“Frailty is the most problematic expression of population ageing”

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

Identifying frailty in hospital

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

New Collaboration Looks for Trans-Atlantic Common Ground in Geriatrics

Top research journals launch international editorial series tackling the latest in geriatrics clinical practice & public policy. Up first: commonalities “across the pond” for older adults with multimorbidity.

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

The UK versus the Netherlands: Where would you want your grandmother to be looked after?

Barry Evans and Rachel Cowan are Specialty Trainees in Geriatric Medicine currently working as Clinical Fellows in Quality Improvement for Integrated Medicine in the East Midlands. They recently had the opportunity to undertake an exchange with Anouk Kabboord – Elderly Care Physician trainee in the Netherlands.

dutchAt a time when the European narrative is being rewritten, a common challenge facing all European nations is population ageing. Seeing and learning from different European countries’ responses to an ageing population is an invaluable opportunity to learn, discuss and share innovation between countries. As part of Health Education East Midlands’ Quality Improvement Fellowship, we were recently able to set up an exchange between the UK and the Netherlands for geriatricians in training to see and learn from each other’s working environments. Continue reading

Can Irish set dancing benefit your health?

Joanne Shanahan is a Chartered Physiotherapist and Irish set dancing teacher. She completed her PhD in the University of Limerick. Joanne was the lead co-author of “Set dancing for people with Parkinson’s disease: an information resource for Irish set dancing teachers”. In this blog Joanne discusses her research.

irishSet dancing is an Irish cultural and social dance form. It involves dancing in a group of eight (sometimes four) people and is accompanied by the lively distinct beat of Irish dance music. Today set dancing is enjoyed by people worldwide with classes, workshops and ceilis organised all year round. Until recently the health benefits of set dancing were unknown. Recent Age and Aging publications by Shanahan et al. (2016), presented at the Irish Gerontology Society Annual Meeting 2016, have informed this question. 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

Wrinkly hands or ‘cocaine ‘fro’? You decide…

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.

grandmaI came across a USA you tube clip the other week which challenged my thinking on HCOP care. The footage was of a young man who has teamed up with his grandma to make, what I would describe as ‘stereotype-busting videos’ of his visits to see grandma in ‘the ‘hood’. I initially thought it was controversial and mildly exploitative (after all he talks to his grandma about her ‘cocaine ‘fro hairdo). I had to watch them a few times to decide that actually, this challenges my perceptions of how we engage with older people. Watching grandma rolling meatballs to ‘roll out’ rap music and shimmying her shoulders following a successful bottle flip challenge, I was hooked. The couple do Q & A sessions, mannequin challenges and twerking dance offs, cover naughty topics, and cause general mayhem and shenanigans at a pet store, among other (more saucy) clips, and seem to have a great deal of fun together in the process.

Continue reading

Global Summit on Aging and Health- personal reflections on a conference and a cultural exchange

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President of the BGS. She is currently Clinical Lead for integration in Leeds and Chairman of the BGS Community Geriatrics Special Interest Group. She tweets @EileenBurns13

chinaI was fortunate enough to attend and speak at a Global Summit on Aging held in Shanghai recently. It was a fascinating event, with speakers from an enormous variety of backgrounds- from the US Embassy in Beijing, the World Health Organisation, and the United Nations Population Fund, as well as numerous Chinese Government office holders.

The summit was jointly organised by Columbia University, USA (under the auspices of the wonderful Professor Linda Fried) and Fudan University in China. 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

Esther Clift’s African Blog Series; Part 4 ‘Healthy ageing’

Esther Clift is a Consultant Practitioner Trainee in Frailty with Health Education Wessex. This is the final part of a four part BGS blog series about her time in Africa. She tweets @EstherClift

healthy-ageing“Healthy ageing” is defined by the World report on ageing and health as the process of developing and maintaining the functional ability that enables well-being in older age.

What does that look like in developing countries?

I have had the privilege of travelling through some of Kenya and Uganda and I asked how people view their prospects, as they grow older. Some like Nathani in rural Jinja, Uganda, a retired academic and researcher with a PhD from Strathclyde University felt that his future was tied up in his land, and his children. He had both, and at 74 was fit and well, and held in high esteem by his community. He described his children as his wealth. Continue reading