speakers Series: “Interface medicine”

Eva Kalmus has been working as Interface Medicine GP at Epsom and St Helier NHS Trust since February 2015 and previously looked after inpatient beds at New Epsom and Ewell Community Hospital. She was also a community ward GP in Wandsworth and virtual ward lead in Epsom. Currently her work is focussed on discharging patients for whom the acute hospital no longer offers net benefit as quickly and efficiently as possible and improving communication, aiming for primary, community and social services to pick up where secondary care stops. She will be speaking at the upcoming BGS Autumn Meeting in London.

“Interface medicine” has a number of definitions in different contexts—it seemed an appropriate title to describe primary care-trained doctors working in community or hospital settings whose aim is to maximise quality of life for older frail patients using skills and knowledge from both general practice and geriatric medicine.

On one side are Interface Medicine GPs now titled GeriGPs within BGS; on the other are Community Geriatricians but there is significant overlap in what we do. Working together we can best support our patients—and it is a very satisfying extension to our core business. Continue reading

Improving Continence Care for Older People

Vikky Morris is Chair of the BGS Bladder and bowels Special Interest Group. She will be speaking at the upcoming event Improving Continence Care in Older People on 21 September in Manchester.

1 in 3 women and 1 in 7 men over the age of 65 experience urinary incontinence. It is a significant problem associated with falls, fractures, social isolation, depression, urinary tract infections and moisture lesions. Faecal incontinence affects up to 10% of the population, although its prevalence is much higher in older people, nursing home residents (up to 60%), patients with cognitive impairment and neurological conditions. Numbers are also likely to be an underestimate due to the stigma attached to incontinence. Both urinary and faecal incontinence are associated with great expense, both personal and to the NHS (more than 2% of the NHS budget). In addition, in older people, incontinence is second only to dementia as a reason for admission to a residential or nursing home. Continue reading

Forging international links, sharing ideas and developing friendships to build research collaborations

Dr Jenni Burton (@JenniKBurton) from the University of Edinburgh and Dr Patrick Wachholz (@Patrick23711608) from Sao Paulo State University joined 12 researchers from across the UK and 17 from across Brazil to participate in a Newton Fund researcher links workshop: ‘Identifying and addressing shared challenges in conducting health and social care research for older people’, held between the 11th-15th of June in Botucatu, Brazil. The workshop was funded by the British Council and the Sao Paulo State Research Foundation (FAPESP) and organised by the University of Nottingham and UNESP.

Over the course of five days we worked together under the supervision of our Brazilian and UK mentors (Prof Alessandro Ferrari Jacinto, Prof Paulo Villas Boas, Prof Vanessa Citero, Dr Adam Gordon, Prof Tom Dening & Dr Jay Banerjee) to share ideas, learn from each other and work on developing new collaborative research projects.

To set the scene, Brazil is the largest country in South America with an estimated population of 16 million adults aged 65 and over. Sao Paulo State has a population of 41 million people and is the most economically and research active state in Brazil with 34% of the GDP. Amazing stat of the week was that for every four research papers published in Latin America, two will be authored in Sao Paulo State! Continue reading

Autumn Speakers Series: The boundary between health and social care

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham.  He is currently principal investigator for the Dunhill Medical Trust funded PEACH study which considers using quality improvement collaboratives to implement Comprehensive Geriatric Assessment in care homes.  His twitter handle is @adamgordon1978.  You can follow the PEACH study @PEACHstudy. He will be speaking at the upcoming BGS Autumn Meeting in London.

Care home residents in the UK receive their healthcare predominantly through the National Health Service. Their social care – primarily focussing on enablement to support activities of daily living and supporting participation in society – is provided by staff in their care home.

Or at least that’s how it looks on paper.  In reality, the boundary between health and social care is less well defined.  Providing care to the older people who live in care homes, many of whom have multiple conditions and are approaching the end of their life, requires frequent give and take between healthcare and care home staff. Continue reading

BGS Management and Leadership Weekend: ‘LITTLE SPARKS’ to ‘BIG BANGS’

Barry Evans has been a specialty registrar in geriatric and general internal medicine since 2014. He has an interest in innovative models of care and that improve the health and quality of life of older people and QI Projects which improve the working lives of doctors in training. Here he discusses the Trainees’ Leadership and Management Weekend. He tweets @barryjames86 

Having commenced training in geriatric medicine in 2014, I’m often surprised by the speed at which my training has gone. If the last couple of winters in the NHS are anything to go by, there is no shortage of experience in clinical work for trainees in geriatric or internal/acute medicine, and despite the recently promised ‘cash injection’ for the NHS, there is unlikely to be a shortage of clinical work soon!

This clinical work allows us to see the entirety of the older person’s care journey, as geriatricians work in the community, in A&E, in acute medicine, on wards (medical and surgical!), and in intermediate care/rehabilitation – to name just a few. Continue reading

We need to talk about loneliness

Dr Shibley Rahman is an academic physician interested mainly in dementia and frailty. He tweets at @dr_shibley

This was my first ever BGS conference, just down the road from me, at the Wellcome Collection, London. The day was spent discussing ‘Loneliness in older people and its impact on health’ chaired by Professor Tahir Masud (@TashMasud), President-Elect of the British Geriatrics Society.

In a recent paper by Utz and colleagues (2014), the following is offered:

The term loneliness is often equated with social isolation or social participation. However, seminal work attempted to distinguish loneliness from these constructs by defining it as the cognitive or psychological appraisal of social relationships and activities. For example, loneliness has been conceptualized as the lack of “meaningful” social relationships or “incongruence” between actual and desired levels of social interaction.” Continue reading

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. Continue reading

Identifying older patients with frailty from routinely collected hospital data

Dr Thomas Gilbert is a consultant geriatrician (Hospices Civils de Lyon, FRANCE), with interests in Health Services Research. He worked with Dr Jenny Neuburger and colleagues from the Nuffield Trust in London on the development of the Hospital Frailty Risk Score whilst he was a clinical research fellow under the mentorship of Prof. Simon Conroy in Leicester (Department of Health Sciences).  He will be speaking at the Urgent care for frail older people event on 25 May at Horizon in Leeds. 

Advances in health care have helped people in developed countries live longer than ever before. This is good news for all of us, but it also presents a challenge to our health systems and a need to rethink the way that we provide healthcare. Out of nearly 20 million people admitted to an NHS hospital in the UK in 2015, a quarter were aged 75 years or older, and this proportion is set to increase.

For some older people, hospitalisation is associated with increased harms over and above their presenting clinical condition. Recognising that age alone is insufficient to identify and respond to such vulnerability, the term ‘frailty’ is increasingly being employed to highlight patients exposed to an increased risk of poor outcomes and likely to require higher resource use. Continue reading

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. Continue reading

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. Continue reading