Tribalism Kills; The Journey Towards Genuine Integration

David Attwood is a GP with a Specialist Interest in Older People. He is a Committee Member of BGS’s GeriGP Group. He tweets @DavidAttwood12

“You have twenty-one children?!” I asked incredulously. The Fanta that was halfway to my mouth almost left my hand to land on my khaki coloured trousers.

“Yes, twenty-one.” William replied, between mouthfuls of Nile perch. After a pause to finish chewing he casually added, “and four wives.”

The Fanta fell out of my mouth to land on my trousers.

“Do they all get on well?”

He screwed his face and smiled mischievously “No! They are constantly arguing!!”

I had to laugh.

Forging international links, sharing ideas and developing friendships to build research collaborations

Dr Jenni Burton (@JenniKBurton) from the University of Edinburgh and Dr Patrick Wachholz (@Patrick23711608) from Sao Paulo State University joined 12 researchers from across the UK and 17 from across Brazil to participate in a Newton Fund researcher links workshop: ‘Identifying and addressing shared challenges in conducting health and social care research for older people’, held between the 11^th-15^th of June in Botucatu, Brazil. The workshop was funded by the British Council and the Sao Paulo State Research Foundation (FAPESP) and organised by the University of Nottingham and UNESP.

Over the course of five days we worked together under the supervision of our Brazilian and UK mentors (Prof Alessandro Ferrari Jacinto, Prof Paulo Villas Boas, Prof Vanessa Citero, Dr Adam Gordon, Prof Tom Dening & Dr Jay Banerjee) to share ideas, learn from each other and work on developing new collaborative research projects.

To set the scene, Brazil is the largest country in South America with an estimated population of 16 million adults aged 65 and over. Sao Paulo State has a population of 41 million people and is the most economically and research active state in Brazil with 34% of the GDP. Amazing stat of the week was that for every four research papers published in Latin America, two will be authored in Sao Paulo State!

Older people are not only living longer: positive results in the temporal trends of physical functioning

Giola Santoni is a researcher on health status and health trends in older people. She has worked at the Aging Research Center, Karolinska Institutet in Sweden and she is currently a biostatistician at the same institute.

Anna-Karin Welmer is associate professor and senior university lecturer at Karolinska Institutet. She is vice-principal investigator of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) population-study. Anna-Karin’s primary area of research interest is the epidemiology of physical function, disability and falls in older persons.

Despite the rapid gain in life expectancy in the last century, it is not clear if the added years consist of healthy years or years lived in poor health and disability.

Previous studies have reported stable or even declining levels of disability. However, disability is defined as the inability to perform basic activities of daily living independently in the environment a person lives. Disability trends can therefore be influenced by changes in the environment such as development of technical equipment. To what extent does the encouraging trend towards declines in disability in the older population reflect actual improvements in physical function?

It’s time to BREAKDOWN these BAME BARRIERS

Dr Gaggandeep Singh Alg is currently a Consultant (AUC) Physician and Geriatrician working at the Royal Berkshire Hospital, UK. He is active in charity work supporting the most vulnerable in society and has an interest in equality and diversity. Twitter Handle @DrGSAlg

How often do we hear about the rapidly growing population of older people? Yes, we hear about it almost every day. But who are these older patients? Where are they originally from? What is their cultural and religious background? No one seems to be talking about that!

In the last 8 years while doing charity work in my free time I have noticed a growth in the older population from black, Asian and minority ethnic (BAME) groups. Older people from BAME backgrounds suffer from the same illnesses our other patients suffer from. However, in my experience they do not always know when and how to seek help. They have cultural, religious and language barriers which may prevent them from accessing health care services. Through the charity work I have seen many over 65 year olds living with signs and symptoms of various diseases, who have not been able to access the services we have built and provide!

The Great Balancing Act – perspectives from older people on falls risk

Dr Kristy Robson is a Lecturer in Podiatry at Charles Sturt University, a regional university in Australia. In this blog she shares a recent Age and Ageing publication that explores the behavioural decisions older people make when they knowingly and unknowingly undertake activities or tasks that pose a risk of falling. She tweets @KristyRobson2

Fall related injuries in older people constitute a significant public health issue in Australia and internationally. Falling represents the leading cause of unintentional injury in this population with approximately one third of older adults falling each year. Effective management of falls in older populations has proven to be challenging. Despite the substantial focus on falls prevention by the Australian government over the last decade the age standardised hospital admission rates attributed to falls continue to increase. The complexity of managing falls risk in the diverse populations found within Australia, coupled with an ageing population and finite resources, drives the need to better understand factors that can influence falling from the perspective of the older person.

