HIV and Older People

World AIDS Day is dedicated to fighting stigma and discrimination, and raising awareness of the HIV/AIDS pandemic. We mark this day by, in turn, raising awareness of older people with HIV.

Incidence and prevalence of HIV in older people is increasing. In the UK one in five adults with HIV is aged over 50. This is a consequence both of the expansion in uptake of HIV testing and diagnosis and major improvements in treatments which are helping people with HIV to live longer.

The fact that older people with HIV are living longer where there is access to treatment is a cause for celebration but it also brings challenges for geriatric medicine. Older people with HIV commonly experience co-morbidities such as cardiovascular disease, osteoporosis and dementia. Medical management of HIV in older people requires considerations of complex drug interactions and co-morbidities.

Early diagnosis of HIV is key to improving prognosis. Treatment with highly active anti-retroviral therapy (HAART) significantly prolongs life expectancy, however it is associated with an increased risk of side effects in older patients. Continue reading

Older people are living longer than before, but are they living healthier?

Ruby Yu is a research assistant professor at the Chinese University of Hong Kong (CUHK), specialising in gerontology and geriatrics. She is also a research fellow at the CUHK Jockey Club Institute of Ageing. Her recent paper Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: An Age-period-cohort Analysis was published today in Age and Ageing journal.

There is no doubt that people from countries all over of the world are living longer, but there is little evidence to suggest that older people today are living healthier than their predecessors did at the same age. This is a major cause of concern for many governments around the world because if the added years of people today are dominated by chronic diseases and functional disabilities, there will be negative implications (e.g., extended treatment for older people which increases the health and social care cost to society). Continue reading

Catching some zzz’s with Z-drugs? You might want to reconsider

Dr Ilan Matok heads the pharmacoepidemiology research unit in the Hebrew University of Jerusalem’s School of Pharmacy, and directs research evaluating the safety of medication. Their research was recently published in Age and Ageing.

Insomnia is a very common medical complaint, and increases with age. Patients with insomnia often report increased daytime fatigue, confusion, anxiety, and depression. While insomnia can have a significant negative impact on quality of life, a recent study highlights the need for careful consideration in the use of sleeping medication to manage this condition, especially among older adults.

It is widely recognized that the use of traditional “benzodiazepine” type sleeping medication (e.g. nitrazepam), increase the risk of fractures and falls in older adults. However, less is known about the safety of “non-benzodiazepine” sleeping medication, otherwise known as “Z-drugs” (e.g zopiclone). In fact, these drugs have been marketed as safer than benzodiazepine medication, and are often perceived as such by clinicians and patients alike. Continue reading

Advanced Professionals supporting our frail patients, but how?

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

Nationally there is increasing recognition of the needs of frail older people in health systems, and  the UK’s rapidly ageing population will only increase in the years to come.

Dr Ram Byravan (Consultant and Clinical Director Heart of England Elderly Care) states that the prevalence of multimorbidity is on the rise, with 44% of people over 75 now living with more than one long-term condition –  geriatricians and GPs are uniquely suited to lead the response to the challenges of caring for this group. Continue reading

Comprehensive Geriatric Assessment and the role it plays in improving care delivered to the older person

Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital Dublin, and Clinical Lead for the National Clinical Programme of Older People in Ireland.  

Ms. Carmel Hoey is a Nursing & Midwifery Planning and Development Officer at the NMPD Unit, Galway, and HSE Service Planner for the National Clinical Programme of Older People in Ireland. 

Countries around the world are seeing significant growth in the numbers of people living longer and healthier lives. We all need to reflect proactively on how we can best maximise the intergenerational benefits this will undoubtedly bring and we must also address the challenges it will generate.

Ireland is no different, with a substantial growth evident in our older population. The number of people aged over 65 years increased by 14% between 2006 and 2011. An increase of 17% is predicted between 2011 and 2016, and a further 17% is expected by 2021 (Central Statistics Office, 2013). Continue reading

Is it time to redefine old age?

