Older HIV-Infected Adults are Geriatricians’ Business

Fátima Brañas is a consultant geriatrician and the clinical lead for orthogeriatrics at the Infanta Leonor University Hospital in Madrid (Spain). She holds a PhD, specializing in HIV infection in older adults, and is working hard in this field—from both a clinical and a research point of view—to provide all the benefits of a geriatric assessment for older HIV-infected adults. She recently co-authored ‘Frailty and physical function in older HIV-infected adults @FatimaBranas

hivThe HIV-infected population is aging due to the success of combination antiretroviral therapy, which prolongs survival, and also because of the growing number of newly diagnosed cases in older adults. Nowadays, over half of people infected with HIV are older than fifty years, which is the age cutoff accepted by the scientific community to consider someone an HIV-infected older adult. Fifty is only their chronological age, but biologically they are older, as accelerated aging in this population has been demonstrated. So, it seems that in the coming years, HIV care is going to be focused on a growing group of older adults and their specific problems. This means more than only survival, infection control, or avoiding the adverse events caused by antiretroviral drugs; it also includes consideration of comorbidities, polypharmacy, functional decline, and geriatric syndromes. Continue reading

It’s not how old you are that matters, so much as how you are old…

Professor Martin Vernon qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. He has been the British Geriatrics Society Champion for End of Life Care for 5 years and was a standing member of the NICE Indicators Committee. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England.

mj-vernon-officialWhile celebrating successful ageing we must not be led into complacency. There is marked inequality between least and most socioeconomically deprived areas with men living on average up to 8 years less in the most deprived areas.

The NHS England Five Year Forward View notes that support for frail older patients is one of the three areas that the NHS faces particular challenges. It is therefore potentially game-changing that we are now making positive steps towards addressing this through routine frailty identification and promoting key interventions targeted at falls risk identification and medication review. Continue reading

Multi-morbidity – the case for change

David Paynton is a GP in an inner city surgery. He is also the Clinical Lead for Commissioning for the RCGP.

Dr David Paynton

Generalists are the solution.

For too long policy makers have ignored what clinicians on the front line have been telling them, people with multiple conditions not only exist but are the mainstream.

It is our failure to recognise this fact that has put pressure in the system as the NHS struggles to keep its head above water especially when one adds social factors, depression and mental health into the mix of complexity.

The RCGP “responding to the needs of patient with multi-morbidity” has created a powerful case for change with the need to substitute ever-increasing investment into super specialism by a call for the generalist to support those with multi-morbidity in the community. Continue reading

BGS raising the profile of Sarcopenia and Frailty in older people

1025_atrophySarcopenia, the loss of skeletal muscle mass and function that accompanies ageing, has emerged as a key topic in geriatric medicine and represents a rapidly expanding field of research. Prevalence may be as high as 1 in 3 for frail older people living in care homes. There is increasing appreciation of sarcopenia’s importance for an ageing population and a growing understanding of its causes. The condition is closely linked to physical frailty and detection of sarcopenia is beginning to be incorporated into clinical practice, and to undergo large clinical trials.

To better represent this area the British Geriatrics Society has announced the formation of a new Special Interest Group (SIG) focusing on sarcopenia and frailty research.

In addition, to help raise the profile and aid the recognition of sarcopenia, a dedicated session covering diagnosis and treatment of the disease is being held at the BGS Autumn Meeting in Glasgow. Continue reading

Joining up care for older people with frailty

Across the UK, innovative collaborations between GPs and specialist geriatricians are paving the way to better care for older people with frailty

rcgp-bgd-coverA new joint report from the Royal College of GPs and the British Geriatrics Society has been published today, showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Advancements in medicine are a great success story, and as a result our patients are living longer, but they are also increasingly living with multiple, long term conditions and that brings a number of challenges for general practice and the wider NHS.

Older patients make up the majority of those attending GP surgeries and acute hospitals so getting the right combinations of care in the right place and at the right time is crucial to avert avoidable admissions and delayed discharge from hospital. 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

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

Paramedics; Frailty detection and admission avoidance

Dr Amy Heskett works as a Speciality Doctor within the West Kent Urgent Care Home Treatment Service. This team aims to prevent hospital admissions by working alongside GPs, nurses, carers and paramedics to provide a holistic management plan. She writes a blog about her experiences on her blog communitydoctoramy.wordpress.com and can be found on twitter @mrsapea

paramedics-photoThe West Kent Home Treatment Service provides home-based medical treatments to avoid hospital admissions when appropriate. Referrals come from GPs, Community Nurses and Paramedics; but more importantly our team widens as soon as we start to work with patients, their family and carers.

A day of referrals began with a call from a Paramedic who had attended V after she had fallen in her bedroom, but luckily sustained no injury. This was on a background of dementia and the need for daily support from her son to assist with meals, prompt medications and support trips made outside the home. V’s only other medical history was that of hypertension and one fall a year ago. V was normally able to get herself to the toilet and used a stick to mobilise slowly indoors; while carers attended once a day to provide personal care. Continue reading

Take the high road or the low road…but don’t miss the BGS in Glasgow this November!

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President-Elect of the BGS. She is currently Clinical Lead for integration in Leeds and Chairman of the BGS Community Geriatrics Special Interest Group. She tweets @EileenBurns13

eileenburnsThe Autumn Meeting of the BGS in Glasgow this November looks to be a great event with a broad range of topics and sessions.

But the day that excites me the most is Wednesday November 23rd.

Many of us have been approached by commissioners of services to “move into the community” in some way (in whichever part of the UK we are based). Others have seen the need to look at alternatives to acute hospital care for older patients with less severe illnesses, and it’s been clinicians rather than commissioners or managers who have been the spark for new developments. Continue reading

Palliative care for frail older people: what, when and how?

Anna Bone is a Cicely Saunders International PhD Training Fellow in the Department of Palliative Care, Policy, and Rehabilitation at King’s College London. In this blog Anna discusses her recent Age and Ageing paper on developing a model of palliative care for frail older people. This is part of the OPTCare Elderly Study, a joint project between King’s College London and Sussex Community NHS Foundation Trust, led by Dr Catherine Evans. @AnnaEBone

aaIn the minds of many, palliative care is synonymous with cancer and end of life. This is unsurprising, as it is within this context that palliative care has developed. The goal of palliative care is to relieve suffering and improve the quality of life of people with life threatening illness. It is increasingly believed that palliative care has much to offer to other patient groups whose health is deteriorating, and not just at the end of their life.
People are now living longer, with multiple chronic illnesses and frailty, and dying at older ages. We need to consider the needs of this growing group. Specialist palliative care services for frail older people with deteriorating health may provide an extra layer of support to help them and their families live as well as possible. Continue reading