How do geriatricians improve outcomes after hip fracture?

Jenny Neuburger is a Senior Research Analyst at the Nuffield Trust  (@NuffieldTrust) and a Visiting Research Fellow at the London School of Hygiene & Tropical Medicine. She and her co-authors have recently published research in Age and Ageing journal.

hipWe have just published a paper showing that geriatrician involvement in hip fracture care can improve patient outcomes.  Patients treated on wards with higher numbers of geriatrician hours tended to have lower mortality within the 30 days after presentation.

We measured geriatrician hours worked in orthopaedic departments using data collected via the National Hip Fracture Database annual survey each year from 2010 to 2013 for English hospitals.  Over this period, geriatrician hours increased from 1.5 to 4.0 hours per patient, reflecting investments made in response the financial incentives introduced under the Best Practice Tariff scheme. Continue reading

Developing new guidance on how to measure lying and standing blood pressure- harder than you think!

Shelagh O’Riordan is a consultant geriatrician and the clinical lead for the National Audit of Inpatient  Falls. She was an acute hospital geriatrician in Canterbury in Kent for 14 years but moved in September 2016 to work Kent Community Foundation Trust as a community geriatrician. She developed and runs East Kent Falls and Osteoporosis service. She tweets at @jupiterhouse1  

bpAs the clinical lead for the National Audit of Inpatient Falls (NAIF) I have been involved in the development of some new tools to standardise fall prevention in hospitals and they are being launched this month. The first of these was launched on 13/01/17 and is on the measurement of lying and standing blood pressure.

One of the results we found in the last audit round (data collected May 2015) was that on average only 16% of patients over 65y in an acute hospital after 48 hours had had a lying and standing BP recorded! I found this to be a fairly shockingly low number. I’m known, like many geriatricians, to be a bit obsessed with measuring lying and standing BP. Continue reading

Time to Up our Game (TUG) in the management of falls!

Debra Eagles is a Resident in Emergency Medicine at The Ottawa Hospital in Canada. Here she discusses her recent Age & Ageing paper.

970Your medical student reviews a case with you.  It is a 78 year old woman who presents with right knee pain subsequent to a recent fall.  The student has taken a comprehensive falls history and physical examination.  After reviewing the knee x-ray, the student summarizes the case by stating the patient suffered a mechanical fall, luckily without evidence of fracture and can be discharged home.  But wait, you say, can she safely mobilize?  The medical student smiles triumphantly, yes, she was able to use her walker to ambulate a short distance.  Excellent, you say, she can be discharged home.  But you wonder, is there anything further you can do to determine what her risk of negative outcomes associated with falling is. Continue reading

The steps we are taking to reduce inpatient falls

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

patient-falls-preventionHow good is your department and hospital at preventing your patients falling? About 600 inpatients fall every day. As clinicians, we are fully aware of the injuries that can result from older people falling in hospital and the serious effect a fall can have on their recovery. So what can we do to prevent this happening? NICE guidance suggests we can reduce the number of falls by up to a third. The issue is high on the national patient safety agenda, but we need to be able to gather reliable data to ascertain if greater awareness is leading to the falls rate reducing.

Last year, the London Royal College of Physicians carried out an audit of hospital policies and practice in falls prevention, producing a national picture and a report on each hospital in England and Wales. The audit items were based on guidance from NICE and NPSA. You can access the national report here. Please find the time to take a look at your hospital’s data. Continue reading

Time to move: Get up, Get Dressed, Keep moving

Dr Amit Arora is a Consultant Physician and Geriatrician at University Hospital of North Staffordshire, Stoke on Trent and an Honorary Clinical Lecturer at Keele University.

deconditioning-1Many years ago I was subject to restricted mobility following an emergency appendicectomy. It took me a surprisingly long time to regain my strengths and abilities- I noted that despite the youth and the will, my muscles would not move and it took a while to recover back to normal!

When I co-relate this to the frail older people that I see in hospitals, I can understand why someone who was able to function well before they came to hospital takes longer to regain their pre-admission functionality.  Prolonged hospital stay, bed rest and attendant risks may lead to loss of muscle power, strength and abilities. This is something we surely need to avoid. It should help achieve a shorter length of stay, better outcomes for patients and better ability at discharge. Continue reading

A circulating marker of bone remodelling is associated with cognition in older age

Steven Bradburn is a PhD student at Manchester Metropolitan University. His research interests focus on age-related cognitive decline and physical functioning in later life. He recently published Association between Osteocalcin and Cognitive Performance in Healthy Older Adults in Age and Ageing journal.

aaCognitive decline and reductions in bone health regularly co-manifest during advancing age. Previous studies have shown relationships between bone mineral density and risks of Alzheimer’s disease and cognitive decline, especially in older women. This raises the possibility that factors related to bone regulation and function may also influence cognitive wellbeing.