When low blood pressure is too low in old age

Sven Streit is a general practitioner at the Institute of Primary Health Care (BIHAM) in Bern (CH) and PhD Candidate at Leiden University Medical Center (NL). In this blog, he introduces the results of his PhD in a recent Age & Ageing paper on blood pressure, mortality risk and cognitive decline in a population-based cohort of oldest-old (all 85 years) in Leiden. He tweets @Sven_Streit

With increasing age, blood pressure rises as a consequence of arterial stiffness. It has been debated whether or not to it is beneficial to treat hypertension in old age, especially in >75-year-olds when they have multimorbidity, polypharmacy or frailty. Large hypertension trials showed that lowering blood pressure in over 60-year-olds is beneficial and lowers the risk for myocardial infarction, stroke and all-cause mortality, even in >80-year-olds. However, these trials lack generalizability and typically excluded patients with multimorbidity and frailty. At the same time, observational studies raise concerns about lowering blood pressure too much, since there are several cohort studies showing a reverse association between low blood pressure and increased mortality and accelerated cognitive decline starting from age >75-year-olds.

Frequent drinkers unravelled

Beth Bareham, NIHR SPCR  doctoral fellow at Newcastle University Institute of Health and Society and Institute for Ageing (@bkateb1) She co-authored the Age and Ageing Paper Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences with Professor Eileen Kaner @EileenKaner, Liam Spencer @LiamPSpencer and Professor Barbara Hanratty @BarbaraHanratty.

Within the United Kingdom, older people experience more alcohol-related hospitalisations and deaths than any other age group. Risky drinking amongst  older people is not just confined to the United Kingdom. Potentially harmful patterns of drinking are common amongst older age groups across the globe. Older people are not only at risk because they drink more often, but also because quantities of alcohol that may have been safer earlier in life have the potential to damage an older person’s health if, like most, they have medical conditions or take medications. However, moderate drinking in older age has been linked with some health benefits, and drinking may also have a positive impact on their social lives. The impact of alcohol on older people is complex, and many different factors can influence their choices. To modify riskier drinking in later life and support people to live longer, healthier lives, it’s vital that we understand these complexities. 

‘How low to go?’ Top transatlantic research journals debate antihypertensive treatment in older people

The scientific journal of the British Geriatrics Society, Age and Ageing, and the Journal of the American Geriatrics Society have launched a joint initiative, publishing two articles debating the relative benefits and risks of treating hypertension in older people.

It is widely recognised that raised blood pressure is probably the single most important treatable risk factor for cardiovascular disease in later life. The evidence that older people can benefit from antihypertensive drugs has accumulated with a succession of randomised controlled trials over the past 35 years. These trials have shown reduced risk of stroke and myocardial infarction, as well as decreased total mortality. However, despite the extensive evidence that is now available, questions remain about who to treat and on optimal blood pressure targets. Consequently practice varies widely and many clinicians are uncertain about what best to recommend for their older patients.

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’. 

Asking the Big Questions in Dublin’s Fair City – Part 2

Mary Ni Lochlainn is an Academic Clinical Fellow in Geriatric Medicine. She works at King’s College Hospital NHS Foundation Trust.

In the world of Alzheimer’s research we heard from Professor Michael Rowan, who focused on amyloid and ageing. Sleep and mood disorders can pre-date dementia diagnoses, and we see circadian rhythm disturbances in Alzheimer’s disease (AD). Is there a window of opportunity here for preventative interventions? Alzheimer’s is a disease of abnormal protein aggregation – both amyloid and tau. Protein clearance tends to happen at night. Can we draw connections here? Prof Rowan explained that a recent New England Journal of Medicine paper showed 30% of patients didn’t have any amyloid even though they had been diagnosed with AD and enrolled in a trial. So what does this mean? Do these patients have another dementia? It cannot be denied that a blood or cerebrospinal fluid test would be very helpful in this diagnostic process.