Vedamurthy Adhiyaman is a geriatrician working is North Wales. Here he discusses why we should redefine old age. He tweets @adhiyamanv 

Western literature arbitrarily defines old age as people above the age of 65 (Oxford textbook of geriatric medicine, Wikipedia etc). Few authors subdivide old age further as young old (65-74), old (75-84) and old-old (85+). This would make our reigning monarch ‘old-old’ and the next in line to the throne and our patron, old (not sure whether he would like to be called old…). And definitions of old age vary according to different parts of the world. For African countries, the United Nations set the age 60+ and the WHO defines 50+ as old. Dictionaries define old age as a later part of normal life without defining any numbers. Continue reading

Autumn Speakers Series: Ageing and economic growth – not all doom and gloom?

Baroness Sally Greengross is Chief Executive of the International Longevity Centre – UK and has been a crossbench (independent) member of the House of Lords since 2000. She Co-Chairs four All-Party Parliamentary Groups: Dementia, Corporate Social Responsibility, Continence Care and Ageing and Older People. She was awarded a Special Lifetime Achievement Award at the BGS 70th Anniversary Reception on 6 March 2017.  She will be speaking at the upcoming BGS Autumn Meeting in London.

What are the economic and societal effects of a global ageing society and the increasing need for a healthy older population who will be employed into their 70s? 

Firstly it is worth saying that ageing and economic growth – is not all doom and gloom? Population ageing is a global phenomenon. The rate of growth in older people (people aged over 65) is expected to far outpace the rise of the working age population (people age 15-64). The old age population will grow by more than 300% over the course of this century by comparison with the working age population which will grow by less than 50%. Continue reading

The Second BGS Cultural Revolution- and the Living Well SIG

Sir Muir Gray has worked for the National Health Service in England since 1972, occupying a variety of senior positions during that time. He is an internationally renowned authority on healthcare systems and has advised governments of several countries outside the UK including Australia, New Zealand, Italy, Spain and Germany. He tweets @muirgray

The British Geriatrics Society can be proud of the culture change it has achieved by providing leadership in the last seventy years.  When the BGS was founded the prevailing beliefs of not only the public but also the medical profession, were that the problems of older people were due to the ageing process and not due to treatable disease – older people therefore needed “care” rather than accurate diagnosis, effective treatment and rehabilitation. The BGS and individual consultants should be proud of their achievements. There has been a revolution in the care of older people with disease. Continue reading

Autumn Speaker Series: Exercise during periods of decompensation. What is the current evidence?

Stephen Lim is a Clinical Research Fellow and a Specialist Registrar in Geriatric Medicine in Academic Geriatric Medicine at the University of Southampton. His research interest is in physical activity and deconditioning in hospital. He will be speaking at the upcoming BGS Autumn Meeting in London. He tweets at @StephenERLim

Hospital-associated deconditioning is high on the agenda across hospitals in the UK and many hospital trusts have jumped on the ‘endPJparalysis’ bandwagon to encourage patients to get up and get moving, – and rightly so! It is encouraging to see that healthcare professionals and non-clinical staff members are increasingly aware that prolonged bedrest and immobility is bad medicine.

During an acute illness, older people are at risk of worsening sarcopenia and consequently a decline in physical function. The hospital environment, altered mental state, physiological stresses and poor nutrition (as a sequelae of the acute illness), are some of the important risk factors contributing to a loss of function. Continue reading

Promoting Activity, Independence and Stability in Early Dementia (PrAISED)

Professor Rowan H Harwood is a geriatrician at Nottingham University Hospitals NHS Trust, and the University of Nottingham, with particular interests in delirium, dementia and end of life care, who maintains an active portfolio of research. He tweets @RowanHarwood 

Can exercise-based therapy prevent or delay disability and dependency in those in the early stages of dementia?

We have heard the drum beat of gloomy messages. We cannot continue to cope with ever greater demands for health and social care. Prevention is better than cure, but the NHS is ‘on the hook’ for failing to take prevention seriously.

There is a semblance of a response. Sustainability and Transformation Plans emphasise prevention. We know that some groups, such as people with frailty or dementia, are at risk of crises and functional decline, and on the cusp of dependency and need for services. It makes sense to identify people at risk earlier, and intervene. Continue reading