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

Older people and poor care: a human rights issue

In this blog Helen Wildbore, Policy and Programmes Manager at the British Institute of Human Rights, shares some key points from her speech to the All-Party Parliamentary Group on Ageing and Older People’s inquiry on human rights on 24th April. Helen shared the platform with Dr Eileen Burns, President of the British Geriatrics Society.

Why is poor care a human rights issue? At the British Institute of Human Rights (BIHR), we work with people at the sharp end of public services and people placed in vulnerable situations, including older people. When things go ‘wrong’ and people receive poor care, their first thought isn’t necessarily their rights.

But human rights can be a powerful tool 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

Where and how would you want to spend your last 1000 days?

Premila Fade is a Geriatrician with an interest in medical ethics and end of life care. Here she discusses BGS’s Living and Dying Well with Frailty event which was held on 6 March in London. She tweets @premzf 

If you were an older person living with frailty where and how would you want to spend your last 1000 days?  It is often difficult to accurately predict prognosis for older adults living with frailty and they have different needs at the end of life to younger people.  Traditional models of specialist palliative care do not always meet these needs or those of the carers and family supporting them.

What makes frailty different from other conditions at the end of life is that there can be prolonged periods of relative stability and then a potentially mild illness/insult causes a significant or catastrophic deterioration. This acute deterioration often triggers the conventional response to crisis – 999, ambulance to ED, investigations and the commencement of invasive medical treatment. Continue reading

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