Wilco Achterberg (1963) is an elderly care physician and a Professor of institutional care and elderly care medicine in Leiden, the Netherlands. His research focus is on the most vulnerable elderly, most of whom live in nursing homes, and is centered around two themes: pain in dementia and geriatric rehabilitation. He tweets @wilcoachterberg
The Netherlands have been very fortunate to have had a very good insurance system for long term care, which provided good funding for nursing home care. That is why in a typical Dutch Nursing home you can find, next to nurses, therapists like physiotherapists, occupational therapists, psychologists, dieticians and even physicians. In 1989, a 2 year post graduate medical training program started, and ‘nursing home physician’ became an officially recognised medical specialism. The biggest challenge for Ageing Holland is not how to provide good care for older persons, but how to pay for that care. Therefore, for several years now government is trying to find other ways of caring for vulnerable and care dependent persons. Continue reading →
Richard Walker is a Consultant Geriatrician at North Tyneside General Hospital, and Honorary Professor of Ageing and International Health at Newcastle University. He has a research interest in non-communicable diseases in sub-Saharan Africa (SSA) and is Associate International Director for SSA for the Royal College of Physicians, London. He is the Clinical Lead for the Northumbria / Kilimanjaro Christian Medical Centre health link and Chair of the Movement Disorders Society African Task Force. In this blog article he discusses the growing challenge of Parkinson’s Disease in SSA.
Population ageing remains a continuous challenge for health care providers due to the escalating number of patients with chronic conditions. This represents a considerable economic burden for health systems across the globe. Ever since its debut in the 80’s, prevention, early diagnosis, and treatment of human immunodeficiency virus (HIV) infection has captured the attention of the scientific community. Highly active antiretroviral therapy (HAART) radically modified the paradigm of living with HIV by prolonging survival and improving the prognosis of a previously terminal disease. Today, thanks to HAART, HIV is a chronic condition with a life expectancy similar to that of the general population and a significantly improved quality of life. However, the changes in survival for HIV infected individuals have unearthed the appearance at an earlier age of health problems that used to be observed exclusively in older adults. Continue reading →
Romke van Balen is an Elderly Care Physician in Rotterdam and Senior Researcher in Leiden. His main field of interest is geriatric rehabilitation. He will be speaking at the upcoming BGS Autumn Meeting in London.
Although geriatric rehabilitation in most countries is considered to belong to the core tasks of geriatricians, there is no consensus about definition and target groups of patients.
Decades ago, the Boston Working Group defined geriatric rehabilitation as a multidisciplinary set of evaluative, diagnostic and therapeutic interventions whose purpose it is to restore functional ability or enhance residual functional capacity in elderly people with disabling impairments. When looking at this definition, one wonders if it separates geriatric rehabilitation from the general aim of geriatric medicine. Only palliative care clearly has another aim. Continue reading →
Professor Roger Wong is Executive Associate Dean, Education in the Faculty of Medicine, University of British Columbia (UBC). He is a consultant geriatrician at Vancouver General Hospital, where he founded the Acute Care for Elders (ACE) unit that is replicated across Canada and internationally. He tweets at @RogerWong10 and is a key opinion leader in geriatrics and ageing. In this blog article he discusses the determinants that can transform the future of acute care for older people. He will be speaking at the upcoming BGS Autumn Meeting in London.
For all of us who work with seniors in the hospital setting, we often wonder what the future holds for acute care for older people. While our crystal ball may appear blurry on some of the exact details, we can certainly take a sneak preview now on three determinants that can change and shape the future of acute care geriatrics.
First, disruptive innovation in the medical sciences has already begun to transform the delivery of healthcare in seniors. Take cancer for example, which affects a significant number of older people every year. Continue reading →
Dr. Susan Freter is an Associate Professor of Medicine at Dalhousie University, and a staff geriatrician at the Nova Scotia Health Authority in Halifax, Canada. She has a special interest in delirium prevention and management in orthopaedic patients.
Geriatricians talk a lot about post-operative delirium. It is common after surgeries, especially in people with a lot of risk factors (or we could say, especially in the presence of frailty), and even with recovery it makes for a bad experience. The occurrence of hip fracture, which mostly befalls patients who are older and frail, demonstrates this routinely. We know that taking extra care with at-risk patients can help to prevent delirium. Taking extra care can manifest in different forms: educating the caregivers, paying attention to hydration (is the patient actually drinking the cup of water that is plonked down in front of them?), paying attention to constipation (preferably before a week has gone by), making sure hearing aids are in the ears, and using medication doses that are geared for frailty, rather than for strapping 20 year olds. But how can what we talk about be translated into what we do? Does the ‘doing’ actually work in practice? Continue reading →
Richard Walker is a Consultant Geriatrician at North Tyneside General Hospital, and Honorary Professor of Ageing and International Health at Newcastle University. He has a research interest in non-communicable diseases in sub-Saharan Africa (SSA) and is Associate International Director for SSA for the Royal College of Physicians, London. He is the Clinical Lead for the Northumbria / Kilimanjaro Christian Medical Centre health link and Chair of the Movement Disorders Society African Task Force. In this blog article he discusses the growing challenge of ageing in Africa.
Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital in Dublin, Ireland. The aim of this article is to provide an overview of the clinical syndrome of frailty, how it can be considered and effectively managed as a long-term condition.
One of the greatest challenges posed by an ageing population is the ability of healthcare professionals to understand, recognise and manage vulnerable older adults at increased risk of adverse healthcare outcomes. This frailty syndrome is age associated and is most marked in among those over 75 years of age. The older person showing signs of frailty is at increased risk of long term institutional care, hospitalisation, prolonged length of hospital stay and mortality, and will require specific interventions that span several health and social care services to enable them to live well for their remaining years. 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 →
Healthcare professionals across the Atlantic and around the world need to think beyond single-disease guidelines as they look to provide high-quality, person-centered care for more and more older adults living with multiple chronic conditions, so say editors from the Journal of the American Geriatrics Society and the British Geriatrics Society’s (BGS’s) Age and Ageing in the first from a series of joint editorials launched today. The series will look for common ground in geriatrics “across the pond,” beginning here with the U.K.’s National Institute for Health and Care Excellence (NICE) guideline on multimorbidity, the medical term for those living with several chronic health concerns. Continue reading →