In our study, using the cross-sectional MyoAge cohort, we evaluated the relationship between bone mineral density and proteins related to bone metabolism in the blood with measures of cognitive functioning in physically and mentally healthy older adults. Continue reading

A Bespoke Blue Light Response to Frail Older Fallers: Makes Complete Sense – But Does It Work?

Spencer Winch is a specialist paramedic in urgent care and a trainee advanced clinical practitioner in emergency care. He has a special interest in falls and care of the frail older patient and his time is currently split between the ambulance service, the local emergency department and a masters degree in advanced clinical practice. @spencerlwinch

Anna Puddy, Kate Ellis, Gill Carlill, Josie Caffrey, Claire Wiggett and Moyra Pugh are all advanced hospital based occupational therapists specialising in emergency, acute and elderly care. @TheRealAnnaPud, @OTMoyra, @CaffreyJosie

South Western Ambulance VX09FYPWith falls in patients over the age of 65 making up 8.5% of the emergency workload locally, paramedics and the ambulance service have found themselves in a prime position to assess, treat and discharge this cohort of patients pre-hospitally. This upholds Keogh’s vision that care and treatment should be delivered closer to home without the need for hospital, and is being achieved by ambulance crews on a daily basis as highlighted in a consultant paramedic colleague’s (NWAmb_Duncan – link to BGS blog) recent blog. Higher education and degree based programmes for the paramedic profession now encourage more thorough assessment of injury and illness and thoughts around causative factors of falls, length of lie and potential for acute kidney injury. Those that are discharged on scene are then flagged to the community falls prevention teams for mobility, functionality and care assessment provided by nurse and therapists. With increasing demand on all NHS healthcare agencies, these assessments are not instantaneous and literature would suggest that those who have fallen, are likely to fall again within 24 hours without immediate intervention. Continue reading

Musculoskeletal conditions: the case for better data

shutterstock_1889404Musculoskeletal conditions are a major contributor to multimorbidity and are more likely to develop with age. Amy Forbes, Policy Officer at Arthritis Research UK explores the health data issues around musculoskeletal conditions.

Musculoskeletal conditions have a substantial impact on individuals, the health service and society as a whole. A musculoskeletal condition can hinder someone’s ability to do normal activities, significantly affecting their quality of life and limiting independence: common symptoms include pain, stiffness and loss of mobility and dexterity.

Musculoskeletal conditions are a major contributor to multimorbidity. They are the single biggest cause of disability in the UK, accounting for 30.5% of all years lived with disability. Around 20% of the general population consult their GP about a musculoskeletal problem each year, and 82% of people with osteoarthritis have at least one other long term condition like cardiovascular disease, hypertension or depression.

Continue reading

Falling: is the heart to blame?

heartSofie Jansen is a research fellow at the department of Geriatric Medicine in the Academic Medical Center in Amsterdam, the Netherlands. Her PhD focusses on the contribution of cardiovascular diseases to falls in older adults. Last year she spent six months as a visiting researcher in Trinity College, Dublin. In 2015 she will start her training as a Medical & Geriatrics Registrar. In this blog she comments on her recent publication in Age and Ageing journal. 

People often consider falling to be an unavoidable consequence of old age – we’ve all heard stories of a grandmother or elderly aunt who has taken a tumble. As such, falls are often accepted as a fact of life by older persons and those who care for them. But is this really the case? There are a number of factors that individually, or in combination, can contribute to people falling: balance problems, poor vision, the side-effects of medication. Most of these factors can be treated or targeted, leading to a reduction in falls. Recognition of these treatable risk factors is therefore important.

Continue reading

A multidisciplinary network to provide fascia iliaca block for patients with fractured neck of femur

L0061457 Ununited fracture of neck of the femurDr Victoria Ferrier is Regional Anaesthesia Fellow at East Surrey Hospital

Every year, approximately 77,000 hip fractures occur in the UK, accounting for 1.5 million bed days, at an inpatient cost of £0.785 billion. Older patients with hip fracture are at risk of significant morbidity and mortality and there is considerable variation in patient outcomes and management1. Continue reading