Tribalism Kills; The Journey Towards Genuine Integration

David Attwood is a GP with a Specialist Interest in Older People. He is a Committee Member of BGS’s GeriGP Group. He tweets @DavidAttwood12

“You have twenty-one children?!” I asked incredulously. The Fanta that was halfway to my mouth almost left my hand to land on my khaki coloured trousers.

“Yes, twenty-one.” William replied, between mouthfuls of Nile perch. After a pause to finish chewing he casually added, “and four wives.”

The Fanta fell out of my mouth to land on my trousers.

“Do they all get on well?”

He screwed his face and smiled mischievously “No! They are constantly arguing!!”

I had to laugh.

Managing Frailty and Delayed Transfers of Care in the Acute Setting: A call to get involved!

Debbie Hibbert  leads on the NHS Benchmarking Network’s community sector benchmarking projects, manages the Delayed Transfers of Care / Older People’s benchmarking projects, is the Project Manager for the National Audit of Intermediate Care (NAIC), and the National Audit of Care at the End of Life (NACEL). She tweets @Debbie_NHSBN 

In this blog, the Managing Frailty and Delayed Transfers of Care in the Acute Setting project is described. Clinicians are encouraged to get involved with this project, the outputs of which include a bespoke report for participants and access to an online benchmarking toolkit. To receive your log in details or for further information, please contact josh.davies@nhs.net.

Driving quality improvements in the care of older people remains a key issue for the NHS as the population of the UK ages. The NHS Benchmarking Network is back with another project following on from previous work on the care of older people, and delayed transfers of care.  The new project continues the Network’s six-year partnership with the BGS and will help our members to gather much needed data to inform service change and future strategic decisions.

Department of Facebook Cats

Frazer Anderson is a Consultant Community Geriatrician in East Hampshire. He is Honorary Secretary of the BGS.

Now that the vote on the name of our Society has been concluded – and regardless of the result this was the most successful exercise in participatory democracy the Society has ever carried out – I would like to suggest another way of looking at the issue.

In John Gladman’s excellent Marjory Warren Lecture at the Spring Meeting in Nottingham, he presented some challenging statistics on what older people actually want and – more importantly – don’t want. In a nutshell, older people don’t want to be old if it involves disability, dependence and suffering.

10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80

Dan Thomas is an ST6 working in Liverpool. He is the BGS Clinical Quality Group Trainee Rep and the Deputy Media Editor. He tweets @dan26wales

‘10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80’

I have lost count of the number of times I have quoted this fact, I use it when teaching on frailty, and I have used it when assessing people in the emergency department to explain the risks of hospital induced deconditioning. I regularly hear other Geriatricians use this fact. It is emblazoned across much of the #EndPJParalysis material, and is quoted (unreferenced) on the NHS improvement website.

Are we really representing the BGS? Experiences from the Programme Board and a call for your contributions

Shelagh O’Riordan is a Consultant Community Geriatrician and Clinical Director for Frailty Services with Kent Community NHS Trust and tweets @jupiterhouse1 Asan Akpan is a consultant Geriatrician at Aintree University Hospital NHS FT and tweets @asanakpan

In September 2017, the BGS put a call out to its members for Geriatricians with an interest in care homes and Community Geriatrics to represent the BGS at the newly established Hospital to Home Programme Board, an NHS England oversight group and part of the Urgent and Emergency Care (UEC) Transformation Delivery  Programme.

Shelagh had just come to the end of a role at the Royal College of Physicians and, after 14 years, swapped her hospital role for a community one. Asan moved to a different hospital over 4 years ago to do mostly community geriatric medicine and has contributed to developing the service described on page 26 of the joint report on integrated care for frail older people by the BGS and RCGP.

The British Geriatrics Society calls for all healthcare professionals to learn from the Gosport Inquiry to help prevent future tragedies

The British Geriatrics Society is calling all healthcare professionals to review the Gosport Independent Panel Report, and to learn from these shocking events which led to the deaths of over 450 patients who were given opiate painkillers “without medical justification” from 1989 to 2000 at Gosport War Memorial Hospital in Hampshire.

