Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital in Dublin, Ireland. The aim of this article is to provide an overview of the clinical syndrome of frailty, how it can be considered and effectively managed as a long-term condition.
One of the greatest challenges posed by an ageing population is the ability of healthcare professionals to understand, recognise and manage vulnerable older adults at increased risk of adverse healthcare outcomes. This frailty syndrome is age associated and is most marked in among those over 75 years of age. The older person showing signs of frailty is at increased risk of long term institutional care, hospitalisation, prolonged length of hospital stay and mortality, and will require specific interventions that span several health and social care services to enable them to live well for their remaining years. Continue reading →
Professor Kenneth Rockwood has published more than 300 peer-reviewed scientific publications and seven books, including the seventh edition of the Brocklehurst’s Textbook of Geriatric Medicine & Gerontology. He is the Kathryn Allen Weldon Professor of Alzheimer research at Dalhousie University, and a staff internist and geriatrician at the Capital District Health Authority in Halifax in Canada.
Last autumn, at a meeting of the Acute Frailty Network in London, I sat in on a discussion group about identifying frailty in acutely ill older people who come to hospital. Although some participants noted objections about such screening in some quarters, with this audience, there was no need to discuss why it makes sense to identify people at greater risk than their age peers of being harmed by usual hospital care.
Before moving on, let’s consider for a moment why anyone might object to screening for baseline frailty in patients who presented to A&E. For those who see it as reasonable to screen for frailty it almost seems that those who don’t believe that it somehow encourages frail patients unnecessarily to seek hospital care. Continue reading →
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 →
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
The 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 →
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.
While 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 →
David Paynton is a GP in an inner city surgery. He is also the Clinical Lead for Commissioning for the RCGP.
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.
Sarcopenia, 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 →
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 →
Debra Eagles is a Resident in Emergency Medicine at The Ottawa Hospital in Canada. Here she discusses her recent Age & Ageing paper.
Your 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 →
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.
Many 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 →