Asking the Big Questions in Dublin’s Fair City – Part 2

Mary Ni Lochlainn is an Academic Clinical Fellow in Geriatric Medicine. She works at King’s College Hospital NHS Foundation Trust.

In the world of Alzheimer’s research we heard from Professor Michael Rowan, who focused on amyloid and ageing. Sleep and mood disorders can pre-date dementia diagnoses, and we see circadian rhythm disturbances in Alzheimer’s disease (AD). Is there a window of opportunity here for preventative interventions? Alzheimer’s is a disease of abnormal protein aggregation – both amyloid and tau. Protein clearance tends to happen at night. Can we draw connections here? Prof Rowan explained that a recent New England Journal of Medicine paper showed 30% of patients didn’t have any amyloid even though they had been diagnosed with AD and enrolled in a trial. So what does this mean? Do these patients have another dementia? It cannot be denied that a blood or cerebrospinal fluid test would be very helpful in this diagnostic process. Continue reading

Asking the Big Questions in Dublin’s Fair City – Part 1

Mary Ni Lochlainn is an Academic Clinical Fellow in Geriatric Medicine. She works at King’s College Hospital NHS Foundation Trust.

This February marked the first, hopefully of many, Biogerontology for Clinicians International Conference, held at the state-of-the-art Mercer Institute of Successful Ageing (MISA) at St. James’ Hospital, Dublin. Hosted by the inimitable Professor Rose Anne Kenny, of Trinity College Dublin, and staff of The Irish Longitudinal Study of Ageing (TILDA), the programme boasted twelve expert speakers across a day and a half, with the aim of putting recent advances in biology in context with the pathology of ageing. The idea was to bring together leaders in ageing from various backgrounds, to ‘generate meaningful collaborative, translational approaches with significant potential strategic value to service users.’ And it certainly achieved those aims. Continue reading

Spring Speakers Series: Are rules of thumb the answer?

Nathan Davies is a Senior Research Fellow at University College London focusing on care for people with dementia towards the end of life and supporting family carers. In this post he talks about his upcoming talk at the BGS Spring Meeting in Nottingham on his work developing rules of thumb for providing care towards the end of life for someone with dementia.

Can rules of thumb help manage uncertainty and the challenges facing practitioners caring for someone with dementia at the end of life?

We know that caring for someone towards the end of life can be a rewarding and intimate experience with that individual and those close to them. However, unfortunately for practitioners it can also be emotionally tough and challenging. This is particularly the case when caring for someone with dementia towards the end of life. Continue reading

A Taste of the BGS

Fran Kirkham is an F2 doctor at the Royal Sussex County Hospital in Brighton, having graduated from the Cambridge Graduate Course in Medicine in 2016. She originally did an English degree at Cambridge University and worked in PR and Communications for 7 years. She hopes to pursue a career in Community Geriatrics.

“So we drove on toward death through the cooling twilight.”
~ The Great Gatsby, F. Scott Fitzgerald

An FY2 taster week can have a multitude of meanings. For some, it offers a reprieve from their mundane day job, almost as desirable as annual leave. For others, it is an opportunity to try a specialty that piqued their interest as a student. Yet others use it for cynical CV-building, knowing exactly to what profession they aspire and ‘proving commitment’ by spending an extra week doing the job they plan to do for the next 40 years. This may gain marks on the flawlessly-designed points-based applications which determine our chances of working in a specialty that bears any resemblance to our future career hopes or a location which is vaguely practical. Of course, a week is not realistically enough to get a sense of any job, nor ‘prove’ commitment to anything. But, as with many things in the NHS, this is the system in which we operate, so we make the best of it. Continue reading

Practical palliative care after stroke

Dr Ruth England is a Consultant in Palliative Medicine at Royal Derby Hospital. She tweets @DrRuthEngland. She will be speaking at the upcoming BGS event Living and Dying Well with Frailty on 6 March in London. Please note this event has now SOLD OUT.

