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

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