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

You thought walking would keep your spine strong, but…

Dr. Dafne Zuleima Morgado Ramirez is based at the Interaction Centre (UCLIC) at University College London and is a member of the Global Disability Innovation Hub. She tweets at @zuleimamorgado. She has recently published work in Age and Ageing journal.

Walking has been promoted as a way of reducing the risk and progression of osteoporosis. Yet clinical studies have shown that walking does not increase bone mineral density at the spine unless it is performed along with other physical activities, and that even then, improvement is minimal. Physical activity produces vibration that is transmitted from the feet up to the head through the body. Although there is clear evidence that bone formation and resorption are responsive to mechanical stimulation, such as vibration, currently there is limited understanding of the vibration that is transmitted through the lumbar and thoracic spine during walking. Continue reading

New National Osteoporosis Guideline launched today – an opportunity for those aged 70 years or older?

Dr Celia Gregson is a Consultant Geriatrician in Bath and Consultant Senior Lecturer in Bristol. She is also a member of the National Osteoporosis Guideline Development Group. She tweets @celiagregson

The National Osteoporosis Guideline Group (NOGG) is pleased to announce that the UK NOGG 2017 Update was released via their website today.  This new Guideline, accredited by the National Institute for Health and Care Excellence (NICE) in March 2017, includes a number of updates relating to fracture risk assessment, management of osteoporosis and treatment recommendations, all highly relevant for older people.

It is currently recommended that fracture risk should be assessed using the freely available online FRAX tool in all postmenopausal women, and men age 50 years or more, who have risk factors for sustaining a fracture.  Continue reading

Sarcopenia; a key driver of physical frailty

Miles Witham is a Clinical Reader in Ageing and Health, University of Dundee, and is Deputy Editor for Age and Ageing.

The BGS Autumn Meeting 2016 saw the launch of the newest BGS Special Interest Group – the Frailty and Sarcopenia Research SIG. The inaugural session, held in the main auditorium in Glasgow’s SECC was attended by several hundred delegates, and so far, over 100 members have signed up on-line to be part of the new SIG. So why do we need this SIG, and what do we hope it will achieve? Continue reading

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