When older people with dementia are admitted to hospital, they are more likely to die or to stay in hospital longer than people without dementia. Many older people have cognitive impairment (CI) (problems with memory and thinking) which is a main feature of dementia, but have not yet been given a diagnosis, or may have CI due to other medical conditions. We investigated how common cognitive impairment is in older patients in hospital, and what the risks are for these patients of staying longer or dying in hospital. Continue reading →
As a hospital dentist it’s always a heart sink moment when you get the referral from the ward that reads, “Mrs X has lost her dentures, please could you replace them”. If only it was that easy…
Mrs X has not only lost her dentures, but also the ability to eat her meals, communicate clearly, smile at her family and potentially, her dignity.
It is normally a similar story. Mrs X had fallen asleep and her dentures weren’t there when she woke up, she had wrapped them in some tissue to keep them clean, safe or left them on her meal tray. One way or another they were accidentally mistaken for rubbish and disposed of. She had been in hospital for days yet no one had asked if she had dentures and therefore she wasn’t provided with a denture pot to keep them clean. Continue reading →
Sam Shah discusses the HEE supported project exploring hydration, nutrition and mouthcare in hospital and community care settings. The project involves training staff and raising awareness to improve the quality of care, to help avoid admission and to support discharge. The insights from this project will be shared at the BGS Spring Meeting in Gateshead on the 28th April at 9:30-11:00.
We are all accustomed to brushing our own teeth and cleaning our mouths, it’s entrenched in the daily routines of most people. Most of us are able to eat and drink ourselves and we understand the link between what we eat and our how our bodies respond. A big challenge in the care of frail older people, and those in high needs settings, is ensuring their hydration, nutrition and mouthcare needs are supported. Continue reading →
Imagine you’re seeing a consult or you’re on a post-take ward round. How often do we examine a patient and identify cognitive deficits, see that the CT brain scan report and the MMSE score are readily on hand, but then ask staff about the patient’s premorbid cognition and function and are met with blank expressions?
An important factor which complicates the presentation of older people to acute hospitals is the presence of impaired cognitive status (either in the form of dementia, delirium or both). Continue reading →
Dr Terry Quinn (Joint Stroke Association / CSO Senior Clinical Lecturer) has a clinical and research interest in post stroke cognitive decline. Supported by a Stroke Association Priority Program Grant he is pursuing a portfolio of work themed around how to assess cognition and mood in the Acute Stroke Unit. Terry will be sharing some of the findings from this and other work at the BGS Spring Meeting in Newcastle as part of a themed session on dementia. Terry tweets about all things cognitive @DrTerryQuinn and in his role as Coordinating editor of the Cochrane Dementia Group @cochraneDCIG
Specialist societies, clinical guidelines and audit standards all encourage us to assess cognition when patients present with stroke. Intuitively this seems like a sensible idea. We know that patients fear problems with memory and thinking more than they fear physical disability and we know that cognitive problems are extremely common in the post stroke period. What is less clear is how we should assess cognition in stroke. 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 →
Hazel Miller, Consultant Geriatrician, Glasgow Royal Infirmary. Delirium enthusiast (or should that be delirium hater?) hoping she has earned the right to don a cape from time to time… Follow me on twitter @hazelmiller99
It’s fair to say that our understanding and management of delirium has increased hugely over the past ten years. It has gone from being the ultimate in Cinderella syndromes (unanticipated, undiagnosed, untreated, unexplained, unnoticed) to having high profile and energetic researchers and advocates (its own Delirium Superheroes). Everyone is being asked to Think Delirium these days. Continue reading →
Dr Olivier Gaillemin trained in Geriatric Medicine and now works as a consultant physician in Acute Medicine at Salford Royal Foundation Trust. He has developed a Frailty Unit embedded within the Acute Medical Unit. He sat on the NICE guideline development group for NG27 – Transitions of care for adults with Health and Social Care needs – as well as on the committee for the associated NICE Quality Standard QS 136. He attended the King’s Fund conference as a speaker.
On the day of the launch of their report on STPs, the King’s Fund hosted an event on how to improve transitions of care for older people admitted and being discharged from hospital. In these times of very real stress to the systems in which we work, when too often we seem to fail those vulnerable people we are all invested and motivated in supporting, it is easy to become despondent. Continue reading →
Suzanne Timmons is a geriatrician working in Mercy University hospital, Cork and a senior lecturer in University College Cork. She has a big clinical and research interest in delirium and dementia care in hospitals.
Delirium is common in older people admitted to hospital, and is a serious condition that needs to be identified quickly on admission. But many busy hospital staff still don’t routinely screen older people for delirium, even when they have known dementia (dementia puts people at very high risk of delirium: see the Cork Dementia Study).
In this study, we tested out five simple cognitive tests to see if they could be used to screen for delirium. The tests were: the Six-item Cognitive Impairment Test (6-CIT; measuring attention, orientation to time, and short-term memory); the Clock-Drawing test; Spatial Span Forwards (pointing to a sequence of squares in a certain order); reciting the months of the year backwards (MOTYB); and copying a shape containing two intersecting pentagons. Continue reading →
Dr Tom Nutt is Chief Executive of Healthwatch Essex and Dr Oonagh Corrigan led the hospital discharge research as Commissioning and Research Manager. Dr Alex Georgiadis is currently Acting Research and Commissioning Manager at Healthwatch Essex and co-authored the study. Healthwatch Essex tweets at @HWEssex
A major two-year research study undertaken by Healthwatch Essex into the experiences of patients discharged from three hospitals in the county has provided a comprehensive picture of this thorny issue. The report encourages local health and social care commissioners to overcome artificial boundaries and develop a unifying vision of care to provide high quality care.
The report, published at the end of last year, marks the organisation’s most ambitious project to date, involving almost 200 hours of observation and over 200 interviews with patients, staff, and family carers. Continue reading →