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. Continue reading

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’.  Continue reading

Identifying older patients with frailty from routinely collected hospital data

Dr Thomas Gilbert is a consultant geriatrician (Hospices Civils de Lyon, FRANCE), with interests in Health Services Research. He worked with Dr Jenny Neuburger and colleagues from the Nuffield Trust in London on the development of the Hospital Frailty Risk Score whilst he was a clinical research fellow under the mentorship of Prof. Simon Conroy in Leicester (Department of Health Sciences).  He will be speaking at the Urgent care for frail older people event on 25 May at Horizon in Leeds. 

Advances in health care have helped people in developed countries live longer than ever before. This is good news for all of us, but it also presents a challenge to our health systems and a need to rethink the way that we provide healthcare. Out of nearly 20 million people admitted to an NHS hospital in the UK in 2015, a quarter were aged 75 years or older, and this proportion is set to increase.

For some older people, hospitalisation is associated with increased harms over and above their presenting clinical condition. Recognising that age alone is insufficient to identify and respond to such vulnerability, the term ‘frailty’ is increasingly being employed to highlight patients exposed to an increased risk of poor outcomes and likely to require higher resource use. Continue reading

Uncontroversial truths; Discussing urgent care for older people

Stuart Parker is Professor of Geriatric Medicine at Newcastle University and a consultant physician at Newcastle upon Tyne Hospitals NHS Trust where he is helping to develop an acute inpatient service for frail older people. Here he discusses the Urgent care for frail older people – Hospital Wide Comprehensive Geriatric Assessment Meeting on 25 May in Leeds.

Frailty is now widely recognised as a key component of declining health and function in old age.  Older people with urgent care needs are particularly likely to experience frailty.  New acute illness can trigger the onset of frailty in an older person who, in whom the limits of their functional capacity may be urgently revealed. Older people are increasingly the main users of urgent care services. Accordingly, urgent care services for older people need to be able to recognise, evaluate and manage frailty. Continue reading

Book review: Visiting the Memory Café and other Dementia Care Activities

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. In this blog post he reviews the recently published book: Visiting the Memory Cafe and Other Dementia Care ActivitiesHe tweets @berrisfjord

Caroline Baker follows her previous publication, Developing Excellent Care for People Living with Dementia in Care Homes, with another informative and practical guide to asset-based and person-centred care.

Visiting the Memory Cafe and Other Dementia Care Activities has been developed by Baker and her colleagues at Barchester Healthcare as a framework for planning and implementing programmes of activity that optimise the wellbeing of people living with dementia.

The framework encompasses seven domains of wellbeing – identity, connectedness, security, autonomy, meaning, growth and joy – and aligns these with evidence-based activities that can be tailored to individual ability, history, and preference. Continue reading

How (I try!) to avoid a hospital admission for someone with frailty

Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care.  The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting.  The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com

The bag I take on every home visit has numerous pockets with endless equipment and forms required at my fingertips. I clip the same badges and emergency kit to myself at the start of every shift and I take this order and strict routine with me into environments over which I have little control.  It is within this mix of structure and chaos that the creativity to manage conditions and sometimes crises within a community setting arises.

Publications and conferences have explained the importance of avoiding unnecessary hospital admissions (especially for those with frailty) and commissioners require data on the number we have achieved. Continue reading

Creating a ‘Frail Friendly’ Acute Medical Unit… ‘not rocket science’

Teresa Dowsing trained as a physician associate at the University of Birmingham Medical School. She has worked in geriatric medicine for around 7 years and is the Frailty Lead for the George Eliot Hospital NHS Trust. To read more about physician associates and the British Geriatrics Society click here.

Creating a ‘Frail Friendly’ Acute Medical Unit (AMU) at George Eliot Hospital NHS Trust ….or what some specialities in my Trust used to call ‘not rocket science’…

Thinking about the latter part of this title, most of us that try to ‘practice’ geriatrics understand that it does sometimes feel like some form of mysterious dark art. A pinch of medicine, followed by a smidgeon of rehabilitation, mixed together with a drop of social care, a big dollop of communication and a dash of common sense. Simple? Not always….. Continue reading

Delirium awareness is not just for hashtags, it’s for life

Dr Shibley Rahman is an academic physician interested mainly in dementia and frailty. He tweets at @dr_shibley

My most recent experience of delirium was truly terrifying, to the point that, as a care partner of a close relative with dementia experiencing delirium, I felt I needed counselling about this admission to a London teaching hospital.

I have now witnessed delirium ‘around the clock’ for half a month so far.

Delirium research is not taken as seriously as it should be.

Where for example is the research which explains the neural substrates of hypoactive and hyperactive delirium? How long do ‘sleep episodes’ last for? Is it a good idea to wake someone up while he is sleeping? Are there are any neuroprotective agents which prevent long term deterioration after delirium? How much of the delirium will the person experiencing it actually remember? Continue reading

What is “essential” about dementia care?

Dr Shibley Rahman is an academic physician interested mainly in dementia and frailty. He tweets at @dr_shibley

I have often wondered what ‘essential dementia care’ looks like. It must include treating people with respect and dignity.

Failures in dementia care, sustained for a long period of time, however obligate a more detailed response. The concept of personhood was first applied to people with dementia by Tom Kitwood (1997). The concept is used generally to describe what makes up the attributes of “being a person” (Dewing, 2008). According to Kitwood (1997), personhood is ‘a standing or status that is bestowed upon one human being, by others, it implies recognition, respect and trust’. Therefore “dementia care” is potentially a deceptively simple term because respecting personhood means that people are not defined primarily by their conditions. Continue reading

Using a frailty index in the Emergency Department

Dr Audrey-Anne Brousseau is the first fellow in geriatric emergency medicine in Canada. She was recently appointed as assistant professor at the Université de Sherbrooke in Quebec. Her work focuses on developing best practices for older adults in the emergency department.

EDs are often the safety net of the health care system where the mission is to (rapidly) evaluate, intervene and organize transitions of care. With the aging of the population and the growing presence of older adults in EDs, this mission represents a significant challenge because older adults are complex on multiple levels.

How do we determine whether a patient is fit to go back home — or not?  Needs admission —  or not? Would benefit from rehabilitation, additional community services, further assessment — or not?  A comprehensive geriatric assessment will provide this answer, but is rarely readily available in most EDs. Moreover, human and material resources are often limited in public health care system preventing all older adults ED patients to get a geriatric assessment and appropriate interventions. Continue reading