The Inquiry found there was a “disregard for human life” and an “institutionalised practice of shortening lives” at the hospital. In response to the Inquiry’s findings the Society is also calling for increased knowledge of best practice and clinical guidelines, especially in relation to prescribing and pain management in older people. The Society fully supports the families’ ongoing quest for truth and accountability.

Drug burden in older people approaching end of life

Dr. Denis Curtin is a specialist registrar in Geriatric Medicine in Cork University Hospital, Ireland. His paper Drug consumption and futile medication prescribing in the last year of life: an observational study was recently published the Age and Ageing journal.

The vast majority of older adults are admitted to hospital in their last year of life. For many of these people, hospitalizations are frequent and prolonged.

We reviewed the medical records of 410 older adults who were admitted to our hospital in the year prior to death. The median number of days spent in hospital was 32. While in hospital, patients consumed an average of 24 different medications. One-in-six patients consumed 35 or more individual medications. When discharged home from hospital, patients were prescribed an average of 2 unnecessary or inappropriate medications.

The right intervention, at the right time, in the right place…

Stephanie Robinson is an occupational therapist at Harrogate hospital working as the  frailty team leader across the medical elderly wards and previously seconded into the Supported Discharge Service. She has had a key role in cross boundary working, outreaching from frail elderly inpatient based wards to the community.

The right intervention, at the right time, in the right place… How Harrogate District Foundation Trust therapists from the community and in-patient wards are tackling the national bed crisis: piloting a Supported Discharge Service.

The pressure is on in Harrogate – the population of over 60s is 26.5% compared to 22.4% nationally.  By 2030 the district’s over 65 population is predicted to increase by 15,000 people.  One of the Trust’s strategic aims for the next five years is to integrate acute, community and social care to allow patients to be treated closer to home, or at home and reduce reliance on acute beds.  It is understood that therapy assessments completed in a patient’s own home are a more accurate reflection of their capabilities than those completed in the hospital environment.  Based on the Discharge to Assess model, the concept that the hospital is often not the most appropriate place for patients of any age to remain is not a new one.

Why it gets harder to prevent falls when older people leave hospital

Chiara Naseri is a physiotherapist and is currently completing her PhD at Western Australia’s Curtin University School of Physiotherapy and Exercise Science. She has recently published a review in Age and Ageing entitled “Reducing falls in older adults recently discharged from hospital: A systematic review and meta-analysis.”

The paper reveals the complexity of the discharge process for older people and that more support is required than is currently widely recognised. Her team found that falls prevention strategies, known to reduce falls for older people in general, were not as effective for older people following hospital discharge.

Evidence has shown 30% of the population of older people who live in the community fall at least once per year, 10% of these falls result in a serious injury. Whereas 40% of the population of older people who have recently been discharged home from hospital fall within 6 months of discharge, most of these falls occur in the first month and 54% result in a serious injury, particularly hip fractures.

The ‘Geriatrician’s Salute’: emerging evidence on deprescribing

Professor Sarah Hilmer works as a geriatrician and clinical pharmacologist at Royal North Shore Hospital in Sydney, and conjoint professor of geriatric pharmacology at Sydney University, Australia.  Dr Danijela Gnjidic is a pharmacologist who is a NHMRC Dementia Leadership Fellow and Senior Lecturer in Pharmacy Practice at Sydney University, Australia. 

One of the most reversible causes of a geriatric syndrome in our older patients is an adverse drug event.  Approximately 1 in 5 hospital admissions amongst older people are due to adverse drug reactions and during their time in hospital 1 in 6 older people experience an adverse drug reaction.  Consequently, comprehensive medication review is an integral part of the practice of geriatric medicine.

The process of a health professional withdrawing medicines for which the current risk may outweigh the benefit in their patient has been given a variety of names including the ‘geriatrician’s salute’ and increasingly ‘deprescribing’.