Dr. Susan Freter is an Associate Professor of Medicine at Dalhousie University, and a staff geriatrician at the Nova Scotia Health Authority in Halifax, Canada. She has a special interest in delirium prevention and management in orthopaedic patients.
Geriatricians talk a lot about post-operative delirium. It is common after surgeries, especially in people with a lot of risk factors (or we could say, especially in the presence of frailty), and even with recovery it makes for a bad experience. The occurrence of hip fracture, which mostly befalls patients who are older and frail, demonstrates this routinely. We know that taking extra care with at-risk patients can help to prevent delirium. Taking extra care can manifest in different forms: educating the caregivers, paying attention to hydration (is the patient actually drinking the cup of water that is plonked down in front of them?), paying attention to constipation (preferably before a week has gone by), making sure hearing aids are in the ears, and using medication doses that are geared for frailty, rather than for strapping 20 year olds. But how can what we talk about be translated into what we do? Does the ‘doing’ actually work in practice? Continue reading →
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 →
When older people with dementia are admitted to hospital, they are more likely to die or to stay in hospital longer than people without dementia. Many older people have cognitive impairment (CI) (problems with memory and thinking) which is a main feature of dementia, but have not yet been given a diagnosis, or may have CI due to other medical conditions. We investigated how common cognitive impairment is in older patients in hospital, and what the risks are for these patients of staying longer or dying in hospital. Continue reading →
Imagine you’re seeing a consult or you’re on a post-take ward round. How often do we examine a patient and identify cognitive deficits, see that the CT brain scan report and the MMSE score are readily on hand, but then ask staff about the patient’s premorbid cognition and function and are met with blank expressions?
An important factor which complicates the presentation of older people to acute hospitals is the presence of impaired cognitive status (either in the form of dementia, delirium or both). Continue reading →
Hazel Miller, Consultant Geriatrician, Glasgow Royal Infirmary. Delirium enthusiast (or should that be delirium hater?) hoping she has earned the right to don a cape from time to time… Follow me on twitter @hazelmiller99
It’s fair to say that our understanding and management of delirium has increased hugely over the past ten years. It has gone from being the ultimate in Cinderella syndromes (unanticipated, undiagnosed, untreated, unexplained, unnoticed) to having high profile and energetic researchers and advocates (its own Delirium Superheroes). Everyone is being asked to Think Delirium these days. Continue reading →
Suzanne Timmons is a geriatrician working in Mercy University hospital, Cork and a senior lecturer in University College Cork. She has a big clinical and research interest in delirium and dementia care in hospitals.
Delirium is common in older people admitted to hospital, and is a serious condition that needs to be identified quickly on admission. But many busy hospital staff still don’t routinely screen older people for delirium, even when they have known dementia (dementia puts people at very high risk of delirium: see the Cork Dementia Study).
In this study, we tested out five simple cognitive tests to see if they could be used to screen for delirium. The tests were: the Six-item Cognitive Impairment Test (6-CIT; measuring attention, orientation to time, and short-term memory); the Clock-Drawing test; Spatial Span Forwards (pointing to a sequence of squares in a certain order); reciting the months of the year backwards (MOTYB); and copying a shape containing two intersecting pentagons. Continue reading →
Professor Emma Reynish is a consultant physician in Geriatric Medicine at Edinburgh Royal Infirmary, and Professor of Dementia Research, at the University of Stirling where she leads the dementia and social gerontology research group.
In England and Wales more people now die of dementia and/or Alzheimer’s disease than anything else. A similar picture is most likely to exist for the other devolved nations of the UK. For healthcare professionals who are involved in the management of people with dementia, this news offers the opportunity for reflection and action. What does this mean for us and our approach to the older population? Continue reading →
Sue Newsome supported her Father during the last year of his life after he was diagnosed with Vascular Dementia. In this blog she shares her thoughts and feelings from a carer’s perspective.
Supporting someone with Dementia is a contradiction of what it is ok to feel and the guilt about those feelings. A whole raft of thoughts, feelings and behaviours that I continually checked and reviewed. My relationship with Dad changed, he had never said he was scared before and I was to hear this from him throughout his Dementia journey.
Initially in his phone call to me telling me ‘Sue I am scared I am having a Stroke’ which although slurred was articulate, to the same feeling the night before he died when despite his end stage Dementia and aspiration pneumonia, when he struggled to breathe, he managed to say ‘I’m scared’. His fear and mine punctuated our relationship for the last year of his life. Our fear of the future what it held and how we could adapt. It felt like I held my breath for a year. Living on adrenaline, the skipped heartbeat when the phone rang, what had happened to Dad this time! Continue reading →
Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She was one of the speakers at the John’s Campaign Conference. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.
I was proud to be invited to speak this week at the John’s Campaign Conference on 12th October. The conference proved to be an oasis of light, love, and hope in the often gruelling and lonely journey of dementia. Nicci Gerrard and Julia Jones, co-founders of John’s Campaign, who both have personal experience of caring for loved ones with dementia, pulled together a groundbreaking and heartwarming conference, which was nothing short of miraculous. Nicci and Julia began what they described as a ‘kitchen table revolution’ to campaign to change the draconian restricted visiting arrangements of adult hospital care, advocating that people with dementia should have the support of their loved ones while in hospital. Continue reading →
Kirsty Hendry is a research assistant based at Glasgow Royal Infirmary having recently completed her PhD at the University of Glasgow. In this blog she discusses her recent Age and Ageing paper looking at screening of delirium in older, acute care in-patients. Kirsty can be contacted at Kirsty.Hendry0@gmail.com
Delirium, suggested to be the most common psychiatric disorder suffered by older hospitalised individuals, has a low clinical awareness. This is despite existing guidelines such as those produced by the National Institute for Health and Care Excellence (NICE) and Healthcare Improvement Scotland (HIS) being in general agreement that delirium screening is important in older hospitalised patients. Continue reading →