Silent compression fractures: a missed opportunity

Agnes Jonsson is a graduate of University College Dublin in 2013 and is currently working as a Registrar in Orthogeriatrics in St. Vincent’s Hospital in Dublin. Her areas of interest are dementia care and quality improvement. She wrote this blog with input from Dr. Yasser Aljabi, Orthopaedic Registrar. Together they are working to create a pathway of care for vertebral fractures in St. Vincent’s Hospital.

Osteoporotic fragility fractures have an estimated annual cost of 2 billion pounds in the UK. This includes the cost of acute hospital stay, rehabilitation and social care. Only a very small proportion of the cost is invested in pharmacological management and secondary prevention of osteoporosis. The National Osteoporosis Foundation recommends treatment with antiresorptive agents for patients with confirmed osteoporosis on DXA and for patients with neck of femur or vertebral fractures. Vertebral compression fractures have recently started to attract increasing amounts of attention, similar to that shown for hip fractures years ago prior to the implementation of hip fracture pathways of care. Continue reading

Catching some zzz’s with Z-drugs? You might want to reconsider

Dr Ilan Matok heads the pharmacoepidemiology research unit in the Hebrew University of Jerusalem’s School of Pharmacy, and directs research evaluating the safety of medication. Their research was recently published in Age and Ageing.

Insomnia is a very common medical complaint, and increases with age. Patients with insomnia often report increased daytime fatigue, confusion, anxiety, and depression. While insomnia can have a significant negative impact on quality of life, a recent study highlights the need for careful consideration in the use of sleeping medication to manage this condition, especially among older adults.

It is widely recognized that the use of traditional “benzodiazepine” type sleeping medication (e.g. nitrazepam), increase the risk of fractures and falls in older adults. However, less is known about the safety of “non-benzodiazepine” sleeping medication, otherwise known as “Z-drugs” (e.g zopiclone). In fact, these drugs have been marketed as safer than benzodiazepine medication, and are often perceived as such by clinicians and patients alike. Continue reading

Catch a falling star

Dr Kawa Amin is a consultant Geriatrician, Consultant Lead for the Falls Service and Geriatrics Departmental Lead for Safety & Quality at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT). He also represents the BGS on the advisory group for the National Audit of Inpatient Falls (NAIF). Deborah Watkins is a Physiotherapist and the Falls Lead at BHRUT.

Falls are a major cause of disability and mortality for older people in the UK and the problem is likely to increase with an ageing population.  The associated mortality and morbidity from a fall is high with individual consequences ranging from distress, pain, physical injury and loss of confidence to complete loss of independence which impacts on relatives and caregivers.  Usually nurses are the first discipline to attend to a patient following a fall.   Continue reading

Autumn Speaker Series: Exercise during periods of decompensation. What is the current evidence?

Stephen Lim is a Clinical Research Fellow and a Specialist Registrar in Geriatric Medicine in Academic Geriatric Medicine at the University of Southampton. His research interest is in physical activity and deconditioning in hospital. He will be speaking at the upcoming BGS Autumn Meeting in London. He tweets at @StephenERLim

Hospital-associated deconditioning is high on the agenda across hospitals in the UK and many hospital trusts have jumped on the ‘endPJparalysis’ bandwagon to encourage patients to get up and get moving, – and rightly so! It is encouraging to see that healthcare professionals and non-clinical staff members are increasingly aware that prolonged bedrest and immobility is bad medicine.

During an acute illness, older people are at risk of worsening sarcopenia and consequently a decline in physical function. The hospital environment, altered mental state, physiological stresses and poor nutrition (as a sequelae of the acute illness), are some of the important risk factors contributing to a loss of function. Continue reading

The Frailty Industry: Too Much Too Soon?

Steve Parry works in acute medicine and older people’s medicine. He has a special interest in investigation and treatment of falls and blackouts in adult patients of all ages. He is BGS Vice President – Academic and Research.

Fashions come and go, in clothing, news and even movie genres. Medicine, including geriatric medicine, is no exception. When I was a trainee, falls and syncope was the next big thing, pursued with huge enthusiasm by a few who became the many. But when does a well-meaning medical fashion become a potentially destructive fad? Frailty, quite rightly, has developed from something geriatricians and allied professionals always did to become a buzz word even neurosurgeons bandy about. No bad thing for all professionals who see older people to have awareness of the recognition and management of this vulnerable and resource intensive patient group. Continue reading

What is this pill called dance?

Debra Quartermaine is a Qualified Nurse and currently works as the Falls Prevention Co-ordinator as well as the Dance for Health programme coordinator at Cambridge University Hospitals NHS Foundation Trust. Debra has experience of nursing in a variety of specialties including general medicine, care of the elderly, learning disabilities and mental health.

Thousands of emotions well up inside me throughout the day. They are released when I dance.- Abraham Lincoln

Since 2013, two pilot projects, funded through Addenbrookes Charitable Trust [ACT], and Addenbrookes Arts, involving weekly dance and movement sessions were run on elderly care, stroke rehabilitation and neuro-rehabilitation wards at Cambridge University Hospitals NHS Foundation Trust. An evaluation showed that the sessions enhanced wellbeing and health through supporting increased movement, more positive moods, and greater socialisation. Continue reading

We talk a lot about delirium after hip fracture, but what can we do about it?

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

Patients with vertebral fragility fractures treated in hospital – could we do better?

Terence Ong is a Research Fellow funded by the Dunhill Medical Trust at the Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust. He discusses his Age and Ageing Paper Characteristics and outcomes of hospitalised patients with vertebral fragility fractures: a systematic review. He tweets @terenceongkk

Vertebral fragility fractures have received much attention lately due to growing research interest and increased awareness driven by high-profile osteoporosis groups such as the International Osteoporosis Foundation (through its vertebral fracture initiative) and the National Osteoporosis Society.

There is growing literature to support how well vertebral fragility fractures predicts future fractures, morbidity and risk of mortality. However, what has been lacking is research exploring the specific cohort of people with vertebral fractures who are admitted to hospital. Continue reading

‘Look out’ – assessing a patient’s vision for falls prevention, what should it look like?

Dr Kawa Amin represents the BGS on the advisory group for the National Audit of Inpatient Falls (NAIF). He is a Consultant Geriatrician, Consultant lead for falls service and Geriatrics Departmental Lead for Safety & Quality at Barking, Havering and Redbridge University Hospitals NHS Trust.

As part of my role on the NAIF advisory group I have been involved in the development of a new bedside vision assessment tool which enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital.

Being acutely unwell is and in a different environment, is a stressful experience.  Even with reassuring care from clinical teams treating them, older people often need extra support in a ward environment.  Can you imagine how frightening such an experience might be for a patient with visual impairment?  It’s perhaps no wonder that poor vision is a risk for delirium.   Continue reading

The Importance of Preventing Hip Fractures in Senior Women

Jess Walter is a freelance writer and mother. She loves the freedom that comes with freelance life and the additional time it means she gets to spend with her family and pets.

Hip fractures are tremendously dangerous for seniors, but they can be even more insidious and difficult to prevent in women. This type of injury can very quickly have deadly consequences. You or your loved one may require extensive surgery to repair the damage, and this may lead to a host of long term or even potentially deadly medical complications. These can include an increased chance of acquiring aspiration pneumonia, blood clots on the legs, increased difficulty walking after surgery, infections at the point of surgery, or acquiring a serious, antibiotic resistant hospital infection such as MRSA. Continue reading