How to be a Delirium Superhero this World Delirium Day

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

Better Transfers of Care for Older People – how to improve transitions of care

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

Accurate delirium screening when there is no carer available – impossible, right?

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-flatDelirium  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

Hospital discharge – everyone loses when its handled poorly

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

dischargeA 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

Developing new guidance on how to measure lying and standing blood pressure- harder than you think!

Shelagh O’Riordan is a consultant geriatrician and the clinical lead for the National Audit of Inpatient  Falls. She was an acute hospital geriatrician in Canterbury in Kent for 14 years but moved in September 2016 to work Kent Community Foundation Trust as a community geriatrician. She developed and runs East Kent Falls and Osteoporosis service. She tweets at @jupiterhouse1  

bpAs the clinical lead for the National Audit of Inpatient Falls (NAIF) I have been involved in the development of some new tools to standardise fall prevention in hospitals and they are being launched this month. The first of these was launched on 13/01/17 and is on the measurement of lying and standing blood pressure.

One of the results we found in the last audit round (data collected May 2015) was that on average only 16% of patients over 65y in an acute hospital after 48 hours had had a lying and standing BP recorded! I found this to be a fairly shockingly low number. I’m known, like many geriatricians, to be a bit obsessed with measuring lying and standing BP. Continue reading

How can hospitals empower older people with advanced disease?

Dr Lucy Selman is Cicely Saunders International Faculty Scholar in the Department of Palliative Care, Policy, and Rehabilitation at King’s College London, and a Research Fellow at the University of Bristol. In this blog Lucy discusses her recent Age and Ageing paper on an international study of patient empowerment in hospitals in London, Dublin and San Francisco (part of BuildCARE, a project led by Prof. Irene J. Higginson at King’s College London).

superheroEmpowered patients adopt healthier behaviours, use health services more cost-effectively, and experience better quality of life than patients who feel they are passive recipients of healthcare. Across the developed world, policy-makers are waking up to the benefits for patients and health services when people are encouraged to engage with clinicians, make decisions and manage their illness in a way that reflects their own values. Continue reading

Nursing documentation: Mind the gap?

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She is currently a PhD student at The University of Nottingham. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Her blogs are her own opinion and do not represent the opinion of her employer or any other organisation. Co-author and supervisor, Dr. Sarah Goldberg, is an associate professor at The University of Nottingham. She tweets as @se_goldberg

Introduction

docsNew research out this week highlights the importance of nursing documentation for older patients in an acute hospital setting. The research ‘Gaps, Mishaps and Overlaps: Nursing Documentation, how Does it Affect Care?’ published in The Journal of Research in Nursing found that paperwork is time consuming to complete, takes nurses away from caring for patients, and can be counterproductive to delivering good quality nursing care to older people in hospital.

Continue reading

NHS – A giant Diogenes syndrome

Adhi (V Adhiyaman), geriatrician and Chair of Welsh council of the BGS. Tweets at @adhiyamanv

220px-giovanni_battista_langetti_-_diogenesDiogenes was a controversial Greek philosopher who lived in the fourth century BC. He was a cynic and rejected many conventional ideas and lived in a large clay jar in the city of Athens. He lived in a squalor and rejected ideas of normal human decency.

Diogenes syndrome is a disorder characterized by self-neglect, domestic squalor, apathy, compulsive hoarding of garbage and more importantly lack of shame. The syndrome does not refer to the intelligence or the philosophies of Diogenes but rather refers to the way Diogenes lived. A person with primary Diogenes syndrome is intelligent but aggressive, stubborn, suspicious, emotionally labile and has an unreal perception of life. Continue reading

An overview of the Policy Forum for Wales event

Hospital in Bridgend, Wales. He is a care of the elderly physician with an interest in Parkinson’s Disease and movement disorders.
flag_of_wales_2-svgOrganised by the Policy Forum for Wales, this event which was held on 19 October, provided the Welsh Government, and other agencies, the opportunity to engage with key stakeholders and discuss public health policy issues that particularly affect Wales. This seminar was about involving health and social care senior policy makers in developing a vision for Wales and bringing together multiple organisations (public sector, voluntary and third sector) to have a dialogue about how best to influence the Welsh Government’s health and social care policies.

The day was kicked off by chair Mr Huw Irranca – Davies AM, with a cross party group on cancer introducing the theme of the day. This was followed by brief from Professor Siobhan McClelland on current trends in health care in Wales including a £700 million gap in the budget for health and social care (10% of the total health budget). She emphasised that service configurations should be decided according to local need rather than by committee or Government mandate. Continue reading

Getting to grips with multimorbidity and polypharmacy for older people

Dr Kevin Mc Namara is a Senior Research Fellow at Deakin University’s School of Medicine and Centre for Population Health Research. He has a particularly interest in the implementation of models for chronic disease prevention and management, including the management of multimorbidity. His paper, Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia, has been published in Age and Ageing journal.

aaResearchers from Australia offer some valuable insights about effective multidisciplinary care for older people who often have multiple health conditions (multimorbidity) and take multiple medications (polypharmacy). In ageing populations across the developed world, multimorbidity and polypharmacy pose unique and growing challenges for health professionals and systems. Treatments and goals for different health conditions are often not compatible, guideline recommendations may not be feasible, the evidence often lacking for older adults, and health systems are not designed to coordinate the activities of multiple health professionals often involved with care. Continue reading