Palliative care is an active, holistic approach to those facing life-threatening illness. Good palliative care allows us ‘to live as well as possible for as long as possible’; and includes support for those approaching the end of their life.

In the UK, someone suffers a stroke every 5 minutes. Although there has been a decline in stroke mortality, it remains a leading cause of death in those aged over 65.  There a high risk of dying immediately after an event, and 40% of those affected by stroke die within a year. Long term survivors are likely to be burdened with ongoing physical, psychological and social issues. Continue reading

Detectives wanted! – Applying for Geriatric Training

Zosia Beckett is a CMT2 in the West Yorkshire Region and is serving as the Junior representative (FY2 & CMT) on the BGS Trainees Council.

I am currently an ST3 in Geriatrics training in West Yorkshire. Having recently gone through the ST3 recruitment process myself, I thought it would be useful to pass on some advice to those applying this year. So far my experience as a Geriatrics trainee has been really positive; I am enjoying learning more about the sub-specialities of Geriatrics and the challenges of complex medical cases during acute medical takes. I would definitely recommend Geriatrics as a career for those who love to problem solve! Continue reading

Geriatric Oncology: Why older patients need a special approach

Anthea Cree is a clinical oncologist currently undertaking an MD in advanced radiotherapy at The Christie NHS Foundation Trust. She co-founded a group within the hospital to work towards better outcomes and experience for older patients.

I recently did a clinic during which the average age of the patients was over eighty and the oldest nearer to one hundred. This is probably not unusual for the readers of this blog but I’m an oncologist, not a geriatrician.

I’ve been an oncology registrar for six years and even over this short period of time, it seems like encountering octogenarians in clinic has changed from unusual to routine. This is a positive step as a third of cancer patients are over 75 years old and in the past many did not get a chance to see a specialist as they were automatically deemed to be too old for treatment. Continue reading

Can a National Frailty Education Programme be a driver of culture change in healthcare?

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital in Dublin, Ireland, and Deirdre Lang is the Director of Nursing, National Clinical Programme for Older People, Royal College of Physicians of Ireland and Health Services Executive

We all know that population ageing is occurring rapidly. Between 2015 and 2030 the number of people in the world aged 60 years or over is projected to grow by an extraordinary 56%. By 2050, the global population of older people is projected to more than double its size (United Nations, 2015). In Ireland, the population 65 years and over is projected to increase by between 58 and 63 per cent from 2015 to 2030. The older old population (i.e. those aged 80 years of age and over) is set to rise even more dramatically, by between 85 per cent and 94 per cent in this time period (ESRI 2017). Continue reading

A generation of Doctors unable to look after their patients?

Dr Anthony James is a Consultant Physician at Princess of Wales Hospital. 

There have been many changes in recent years. The patients are older with more frailty, multiple comorbidities and a mixture of social and medical issues. These patients are often described as ‘complex’, making them sound as if they are something special. The reality is that they are now the norm and everybody should be able to deal with the norm. These problems are recognised by Royal College of Physicians in Hospitals on the Edge? The time for action (2012);

‘All hospital inpatients deserve to receive safe, high-quality, sustainable care centered around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.’ Continue reading

‘We don’t need no education…’ Teaching about delirium in medical schools

Dr Claire Copeland is a Consultant Physician in Care of the Elderly and Stroke Medicine at Forth Valley Royal Hospital. Her paper Development of an international undergraduate curriculum for delirium using a modified Delphi process has recently been published in Age and Ageing. She tweets at @Sparklystar55

Back in 2015 a workshop at the European Delirium Association (EDA) conference was held to bring together a group of delirium experts. Its purpose? To develop a consensus agreement on a delirium curriculum for medical undergraduates.

Most of you reading this I’m sure will be familiar with delirium. It’s technically been around for centuries. However there are many working in healthcare who still do not know about it. Or if they do, they refer to it by every other name except delirium. Continue reading